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Abstract
BackgroundMany previous studies lack sufficient quantitative evidences about changes in biomechanical properties of the knee in response to proximal fibular osteotomy (PFO). Therefore, the aim of this study was to compare the preoperative and postoperative effects of PFO on mechanical stresses in the knee joint and provide with a biomechanical basis for PFO in the treatment of mild knee osteoarthritis (KOA) with varus deformity.MethodsA total of 10 patients suffering mild KOA with varus deformity were enrolled in this study. Their image data from computerized tomography (CT) and magnetic resonance imaging (MRI) were used for finite element models, and PFO models were established. Static structural analysis was carried out using ABAQUS to compare the von Mises stress distribution and values of the maximal von Mises stress of femoral cartilage, meniscuses, tibial cartilages, and tibial plateau before and after surgery.ResultsThe stress distribution in the cortical bone of the tibial plateau showed that stresses were transferred from the anterior medial area to the posterior medial area after PFO. Values of the maximal von Mises stress in femoral cartilage, medial meniscus, medial tibial cartilage, and tibial plateau after surgery were significantly lower than the preoperative values, with statistically significant differences (P < 0.05). Postoperative values of the maximal von Mises stress of lateral meniscus and lateral tibial cartilage were significantly higher than the preoperative ones, with statistically significant differences (P < 0.05).ConclusionPFO could reduce the stresses in the medial compartment of the knee joint with stress pathways transferring from the anterior medial area to the posterior medial area of the tibial plateau. Therefore, PFO is recommended for the treatment of mild KOA with varus deformity featuring favorably pain-relieving effects.Graphical abstract
Highlights
Knee osteoarthritis (KOA) is one of the most common chronic degenerative joint disease in the elderly and one of the leading causes of the loss of ability to walk in the middle-aged and the elderly
Stress distribution patterns of femoral cartilage, meniscuses, tibial cartilages, and tibial plateau before and after proximal fibular osteotomy (PFO) were illustrated in finite element stress nephogram
Stress in the femoral cartilage was reduced after PFO (Fig. 4)
Summary
Knee osteoarthritis (KOA) is one of the most common chronic degenerative joint disease in the elderly and one of the leading causes of the loss of ability to walk in the middle-aged and the elderly. After more than 40 years development, a study [2] found that about one third of TKA surgery were currently inappropriate, and it was an “over-medical” problem. Conservative treatments, such as non-drug therapy, drug therapy, arthroscopic surgery [3], high tibial osteotomy [4], joint traction [5], and platelet-rich plasma (PRP) therapy [6], are still the first choice for early KOA. High tibial osteotomy (HTO) is a commonly accepted treatment of knee varus deformity resulting from medial femorotibial osteoarthritis (OA) for young and active patients [7]. The aim of this study was to compare the preoperative and postoperative effects of PFO on mechanical stresses in the knee joint and provide with a biomechanical basis for PFO in the treatment of mild knee osteoarthritis (KOA) with varus deformity
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