Abstract
PurposeThe objective of this study was to investigate the effect of a medial open-wedge osteotomy (OWO) and the release of the superficial medial collateral ligament (MCL) on the tibiofemoral cartilage pressure, the MCL tension and the valgus laxity of the knee.MethodsSeven fresh-frozen, human cadaveric knees were used. Medial and lateral mean contact pressure (CP), peak contact pressure (peakCP), and contact area (CA) were measured using a pressure-sensitive film (I-Scan; Tekscan, Boston, MA). The MCL tension was measured using a custom-made device. These measurements were continuously recorded for 5 min after an OWO of 10°. After the osteotomy, the valgus laxity was measured with a handheld Newtonmeter. For one knee, the measurements were continued for 24 h. At the end, a complete release of the superficial MCL was performed and the measurements were repeated at 10°.ResultsThere was relaxation of the MCL after the osteotomy; the tension dropped in 5 min with 10.7% (mean difference 20.5 N (95% CI 16.1–24.9)), and in 24 h, the tension decreased by 24.2% (absolute difference 38.8 N) (one knee). After the osteotomy, the mean CP, peakCP and CA increased in the medial compartment (absolute difference 0.17 MPa (95% CI 0.14–0.20), 0.27 MPa (95% CI 0.24–0.30), 132.9mm2 (95% CI 67.7–198.2), respectively), and decreased in the lateral compartment (absolute difference 0.02 MPa (95% CI 0.03 –0.01), 0.08 MPa (95% CI 0.11 – 0.04), 47.0 mm2 (95% CI −105.8 to 11.8), respectively). Only after a release of the superficial MCL, the mean CP, peak CP and CA significantly decreased in the medial compartment (absolute difference 0.17, 0.27 MPa, 119.8 mm2, respectively), and increased in the lateral compartment (absolute difference 0.02, 0.11 MPa, 52.4 mm2, respectively). After the release of the superficial MCL, a mean increase of 7.9° [mean difference − 0.1° (95% CI −1.9 to 1.6)] of the valgus laxity was found.ConclusionsA release of the superficial MCL helps achieve the goal of reducing medial cartilage pressure in an OWO. There was considerable relaxation of the MCL after an OWO that resulted in a decrease of the mean CP in the medial and lateral compartments of the knee over time. However, cartilage pressure shifted from the medial to the lateral compartment only after release of the superficial MCL. The release of the superficial MCL caused a significant increase in the valgus laxity, which could influence stability after an OWO.Level of evidenceI.
Highlights
An open-wedge osteotomy (OWO) is a successful treatment in patients with medial knee osteoarthritis (OA) and a varus leg alignment [4, 18]
A release of the superficial medial collateral ligament (MCL) helps achieve the goal of reducing medial cartilage pressure in an OWO
Opening the osteotomy gap to 10° caused an average increase in the MCL tension of 203 N (Fig. 2)
Summary
An open-wedge osteotomy (OWO) is a successful treatment in patients with medial knee osteoarthritis (OA) and a varus leg alignment [4, 18]. An OWO unloads the medial compartment and shifts loading of the knee to the lateral compartment [1, 9, 17]. In an OWO, the medial proximal tibia must be exposed; the superficial medial collateral ligament (MCL) overlies this area. The superficial MCL can be left intact by elevating it sub-periostally, or it can be partially or completely released from its distal insertion [8, 11]. There is a debate as to whether or not to release the MCL when performing an OWO. Agneskircher et al [1] concluded in their biomechanical study that if the MCL is not released after an OWO, the contact pressure in the medial compartment is even higher than in the lateral compartment. A release of the MCL has been shown to create a significant valgus instability [11]
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