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Optimal Knee Alignment During Medial Opening Wedge High Tibial Osteotomy for Medial Meniscus Posterior Root Tear: A Biomechanical Cadaveric Study

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Optimal Knee Alignment During Medial Opening Wedge High Tibial Osteotomy for Medial Meniscus Posterior Root Tear: A Biomechanical Cadaveric Study

Takaaki Hiranaka, MD, PhD, AUSTRALIA Adam Redgrift, PhD, CANADA Yizaho Li, PhD, CANADA Larissa Michele Madia, MS, CANADA Ryan Willing, PhD, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR

Fowler Kennedy Sports Medicine Clinic, Western University, London, ON, CANADA

2025 Congress ePoster Presentation 2025 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Meniscus Cartilage Medial

Diagnosis / Condition

Tears Osteoarthritis

Treatment / Technique

Osteotomy Repair / Reconstruction

Sports Medicine

Biomechanics

Summary: Optimal knee alignment during medial opening wedge high tibial osteotomy for treating medial meniscus posterior root tears (MMPRT) is crucial; this study reveals that medial contact pressure at neutral alignment in the intact condition matches 60-65%WBL in MMPRT condition and 50-55%WBL in repair condition.

Background

Medial meniscus posterior root tears (MMPRT) are associated with increased contact pressure in the medial compartment of the knee joint, potentially accelerating cartilage degeneration. Medial opening wedge high tibial osteotomy (MOWHTO) procedures are used to correct varus alignment, subsequently alleviating stress on the medial meniscus and reducing pressure in the medial compartment. However, optimal alignment during MOWHTO for MMPRT remains unclear. This study aimed to investigate the optimal alignment necessary to restore medial contact pressure to normal levels during MOWHTO with and without MMPRT repair.

Methods

A total of 10 fresh-frozen cadaveric legs from human donors (mean age: 61.3 years; range: 33–75 years) were used in this study. A joint motion simulator was employed to simulate the effects of varying the weight-bearing line (%WBL), ranging from 30 to 70%WBL. Tibiofemoral peak contact pressure (PCP) and mean contact pressure (MCP) were measured in both medial and lateral compartments using Tekscan pressure sensors placed under the meniscus, with a 700 N load applied along each simulated weight-bearing line for 30 s. The MMPRT models were created via a femoral posterior approach, incising 3 mm from the root attachment, and MMPRT repair models were anatomically repaired using suture anchors. Measurements were acquired for intact, MMPRT, and MMPRT repair conditions at various alignments (30, 40, 50, 55, 60, 65, and 70%WBL) in both compartments. Neutral alignment was defined as 50%WBL. To compare contact pressure measurements between three conditions, a one-way analysis of variance was conducted, followed by Tukey’s post-hoc test. Statistical significance was set at P = 0.05.

Results

In the medial compartment, PCP was increased by 43% in the MMPRT condition (3.0 ± 0.8 MPa) compared to the intact condition (2.1 ± 0.3 MPa) at neutral alignment (p=0.012). MCP was also increased significantly by 57% in the MMPRT condition (1.1 ± 0.3 MPa) compared to the intact condition (0.7 ± 0.2 MPa) at neutral alignment (p=0.013). With varus alignment, PCP and MCP were increased under three conditions, with strongest differences between MMPRT and intact conditions occurring at 30%WBL. PCP and MCP at neutral alignment in the intact condition equaled those at 60–65% and 50–55%WBL in the MMPRT and MMPRT repair conditions, respectively. In the lateral compartment, PCP and MCP were increased with more valgus alignment across three conditions, with no significant differences among the three conditions at any alignment.

Conclusions

The most important finding of this study is that medial contact pressure at neutral alignment in the intact condition equaled those at 60–65% and 50–55%WBL in the MMPRT and MMPRT repair conditions, respectively. These findings provide biomechanical evidence for guiding optimal knee alignment during MOWHTO for MMPRT treatment, potentially improving patient outcomes.

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Optimal Knee Alignment During Medial Opening Wedge High Tibial Osteotomy for Medial Meniscus Posterior Root Tear: A Biomechanical Cadaveric Study

Optimal Knee Alignment During Medial Opening Wedge High Tibial Osteotomy for Medial Meniscus Posterior Root Tear: A Biomechanical Cadaveric Study

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Optimal Knee Alignment During Medial Opening Wedge High Tibial Osteotomy for Medial Meniscus Posterior Root Tear: A Biomechanical Cadaveric Study

Optimal Knee Alignment During Medial Opening Wedge High Tibial Osteotomy for Medial Meniscus Posterior Root Tear: A Biomechanical Cadaveric Study

Background

Methods

Results

Conclusions