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Increased kinematic changes in ascending compared with descending biplanar cut in open wedge high tibial osteotomy—a multibody simulation

Maximilian Jörgens|Sonja Ehreiser|Lennart Schroeder|Julius Watrinet|Wolfgang Böcker|Boris Michael Holzapfel|Klaus Radermacher|Julian Fürmetz
대한슬관절학회 (Korean Knee Society)|2024.12|Knee Surgery and Related Research|제36권 |pp. 35-35|DOI 10.1186/s43019-024-00244-3

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키워드

Open wedge high tibial osteotomyBiplanar cutMultibody simulationBiomechanics of the kneePatellofemoral tracking

초록

Background: The ascending or descending extended biplanar tibial cut in open wedge high tibial osteotomy (owHTO) not only changes the lower limb anatomy in the coronal plane, but also leads to different three-dimensional (3D) changes in the patellofemoral joint. This study aimed to perform a comprehensive analysis of the dynamic biomechanical changes in the knee joint using a multibody simulation model. Methods: Thirteen 3D computer-models derived from lower limb computer tomography scans were used for owHTO. Osteotomies with ascending or descending biplanar cut were simulated for each wedge height from 6 mm to 12 mm (1 mm interval). Multi-body simulation was used to analyze differences in patellar shift, patellar tilt, mediolateral patellar rotation and tibiofemoral rotation during a squat simulation from 5° to 100° knee flexion. Results: The main effects of an ascending compared to a descending extended biplanar cut in owHTO were characterized by an increase in lateralization of the patella and rotation, along with reduced tilt. Linear mixed models revealed statistically significant effects of both wedge height and cut variant on knee kinematics at 100° knee flexion, with the influence of the cut variant (ascending/descending) being higher on all analyzed kinematic parameters. Conclusion: Significant differences in the changes in patellofemoral shift, tilt, rotation and tibiofemoral rotation were observed when performing owHTO with an ascending versus a descending biplanar cut. Apart from tibiofemoral rotation, the resulting kinematic changes were greater with an ascending cut.

Abstract

Background: The ascending or descending extended biplanar tibial cut in open wedge high tibial osteotomy (owHTO) not only changes the lower limb anatomy in the coronal plane, but also leads to different three-dimensional (3D) changes in the patellofemoral joint. This study aimed to perform a comprehensive analysis of the dynamic biomechanical changes in the knee joint using a multibody simulation model. Methods: Thirteen 3D computer-models derived from lower limb computer tomography scans were used for owHTO. Osteotomies with ascending or descending biplanar cut were simulated for each wedge height from 6 mm to 12 mm (1 mm interval). Multi-body simulation was used to analyze differences in patellar shift, patellar tilt, mediolateral patellar rotation and tibiofemoral rotation during a squat simulation from 5° to 100° knee flexion. Results: The main effects of an ascending compared to a descending extended biplanar cut in owHTO were characterized by an increase in lateralization of the patella and rotation, along with reduced tilt. Linear mixed models revealed statistically significant effects of both wedge height and cut variant on knee kinematics at 100° knee flexion, with the influence of the cut variant (ascending/descending) being higher on all analyzed kinematic parameters. Conclusion: Significant differences in the changes in patellofemoral shift, tilt, rotation and tibiofemoral rotation were observed when performing owHTO with an ascending versus a descending biplanar cut. Apart from tibiofemoral rotation, the resulting kinematic changes were greater with an ascending cut.

참고문헌 (39)

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