Abstract
Objectives:
Lateral meniscus deficiency with valgus malalignment increases the risk and rate of lateral compartment osteoarthritis. Lateral meniscus allograft transplantation (LMAT) with concomitant varus-producing lateral opening wedge distal femoral osteotomy (LOWDFO) is an available option to treat this pathology. No biomechanical data currently exists evaluating the effect on joint forces with these combined procedures. The purpose of this study is to evaluate the effects of LMAT with concomitant varus-producing LOWDFO on lateral and medial compartment biomechanics. We hypothesize that LMAT restores lateral compartment biomechanics back to native intact forces, varus-producing LOWDFO improves lateral compartment forces following LMAT, and medial compartment forces change to a lesser degree in response to mechanical varus.
Methods:
Ten human cadaveric knees underwent varus-producing LOWDFO and were placed in an external fixator. Anatomic alignment was standardized for each knee and utilized as a proxy for mechanical alignment. Thin film Tekscan pressure sensors were placed sub-meniscal and specimens were loaded on a biaxial dynamic testing machine to 800N within a custom designed apparatus, with loading angles between 9° valgus and 6° varus of mechanical alignment. Testing conditions included the intact meniscus, lateral meniscus deficiency, and LMAT. Statistical analysis was performed by creating two-factor random-intercepts linear mixed-effects models to compare peak pressure and contact area among the three experimental meniscus conditions.
Results:
Isolated varus-producing LOWDFO to 6° varus in the setting of meniscus deficiency was unable to restore joint forces to the level of the intact meniscus in neutral alignment (Mean Contact Pressure: 175%, Peak Pressure 135%, Contact Area -41%, P>0.05). LMAT restored mean contact and peak pressures, with no significant differences compared to the intact meniscus (P<0.05). LMAT resulted in significantly lower contact areas from 9° valgus to 0° (P>0.05), but this was restored to intact state at 3° and 6° varus (P<0.05). Within the lateral compartment following LMAT, every additional 1° of DFO correction contributes to a decreased in mean contact pressure of 5.6% (-0.0479 N/mm2)(Figure 1), a decrease in peak pressure of 5.9% (-0.154 N/mm2)(Figure 2), and a decrease in contact area of 1.4% (6.99 mm2)(Figure 3), as compared to forces in neutral alignment. Within the medial compartment following LMAT, every additional 1° of DFO correction contributes to an increase in mean contact pressure of 7.3% (+0.034 N/mm2), an increase in peak pressure of 12.6% (+0.160 N/mm2), and an increase in contact area of 4.3% (20.53 mm2), as compared to forces in neutral alignment. However, baseline forces in the medial compartment are significantly lower at baseline compared to lateral compartment forces (P>0.05).
Conclusions:
This is the first biomechanical study evaluating the effects of concomitant LMAT and varus-producing LOWDFO. Isolated varus-producing LOWDFO is inadequate to restore forces in the meniscus deficient knee. LMAT restores near normal forces, and concomitant LOWDFO improves the lateral compartment biomechanical profile. Although to a smaller magnitude, force changes in the medial compartment are significant with varus-producing LOWDFO. Unloading to 0° following LMAT may be ideal. Overall, this study provides tools to for the surgeon to individualize alignment correction for each patient to optimize outcomes.
Mean Contact Pressure
Peak Contact Pressure
Contact Area