The effect of lateral opening wedge distal femoral osteotomy on medial knee opening: clinical and biomechanical factors.
OBJECTIVE
The case of a patient with knee valgus and instability due to combined ACL-MCL laxity who underwent lateral opening wedge distal femoral osteotomy (DFO) is presented. The symptoms of instability resolved following the surgery. It was unclear whether the increase in valgus stability was related only to a decrease in valgus moments during stance or also to a medial tensioning effect. We therefore performed a laboratory cadaveric study. The purpose of this study was to examine whether after MCL and ACL sectioning, lateral opening wedge DFO would result in decrease in medial opening under static conditions of valgus stress.


METHODS
Medial knee opening under valgus load of 9.8 Nm was tested in 8 cadaveric specimens in scenarios of MCL and ACL sectioning and compared before and after performing lateral opening wedge DFO.


RESULTS
When the superficial MCL was sectioned, medial knee opening in 30° flexion decreased after lateral opening wedge DFO compared to medial opening before the osteotomy (i.e. from 6.5 ± 0.5° to 5.6 ± 0.5°, p = 0.01). When the superficial MCL, deep MCL, and ACL were all sectioned, medial knee opening in extension decreased after lateral opening wedge DFO compared to medial opening before the osteotomy but this was not significant (i.e. from 6.8 ± 0.5° to 6.1 ± 0.5°, p = n.s.).


CONCLUSIONS
In superficial MCL-transected knees, medial laxity at 30° of knee flexion decreased after lateral opening wedge DFO. However, the clinical relevance of the laxity decrease observed remains uncertain since the reduction was small in magnitude.
Department of Orthopedic Surgery, Meir General Hospital, Sapir Medical Center, Tsharnichovski Street 59, 44281, Kfar Saba, Israel, iftachhetsroni@gmail.com.
Iftach
I
Hetsroni
Stephen
S
Lyman
Andrew D
AD
Pearle
Robert G
RG
Marx
D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D017888:Medial Collateral Ligament, Knee / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular