title: Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  Seven 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°.
  
  
  RESULTS
  There 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.
  
  
  CONCLUSIONS
  A 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.
  
  
  METHODS
  I.
authors.affiliation: Department of Orthopaedics, Radboud University Medical Centre, P.O. box 9101, 6500 HB, Nijmegen, The Netherlands. Nienkevanegmond@hotmail.com.
authors.forename: N
authors.initials: N
authors.lastname: van Egmond
authors.affiliation: Orthopaedic Research Laboratory, Radboud University Medical Center, P.O. box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Hannink
authors.affiliation: Orthopaedic Research Laboratory, Radboud University Medical Center, P.O. box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Janssen
authors.affiliation: Orthopaedic Research Laboratory, Radboud University Medical Center, P.O. box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Vrancken
authors.affiliation: Orthopaedic Research Laboratory, Radboud University Medical Center, P.O. box 9101, 6500 HB, Nijmegen, The Netherlands.|Laboratory of Biomechanical Engineering, University of Twente, P.O. box 217, 7500 AE, Enschede, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Verdonschot
authors.affiliation: Department of Orthopaedics, Radboud University Medical Centre, P.O. box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van Kampen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D017888:Medial Collateral Ligament, Knee / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D013977:Tibia / Q000601:surgery*; D016474:Weight-Bearing / Q000502:physiology*
keywords: Biomechanical study; Open-wedge high tibial osteotomy; Release medial collateral ligament; Tibiofemoral cartilage pressure; Valgus laxity