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Comparison of the efficiency of an extra-articular absorber system and high tibial osteotomy for unloading the medial knee compartment: an in vitro study

Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The unloading effect of an extra-articular absorber system on the knee joint medial compartment was compared with high tibial osteotomy (HTO) under physiological conditions in vitro.

Methods

Seven fresh-frozen cadaveric knees were used to test isokinetic flexion–extension motions under physiological loading using a biomechanical knee simulator. Tibiofemoral area contact and peak contact pressures were measured using pressure-sensitive film in the untreated medial compartment. Pressures were measured after KineSpring System implantation and HTO (5° and 10° correction angles) performed with an angular-stable internal fixator (Tomofix).

Results

Implantation of the unloading device resulted in significantly decreased medial compartment area contact pressure (Δ0.02 ± 0.01 MPa, p = 0.001) and peak contact pressure (Δ0.3 ± 0.1 MPa, p = 0.001) compared with the first test cycle results in the untreated knee. HTO significantly decreased the pressure (p = 0.001). Compared with the first test cycle, HTO (5° correction angle) decreased the mean contact pressure by Δ0.03 ± 0.01 MPa and peak contact pressure by Δ0.3 ± 0.01 MPa. With a 10° correction angle, HTO decreased contact pressure by Δ0.04 ± 0.02 MPa and peak contact pressure by Δ0.4 ± 0.1 MPa compared with that at the 5° correction angle.

Conclusion

Implantation of an extra-capsular unloading device resulted in a significant unloading effect on the medial compartment comparable to that achieved with HTO at 5° and 10° correction angles. Thus, implantation of an extra-articular, extra-capsular absorber could become the method of choice when treating patients with unicompartmental osteoarthritis that cannot be adequately treated by HTO because of their straight-leg axis.

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Acknowledgments

Funding was provided by Müller-Fahnenberg Stiftung.

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Correspondence to Gerrit Bode.

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Conflict of interest

None of the authors has any conflict of interest.

Funding

The study was funded by the Müller-Fahnenberg Study of Freiburg University.

Ethical approval

The ethics committee of Hannover University approved this study (ID 3083-2016).

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Bode, G., Kloos, F., Feucht, M.J. et al. Comparison of the efficiency of an extra-articular absorber system and high tibial osteotomy for unloading the medial knee compartment: an in vitro study. Knee Surg Sports Traumatol Arthrosc 25, 3695–3703 (2017). https://doi.org/10.1007/s00167-016-4358-9

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  • DOI: https://doi.org/10.1007/s00167-016-4358-9

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