Effect of articular step-off and meniscectomy on joint alignment and contact pressures for fractures of the lateral tibial plateau

Bo Bai, Frederick J. Kummer, Debra A. Sala, Kenneth J. Koval, Philip R Wolinsky

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objectives: To determine the effects of intraarticular step-off and lateral meniscectomy on the alignment of the articular axis, contact area, and pressures for lateral tibial plateau fractures. Design: Biomechanical cadaver study. Intervention: Six fresh cadaveric knees were used. A simulated split fracture of the lateral tibial plateau was reproducibly created by osteotomies, and articular step-offs of zero, one, two, four, and six millimeters were achieved by using support shims. The knee was loaded with 500 newtons in 0 degrees and 350 newtons in 30 degrees of flexion. A digital camera determined changes in the alignment of the articular axis, and F-Scan sensors were inserted into the medial and lateral joint compartments to determine the pressures and pressure distributions. Main Outcome Measurement: Each specimen was tested at step-offs of zero, one, two, four, and six millimeters, with the presence or absence of the lateral meniscus. The changes in alignment of the articular axis, the contact area, and the average and maximum contact pressures for each condyle were obtained. Results: Increased articular step-off heights progressively increased valgus angulation and average and maximum contact pressures and progressively decreased contact areas in lateral compartment. At a six-millimeter step-off with 0 degrees of flexion, the valgus angle increased an average of 7.6 degrees, and average contact pressures and maximum contact pressures increased an average of 208 percent and 97 percent, respectively, and contact area decreased an average of 33 percent (p < 0.05). Meniscectomy increased valgus angles by an average of 38 percent and contact pressures by an average of 45 percent and decreased contact areas by 26 percent in the lateral compartment at the same articular step-off heights (p < 0.05). Conclusion: The results of this study show the importance of decreasing articular step-off heights in treating lateral tibial plateau split fractures, particularly if a meniscectomy is performed.

Original languageEnglish (US)
Pages (from-to)101-106
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume15
Issue number2
DOIs
StatePublished - Feb 2001
Externally publishedYes

Fingerprint

Tibial Fractures
Joints
Pressure
Knee
Tibial Meniscus
Osteotomy
Cadaver
Bone and Bones

Keywords

  • Articular step-off
  • Contact pressure
  • Fracture
  • Meniscectomy
  • Tibial plateau

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Effect of articular step-off and meniscectomy on joint alignment and contact pressures for fractures of the lateral tibial plateau. / Bai, Bo; Kummer, Frederick J.; Sala, Debra A.; Koval, Kenneth J.; Wolinsky, Philip R.

In: Journal of Orthopaedic Trauma, Vol. 15, No. 2, 02.2001, p. 101-106.

Research output: Contribution to journalArticle

@article{6a9fdf42bba14a079d5d2966e5a19746,
title = "Effect of articular step-off and meniscectomy on joint alignment and contact pressures for fractures of the lateral tibial plateau",
abstract = "Objectives: To determine the effects of intraarticular step-off and lateral meniscectomy on the alignment of the articular axis, contact area, and pressures for lateral tibial plateau fractures. Design: Biomechanical cadaver study. Intervention: Six fresh cadaveric knees were used. A simulated split fracture of the lateral tibial plateau was reproducibly created by osteotomies, and articular step-offs of zero, one, two, four, and six millimeters were achieved by using support shims. The knee was loaded with 500 newtons in 0 degrees and 350 newtons in 30 degrees of flexion. A digital camera determined changes in the alignment of the articular axis, and F-Scan sensors were inserted into the medial and lateral joint compartments to determine the pressures and pressure distributions. Main Outcome Measurement: Each specimen was tested at step-offs of zero, one, two, four, and six millimeters, with the presence or absence of the lateral meniscus. The changes in alignment of the articular axis, the contact area, and the average and maximum contact pressures for each condyle were obtained. Results: Increased articular step-off heights progressively increased valgus angulation and average and maximum contact pressures and progressively decreased contact areas in lateral compartment. At a six-millimeter step-off with 0 degrees of flexion, the valgus angle increased an average of 7.6 degrees, and average contact pressures and maximum contact pressures increased an average of 208 percent and 97 percent, respectively, and contact area decreased an average of 33 percent (p < 0.05). Meniscectomy increased valgus angles by an average of 38 percent and contact pressures by an average of 45 percent and decreased contact areas by 26 percent in the lateral compartment at the same articular step-off heights (p < 0.05). Conclusion: The results of this study show the importance of decreasing articular step-off heights in treating lateral tibial plateau split fractures, particularly if a meniscectomy is performed.",
keywords = "Articular step-off, Contact pressure, Fracture, Meniscectomy, Tibial plateau",
author = "Bo Bai and Kummer, {Frederick J.} and Sala, {Debra A.} and Koval, {Kenneth J.} and Wolinsky, {Philip R}",
year = "2001",
month = "2",
doi = "10.1097/00005131-200102000-00005",
language = "English (US)",
volume = "15",
pages = "101--106",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Effect of articular step-off and meniscectomy on joint alignment and contact pressures for fractures of the lateral tibial plateau

AU - Bai, Bo

AU - Kummer, Frederick J.

AU - Sala, Debra A.

AU - Koval, Kenneth J.

AU - Wolinsky, Philip R

PY - 2001/2

Y1 - 2001/2

N2 - Objectives: To determine the effects of intraarticular step-off and lateral meniscectomy on the alignment of the articular axis, contact area, and pressures for lateral tibial plateau fractures. Design: Biomechanical cadaver study. Intervention: Six fresh cadaveric knees were used. A simulated split fracture of the lateral tibial plateau was reproducibly created by osteotomies, and articular step-offs of zero, one, two, four, and six millimeters were achieved by using support shims. The knee was loaded with 500 newtons in 0 degrees and 350 newtons in 30 degrees of flexion. A digital camera determined changes in the alignment of the articular axis, and F-Scan sensors were inserted into the medial and lateral joint compartments to determine the pressures and pressure distributions. Main Outcome Measurement: Each specimen was tested at step-offs of zero, one, two, four, and six millimeters, with the presence or absence of the lateral meniscus. The changes in alignment of the articular axis, the contact area, and the average and maximum contact pressures for each condyle were obtained. Results: Increased articular step-off heights progressively increased valgus angulation and average and maximum contact pressures and progressively decreased contact areas in lateral compartment. At a six-millimeter step-off with 0 degrees of flexion, the valgus angle increased an average of 7.6 degrees, and average contact pressures and maximum contact pressures increased an average of 208 percent and 97 percent, respectively, and contact area decreased an average of 33 percent (p < 0.05). Meniscectomy increased valgus angles by an average of 38 percent and contact pressures by an average of 45 percent and decreased contact areas by 26 percent in the lateral compartment at the same articular step-off heights (p < 0.05). Conclusion: The results of this study show the importance of decreasing articular step-off heights in treating lateral tibial plateau split fractures, particularly if a meniscectomy is performed.

AB - Objectives: To determine the effects of intraarticular step-off and lateral meniscectomy on the alignment of the articular axis, contact area, and pressures for lateral tibial plateau fractures. Design: Biomechanical cadaver study. Intervention: Six fresh cadaveric knees were used. A simulated split fracture of the lateral tibial plateau was reproducibly created by osteotomies, and articular step-offs of zero, one, two, four, and six millimeters were achieved by using support shims. The knee was loaded with 500 newtons in 0 degrees and 350 newtons in 30 degrees of flexion. A digital camera determined changes in the alignment of the articular axis, and F-Scan sensors were inserted into the medial and lateral joint compartments to determine the pressures and pressure distributions. Main Outcome Measurement: Each specimen was tested at step-offs of zero, one, two, four, and six millimeters, with the presence or absence of the lateral meniscus. The changes in alignment of the articular axis, the contact area, and the average and maximum contact pressures for each condyle were obtained. Results: Increased articular step-off heights progressively increased valgus angulation and average and maximum contact pressures and progressively decreased contact areas in lateral compartment. At a six-millimeter step-off with 0 degrees of flexion, the valgus angle increased an average of 7.6 degrees, and average contact pressures and maximum contact pressures increased an average of 208 percent and 97 percent, respectively, and contact area decreased an average of 33 percent (p < 0.05). Meniscectomy increased valgus angles by an average of 38 percent and contact pressures by an average of 45 percent and decreased contact areas by 26 percent in the lateral compartment at the same articular step-off heights (p < 0.05). Conclusion: The results of this study show the importance of decreasing articular step-off heights in treating lateral tibial plateau split fractures, particularly if a meniscectomy is performed.

KW - Articular step-off

KW - Contact pressure

KW - Fracture

KW - Meniscectomy

KW - Tibial plateau

UR - http://www.scopus.com/inward/record.url?scp=0035261374&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035261374&partnerID=8YFLogxK

U2 - 10.1097/00005131-200102000-00005

DO - 10.1097/00005131-200102000-00005

M3 - Article

C2 - 11232647

AN - SCOPUS:0035261374

VL - 15

SP - 101

EP - 106

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

IS - 2

ER -