A Tibial Osteotomy of the Medial Collateral Ligament Insertion to Improve Visualization of the Medial Tibial Plateau: A Cadaveric Study.
Academic Article
Overview
abstract
OBJECTIVES: To compare visualization of the medial tibial plateau articular surface using three surgical approaches: medial collateral ligament (MCL) split, femoral epicondyle osteotomy of the MCL origin, and tibial osteotomy of the MCL insertion. METHODS: Seven matched pairs of fresh-frozen adult cadaveric lower extremity specimens (14 knee specimens total) with no evidence of previous surgery were utilized. Through a medial approach to the proximal tibia, the MCL split technique was performed followed by a sub-meniscal arthrotomy. Standardized distraction of the joint was applied using a universal distractor. A three-dimensional digitizer probe was utilized to map the visible articular surface. These steps were repeated for the femoral osteotomy on the same extremity as the MCL split and the tibial osteotomy on the contralateral matched pair extremity. The tibial osteotomy preserved the meniscofemoral portion of the deep MCL, posterior oblique ligament, and proximal meniscocapsular attachments. Visible articular surface area (mm2) for each of the three techniques was calculated from the mapped data points and compared among techniques. RESULTS: The mean age of the specimens was 77.1 ± 7.2 years. MCL split technique visualized 87.2 ± 28.4 mm2 of articular surface. The medial femoral epicondyle osteotomy provided 614.7 ± 217.6 mm2 of visualization (677% more than MCL split, p < 0.001), while tibial osteotomy achieved 539.0 ± 81.9 mm2 (585% more than MCL split, p < 0.001). No significant difference in visualization was observed between the femoral and tibial osteotomy techniques (614.7 ± 217.6 mm2 vs. 539.0 ± 81.9 mm2, p = 0.44). CONCLUSIONS: Tibial osteotomy of the MCL insertion provided significantly improved visualization of the medial tibial plateau compared to MCL split technique and achieves similar exposure to femoral epicondyle osteotomy, while preserving the soft tissue structures proximal to the meniscus. LEVEL OF EVIDENCE: Level IV.
