Official Journal of the Italian Society of Orthopaedics and Traumatology
Table 1 Previous biomechanical studies on the biomechanical behavior of the various fixation methods of tibial tubercle osteotomy
Author | Year | Type of study | Model | Fixation methods | Results |
|---|---|---|---|---|---|
Cosgarea et al. | 1999 | Cadaver (13 pairs) | Fulkerson osteotomy flat osteotomy | Two 3.5 mm screws (screw material unspecified) | The flat osteotomy resulted in a higher load to failure compared with Fulkerson osteotomy (1639 N versus 1166 N, P < 0.05) |
Davis et al. | 2000 | Cadaver (36 unpaired knees) | Bevel-cut and step-cut flat osteotomies | Two 4.5 mm cortical screws versus 18-gauge stainless (either three- or four-level) cerclage | The failure load for the bevel-cut osteotomies repaired with two screws was 1654 ± 359 N; for the bevel-cut osteotomies repaired with three cerclage wires, 622 ± 283 N; for the step-cut osteotomies repaired with three cerclage wires, 984 ± 441 N; and for the step-cut osteotomy repaired with four cerclage wires, 1099 ± 632 N |
Caldwell et al. | 2004 | Cadaver (40 unpaired tibia) | Flat osteotomy | Two 4.5 mm bicortical screws 18-gauge stainless four-level cerclage. Traction force at 0° and 25° | Screw constructs failed at 1429 ± 348 N (0°) and at 1925 ± 982 N (25°). Wire constructs failed at 1072 ± 260 N (0°) and at 893 ± 293 N (25°) |
Warner et al. | 2013 | Cadaver (5 pairs) | Fulkerson osteotomy | Two 4.5 mm screws versus Three 3.5 mm screws | The maximum failure load for osteotomies secured with two 4.5-mm screws was 1459 ± 540 N, and for three 3.5-mm screws, it was 1360 ± 707 N (P = 0.723) |
Nurmi et al. | 2017 | Cadaver (22 pairs) | Flat osteotomy (straight cut) | 4.5-mm PLLA screws versus 4.5 mm stainless steel screws | The mean yield load was 566 ± 234 N in the bioabsorbable screw group and 984 ± 630 N in the metal screw group (P = 0.002) |
Chang et al. | 2019 | FEA | Flat osteotomy | Two titanium 4.5 mm screws with six configurations: parallel horizontal screws placed at a 20 mm interval, parallel horizontal screws placed at a 30 mm interval, parallel upward screws, parallel downward screws, trapezoid screws, and divergent screws | The configuration of two parallel downward screws yielded the highest stability with the lowest fragment displacement and gap opening. The configuration of two upward screws resulted in the highest fragment displacement and gap deformation between the fragment and tibia. The stress of the osteotomized bone fragment was highest with the configuration of two upward screws |
Chang et al. | 2019 | FEA | Flat osteotomy with three fragment shapes: step cut, bevel cut, and straight cut | Two titanium 4.5 mm screws with three configurations: parallel horizontal screws with an interval of 20 mm, trapezoidal screws with an angle of 45, and parallel downward screws with an interval of 15 mm | The step cut resulted in higher stability than the bevel and straight cut, but the stress was higher. Among the screw configurations, two parallel downward screws resulted in the highest stability, given the same fragment shape. In the horizontal configuration, the step-cut tibia developed the largest contact force to achieve stability of the bone fragment under loading |
Chen et al. | 2019 | FEA | Flat osteotomy (step cut) with 1 mm gap formation either in proximal or distal contact surfaces | Two titanium 4.5 mm screws with six configurations: parallel horizontal screws placed at a 20 mm interval, parallel horizontal screws placed at a 30 mm interval, parallel upward screws, parallel downward screws, trapezoid screws, and divergent screws | Proximal gap model resulted inferior results compared with distal gap model in all screw configurations Among the screw configurations, two parallel downward screws resulted in the highest stability in both models |
Guneri et al. | 2021 | FEA | Fulkerson osteotomy + distalization | Two 3.5 mm cortical screws, Two 4.5 mm cortical screws Three 3.5 mm cortical screws Three 4.5 mm cortical screws Three 3.5 mm screws with 1/3 tubular plate Four 3.5 mm screws with 1/3 tubular plate | Maximum sliding (0.660 mm), gap formation (0.661 mm), and displacement (1.267 mm) were seen with two 3.5 mm screw fixation, followed by two 4.5 mm screws, three 3.5 mm screws, and three 4.5 mm screws, respectively, in the screw group. The minimum displacement was observed with a plate, and two 3.5 mm screw fixation models |
Frame et al. | 2021 | Cadaver (5 pairs) | Flat osteotomy | Two parallel 4.0 mm partially threaded cannulated screws versus Two parallel 4.0-mm partially threaded cannulated screws plus a nonabsorbable suture tape (FiberTape) in a figure-of-8 construct | Two specimens of the standard group exhibited clinical failure during cyclic loading to 400 N. All other specimens survived cyclic loading to 800 N The mean ultimate failure load after the pull-to-failure test was 2475 ± 554 N for the augmented group and 1475 ± 280 N for the standard group |
Current study | 2022 | FEA | Fulkerson osteotomy | Two 4.5Â mm cortical screws were tested in four different configurations (1) Both screws are perpendicular to the osteotomy plane (2) Upper screw is perpendicular to the tibial cortex; the lower screw is perpendicular to the osteotomy plane (3) Both screws are perpendicular to the posterior tibial cortex (4) Upper screw is perpendicular to the osteotomy plane; the lower screw is perpendicular to the posterior tibial cortex | The minimum total displacement was observed in the fourth scenario, which resulted in the highest stiffness |