Large medial proximal tibial angles cause excessively medial tibiofemoral contact forces and abnormal knee kinematics following open-wedge high tibial osteotomy

Recurrent varus deformity and poor outcome sometimes occur following open-wedge high tibial osteotomy, but the mechanism remains unclear. The hypothesis of this study was that an excessively large medial proximal tibial angle with lateral joint surface inclination can worsen postoperative knee biomechanics. A computer-simulated knee model was validated based on a volunteer knee. Osteotomy models with medial proximal tibial angles ranging from 90° to 97° in 1° increments were developed. Varus alignment correction of the distal femur was performed in each model to maintain identical coronal alignment passing through a point 62.5% lateral to the tibial plateau. The peak tibiofemoral contact forces and knee kinematics were compared in each model during walking and squatting. All the osteotomy models demonstrated higher peak contact forces on the lateral tibiofemoral joints than on the medial tibiofemoral joints during walking. However, larger medial proximal tibial angles caused excessive increases in medial tibiofemoral contact forces, and the dominant tibiofemoral contact forces shifted to the medial side. Increased medial proximal tibial angles also caused progressive medial collateral ligament tension in knee flexion, but partial medial collateral ligament release effectively reduced medial tibiofemoral contact forces. Models with large medial proximal tibial angles showed nonphysiological roll-forward of the lateral femoral condyle during squatting and no screw-home movement around knee extension. Excessively large medial proximal tibial angles following open-wedge high tibial osteotomy resulted in increased medial tibiofemoral contact forces and abnormal knee kinematics during knee flexion due to medial joint line elevation and ligament imbalance. •This study used a new computer simulation model in open-wedge high tibial osteotomy.•Large medial proximal tibial angles had harmful effects on knee biomechanics.•Abnormal knee kinematics was related to postoperative ligamentous imbalance.•Medial tibiofemoral overstuffing occurred due to medial joint line elevation.•Partial medial collateral ligament release reduced medial tibiofemoral contact forces.