Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the Modified Maquet Technique

Summary

Objectives: To evaluate the mechanical properties of the distal cortical hinge associated with a new osteotomy design for the Modified Maquet Technique (MMT).

Study design: Ex vivo mechanical study.

Methods: The osteotomy was started 10 mm caudal to the tibial tuberosity and extended over 150% of the length of the tibial crest; it was slightly curved distally to stay at a distance of 2 to 4 mm from the cranial cortex, according to the body weight. Ninety-six tibiae were tested in advancement, and 60 tibiae were axially loaded perpendicular to the tibial plateau, until failure of the crest. Desired advancement was measured using the common tangent method in 60 tibiae. Angle of opening, thickness, and area of the cortical hinge were recorded.

Results: Desired advancement of 6 mm, 9 mm, 12 mm and 15 mm was recorded in 16, 12, 18 and 14 tibiae respectively. Mean maximal advancement in these bones was 15.6 ± 6.4 mm, 20.8 ± 5.2 mm, 21.3 ± 5.2 mm and 22.7 ± 5.2 mm respectively. The desired advancement was reached in all but one tibia. Advancement was mainly influenced by the angle of opening and the stiffness of the cortical hinge. Mean ultimate load to failure was 6.12 ± 2.4 times the body weight. It was significantly associated with the body weight, thickness, and area of the cortical hinge.

Clinical relevance: Mean maximal advancement was higher than clinically required without occurrence of fissure or fracture. Ultimate load to failure and maximal advancement could be predicted using calculated formulae.

Keywords

Cranial cruciate ligament - modified Maquet Technique - tibial tuberosity advancement - biomechanics

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