Abstract
OBJECTIVES:
To compare visualization of the medial tibial plateau articular surface using 3 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 used. Through a medial approach to the proximal tibia, the MCL split technique was performed followed by a submeniscal arthrotomy. Standardized distraction of the joint was applied using a universal distractor. A three-dimensional digitizer probe was used to map the visible articular surface. These steps were repeated for the femoral osteotomy on the same extremity as the MCL split and for 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 (mm
2
) for each of the 3 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 mm
2
of articular surface. The medial femoral epicondyle osteotomy provided 614.7 ± 217.6 mm
2
of visualization (677% more than MCL split,
P
2
(585% more than MCL split,
P
2
,
P
= 0.44).
CONCLUSIONS:
Tibial osteotomy of the MCL insertion provided significantly improved visualization of the medial tibial plateau compared with MCL split technique and achieves similar exposure to the femoral epicondyle osteotomy, while preserving the soft tissue structures proximal to the meniscus.
LEVEL OF EVIDENCE:
Level IV. See Instructions for Authors for a complete description of levels of evidence.