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Posterior Plate Positioning Without Distal Placement in Medial Closing-Wedge Distal Femoral Osteotomy
Hyun-Soo Moon1,2, Hyoung-Taek Hong3, Min Jung1,4
1Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Orthopaedic Journal of Sports Medicine
|August 14, 2026
Summary
Optimal plate positioning for medial closed-wedge distal femoral osteotomy (MCDFO) involves posterior placement to enhance biomechanical stability. This finite element analysis (FEA) guides surgeons in reducing complications by improving implant positioning.
Area of Science:
- Orthopedic biomechanics
- Surgical implant technology
- Finite element analysis in medicine
Background:
- Mechanical stability and complication rates after medial closed-wedge distal femoral osteotomy (MCDFO) require optimization.
- The precise role of surgical plate positioning in MCDFO biomechanics is not fully understood.
Purpose of the Study:
- To determine the biomechanically optimal plate position for MCDFO using finite element analysis (FEA).
Main Methods:
- Developed 3D finite element models of the distal femur and implant from CT data.
- Simulated MCDFO and tested nine plate configurations varying height and depth.
- Applied physiological loads at multiple knee flexion angles to assess construct stability.
Main Results:
- Posterior and proximal plate positioning significantly reduced osteotomy site micromotion across all flexion angles.
- Posterior-middle placement minimized stress at the lateral femoral hinge.
- Posterior-proximal positioning reduced peak stress on the plate and screws, avoiding yield strength.
Conclusions:
- Posterior plate positioning, avoiding distal placement, enhances bone-implant construct stability in MCDFO.
- Findings offer practical guidance for implant placement to potentially decrease mechanical complications.
