Wear patterns on tibial plateaus from varus and valgus osteoarthritic knees

The size and location of articular cartilage wear was assessed on 106 varus and 37 valgus osteoarthritic tibial plateaus resected during total knee arthroplasty. Anterior cruciate ligament integrity was assessed intraoperatively, and calibrated digital images were used to measure the wear patterns. Complete anterior cruciate ligament deficiency was seen in 25% of the varus and 24% of the valgus knees. Wear patterns on anterior cruciate ligament intact and attenuated varus tibial plateaus occurred in the middle to anterior aspect of the medial plateau. Anterior cruciate ligament deficient varus plateaus had significantly larger wear areas located more posterior on the medial plateau. In contrast, anterior cruciate ligament intact and deficient valgus tibial plateaus had wear located posterior to the center of the lateral plateau. Anterior cruciate ligament integrity is a discrete feature of advanced osteoarthritis that strongly influences the articular wear patterns. The anterior cruciate ligament deficient wear patterns show a wear mechanism that is consistent with the posterior femoral subluxation and posterior tibiofemoral contact observed after acute anterior cruciate ligament rupture. These observations provide insight into the altered knee mechanics that exist in osteoarthritic knees and the resulting mechanical factors that contribute to degenerative changes.