A novel implant system for unloading the medial compartment of the knee by lateral displacement of the iliotibial band

Abstract

Background: Medial knee osteoarthritis (OA) typically occurs with excessive mechanical load within the medial compartment, resulting in degeneration of the articular cartilage. Purpose: A novel extracapsular implant (Latella Knee Implant) has been developed to unload the medial compartment of the knee. The implant displaces the iliotibial band (ITB) over the lateral femoral condyle, thereby increasing its effective moment arm, resulting in a transfer of load from the medial compartment to the lateral compartment of the knee. A cadaveric study was performed to evaluate the effect of altering the moment arm of the ITB on knee biomechanics. Study Design: Controlled laboratory study. Methods: A 6-degrees-of-freedom robotic testing system was utilized to measure medial and lateral compartment loads in 8 freshfrozen cadaveric knees at various ITB loads and knee flexion angles. Measurements were made with and without the implant in place. The system measured the compartment forces at flexion angles between 0° and 30° under 3 simulated loading conditions (300 N quadriceps, 100 N hamstrings, and [1] 0 N ITB, [2] 50 N ITB, [3] 100 N ITB). Results: Lateral displacement of the ITB between 15 and 20 mm resulted in medial compartment unloading between 34% and 65%. Conclusion: Unloading the medial compartment with this novel implant has the potential to address the treatment gap for patients with medial knee OA. Clinical Relevance: Currently, there exists a treatment gap for patients with medial compartment OA who have exhausted conservative management but whose disease and symptoms do not warrant more invasive surgical procedures. An extracapsular implant to unload the medial compartment could fill this treatment gap by providing patients and surgeons with a less invasive option for early to mid-stage OA. Unloading the medial compartment may alleviate pain and improve function, allowing patients with early-stage medial OA to remain active longer prior to considering more invasive options such as arthroplasty.