Biomechanical evaluation of asymmetric metaphyseal cone applications for lateral tibial plateau fractures

Listen to Simon and Amy discuss the paper 'Biomechanical evaluation of asymmetric metaphyseal cone applications for lateral tibial plateau fractures' published in the October 2025 issue of Bone & Joint Research.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Research. Today we're discussing the paper titled 'Biomechanical evaluation of asymmetric metaphyseal cone applications for lateral tibial plateau fractures', published in October 2025 by Y Ren and colleagues. I am Simon and I'm joined by my co-host, Amy.

Hello Simon. I'm quite keen to discuss this one. Tibial plateau fractures often referred to as TPFs are especially common in older people and compose significant challenges during surgeries like total knee arthroplasty or TKA. Gaining better insight into these fractures can greatly affect patient outcomes.

This study focuses on asymmetric metaphyseal cones and their biomechanical performance in managing lateral TPFs during acute TKA. The researchers developed a finite element model to simulate various scenarios.

They utilized a generic size 5 tibia with an integrated asymmetric metaphyseal cone system. They [00:01:00] simulated 12 different lateral TPF patterns and analyzed four physiological loading conditions: standing up, walking, knee bending, and descending stairs. Micromotions and bone strains were evaluated to determine the stability and effectiveness of the cone application.

One of the key findings was that the implant system exhibited stable biomechanical performance when the unsupported surface area ratio of the cone was up to 44%. Micromotions remained below 50 micrometers, which is well within the osseointegration threshold of 150 micrometers. Interestingly, the study noted the highest micromotion and strain concentrations in the posterior lateral region marking it as critical for stability.

Precisely. What's particularly intriguing is their choice of asymmetric cones. Geometrically, asymmetric cones are believed to be more effective in managing uncontained defects that affect a single plateau. These cones combined with stems and bone cement provide a stable platform for the tibial component in [00:02:00] TKA and their research supports that, for example, in the most severe defect cases with a 56% unsupported area ratio, the maximum micromotion observed was 82 micrometers during stair descending, still well below the critical level.

This indicates that even under demanding conditions, the cone can maintain stability and promote bone healing. The implications are substantial. For orthopaedic surgeons, this means asymmetric metaphyseal cones could potentially improve outcomes for patients with severe lateral TPFs. By managing micromotions and strains effectively, these cones help ensure long-term stability and osseointegration, crucial for successful total knee arthroplasty.

In summary, the research here provides strong clinical guidance. It highlights that asymmetric metaphyseal cones are a promising solution for TPFs. Especially with an unsupported area ratio up to 44%. This could significantly enhance surgical outcomes and patient quality of life.

Indeed, Simon. If you are [00:03:00] managing complex TPF cases, incorporating these findings into your practice could be transformative.

Thanks for tuning into this episode of AI Talks with Bone & Joint. We hope you found this discussion both informative and engaging. Stay tuned for more deep dives into cutting edge research. Until next time, this is Simon and Amy signing off.