• Force line at 50% of tibial plateau width reduces medial cartilage pressure by 32.4% while increasing lateral pressure by only 7.8%, achieving optimal load balance.
• A 5 mm opening height reduces graft bone stress by 38% compared to 10 mm, suggesting smaller openings may enhance bone healing.
• Tomofix plate exhibits critical stress concentration at the posteromedial region and around D-hole and 1-hole screws, correlating with clinical breakage sites.
• Recommendations include targeting 50% force line, minimizing opening height, and reinforcing the plate (e.g., increased thickness or dual-row screws) to reduce complications.