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Nazlıgül AS, Gürler A, Tecimel O, Yılmaz S, Doğan M, Akkaya M. The effect of high tibial osteotomy and unicompartmental knee arthroplasty on patellofemoral joint in young patients with medial knee arthrosis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05480-6. [PMID: 39271496 DOI: 10.1007/s00402-024-05480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/23/2024] [Indexed: 09/15/2024]
Abstract
INTRODUCTION Osteoarthritis of the knee is a debilitating disease. In most cases, only the medial compartments are affected. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are the two main procedures commonly used in the surgical treatment of unicompartmental knee osteoarthritis patients not responding to conservative treatment. The aim of our study was to compare UKA and biplanar medial open-wedge HTO in terms of patellofemoral changes and functional score in patients under 60 years of age with medial compartment arthrosis. MATERIALS AND METHODS A retrospective study. A total of 79 patients (37 HTO, 42 UKA) who received one of the two treatments in a single center were examined preoperatively and at a single postoperative follow-up. Posterior tibial slope, lateral patellofemoral angle (LPFA), Q-angle, patellar height, Cincinnati Rating System and Knee Injury and Osteoarthritis Outcome Score (KOOS) functional scores were evaluated in all patients preoperatively and at the 6-month follow-up examination. RESULTS Insall-Salvati ratio remained stable in the HTO group, while there was a minor decrease in the UKA group and the changes between the groups were not statistically significant. Caton-Deschamps ratio increased in the UKA group and decreased in the HTO group, and this change was statistically significant (p < 0.001). LPFA did not change in the UKA group in the postoperative period, while it increased in the HTO group (p < 0.001). Changes in Q angle and Cincinnati Rating System scores were statistically similar between the UKA and HTO groups (p = 0.827 and p = 0.340). CONCLUSIONS In our study, biplanar medial open-wedge HTO and UKA performed with appropriate surgical technique had no negative effect on patellofemoral joint. In patients under 60 years of age with medial compartment osteoarthritis of the knee, both surgical treatments can be performed with appropriate patient selection.
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Affiliation(s)
- Ali Said Nazlıgül
- Department of Orthopaedics and Traumatology, Sincan Training and Research Hospital, Ankara, Turkey
| | - Ahmet Gürler
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Osman Tecimel
- Department of Orthopaedics and Traumatology, Memorial Hospital, Ankara, Turkey
| | - Sinan Yılmaz
- Department of Orthopaedics and Traumatology, Memorial Hospital, Ankara, Turkey
| | - Metin Doğan
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopaedics and Traumatology, Güven Hospital, Ankara, Turkey.
- Ankara Guven Hospital, Department of Joint Surgery, Cayyolu Health Campus, 06810 Cayyolu, Ankara, Turkey.
- Yuksek Ihtisas University, Department of Orthopaedics and Traumatology, 06530 Cankaya, Ankara, Turkey.
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Bechis M, Rosso F, Verocq M, Innocenti B, Rossi R, Bonasia DE. Mathematical explanations for knee osteotomies: "Dear engineer, how would you explain it in a simple way?". Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05366-7. [PMID: 38787456 DOI: 10.1007/s00402-024-05366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Knee osteotomies are effective procedures to treat different deformities and to redistribute the load at the joint level, reducing the risk of wear and, consequently, the need for invasive procedures. Particularly, knee osteotomies are effective in treating early arthritis related to knee deformities in young and active patients with high functional demands, with excellent long-term results. Precise mathematical calculations are imperative during the preoperative phase to achieve tailored and accurate corrections for each patient and avoid complications, but sometimes those formulas are challenging to comprehend and apply. METHODS Four specific questions regarding controversial topics (planning methods, patellar height, tibial slope, and limb length variation) were formulated. An electronic search was performed on PubMed and Cochrane Library to find articles containing detailed mathematical or trigonometrical explanations. A team of orthopedic surgeons and an engineer summarized the available Literature and mathematical rules, with a final clear mathematical explanation given by the engineer. Wherever the explanation was not available in Literature, it was postulated by the same engineer. RESULTS After the exclusion process, five studies were analyzed. For three questions, no studies were found that provided mathematical analyses or explanations. Through independent calculations, it was demonstrated why Dugdale's method underestimates the correction angle compared to Miniaci's method, and it was shown that the variation in patellar height after osteotomy can be predicted using simple formulas. The five included studies examine postoperative variations in limb length and tibial slope, providing formulas applicable in preoperative planning. New formulas were independently computed, using the planned correction angle and preoperatively obtained measurements to predict the studied variations. CONCLUSIONS There is a strict connection among surgery, planning, and mathematics formulas in knee osteotomies. The aim of this study was to analyze the current literature and provide mathematical and trigonometric explanations to important controversial topics in knee osteotomies. Simple and easy applicable formulas are provided to enhance the accuracy and outcomes of this surgical procedure.
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Affiliation(s)
- Marco Bechis
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy.
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy.
| | - Marie Verocq
- Universite Libre de Bruxelles, Ecole Polytechnique de Bruxelles, Avenue F. Roosevelt 50 CP165/56, 1050, Brussels, Belgium
| | - Bernardo Innocenti
- Universite Libre de Bruxelles, Ecole Polytechnique de Bruxelles, Avenue F. Roosevelt 50 CP165/56, 1050, Brussels, Belgium
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
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Elyasi E, Cavalié G, Perrier A, Graff W, Payan Y. A Systematic Review on Selected Complications of Open-Wedge High Tibial Osteotomy from Clinical and Biomechanical Perspectives. Appl Bionics Biomech 2021; 2021:9974666. [PMID: 34754331 PMCID: PMC8572600 DOI: 10.1155/2021/9974666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/09/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The wedge opened during high tibial osteotomy defines the alignment correction in different body planes and alters soft tissue insertions. Although multiple complications of the surgery can be correlated to this, there is still a lack of consensus on the occurrence of those complications and their cause. The current study is aimed at clarifying this problem using a combined medical and biomechanical perspective. METHODS We conducted a systematic review of the literature on selective complications of the surgery correlated with the angles of the opened wedge. Search topics covered tibial slope alteration, patellar height alteration, medial collateral ligament release, and model-based biomechanical simulations related to surgical planning or complications. Findings. The selection process with the defined inclusion/exclusion criteria led to the collection of qualitative and quantitative data from 38 articles. Medial collateral ligament tightness can be a valid complication of this surgery; however, further information about its preoperative condition seems required for better interpreting the results. The posterior tibial slope significantly increases, and the patellar height (using the Blackburne-Peel ratio) significantly decreases in the majority of the selected studies. Model-based biomechanical studies targeting surgical planning are mostly focused on the lower-limb alignment principles and tibiofemoral contact balancing rather than surgical complications. Interpretation. Increased posterior tibial slope, patellar height decrease, and medial collateral ligament tightness can occur due to alterations in different body planes and in soft tissue insertions after wedge opening. This study clarified that information about preoperative alignment in all body planes and soft-tissue conditions should be considered in order to avoid and anticipate these complications and to improve per surgery wedge adaptation. The findings and perspective of this review can contribute to improving the design of future clinical and biomechanical studies.
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Affiliation(s)
- Elaheh Elyasi
- Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France
| | - Guillaume Cavalié
- Service de Chirurgie Orthopédique et Traumatologie, Site Nord., CHU Grenoble-Alpes, La Tronche, France
- Univ. Grenoble Alpes, Laboratoire d'Anatomie des Alpes Françaises, Domaine de la Merci, 38700 La Tronche, France
| | - Antoine Perrier
- Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France
- Service de Chirurgie Osseuse et Traumatologique, Centre de Référence Des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, Rue d'Avron, 75020 Paris, France
| | - Wilfrid Graff
- Service de Chirurgie Osseuse et Traumatologique, Centre de Référence Des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, Rue d'Avron, 75020 Paris, France
| | - Yohan Payan
- Univ. Grenoble Alpes, CNRS, TIMC-IMAG, 38000 Grenoble, France
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Kaya H, Dastan AE, Bicer EK, Taskiran E. Posteromedial Open-Wedge High Tibial Osteotomy to Avoid Posterior Tibial Slope Increase. Arthroscopy 2020; 36:2710-2717. [PMID: 32634477 DOI: 10.1016/j.arthro.2020.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim was to evaluate the influence of the surgical modification on posterior tibial slope (PTS) and patellar height in open-wedge high tibial osteotomy (OWHTO). The secondary aim was to evaluate the influence of preoperative mechanical axis deviations (MA) on PTS METHODS: Between January 2014 and February 2016, patients with a diagnosis of medial-compartment osteoarthritis who had undergone OWHTO with posteromedial osteotomy technique with a minimum follow-up of 3 months were included in this retrospective study. Preoperative and postoperative PTS angles with 3 different methods and patellar heights with respect to the Insall-Salvati and Caton-Deschamps indices were measured on lateral radiographs by 2 observers. Patients were grouped according to preoperative MA (either <10° or ≥10°). PTS changes were compared between groups RESULTS: Thirty consecutive knees of 28 patients were evaluated. Preoperative mean PTS angles were 9.50° ± 4.47° (posterior tibial cortex referenced), 11.51° ± 4.50° (tibial anatomical axis referenced), and 10.80° ± 4.58° (posterior fibular cortex referenced); postoperative angles were 6.10° ± 4.23°, 8.78° ± 4.57°, and 8.11° ± 4.55°, respectively. PTS was significantly decreased postoperatively with respect to all 3 methods (P < .0001). Mean preoperative and postoperative Insall-Salvati indices were 1.04 ± 0.16 and 1.07 ± 0.17, respectively (P = .088). Mean preoperative and postoperative Caton-Deschamps indices were 0.87 ± 0.18 and 0.78 ± 0.18, respectively (P = .017). PTS changes were not statistically significant between groups with respect to MA (P values .861, .723, and .727, respectively) CONCLUSIONS: It is possible to preserve and even decrease PTS with an OWHTO performed posterior to MCL in a posteromedial to anterolateral direction. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Huseyin Kaya
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Ali Engin Dastan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Elcil Kaya Bicer
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Emin Taskiran
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey
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Kim GB, Kim KI, Song SJ, Lee SH. Increased Posterior Tibial Slope After Medial Open-Wedge High Tibial Osteotomy May Result in Degenerative Changes in Anterior Cruciate Ligament. J Arthroplasty 2019; 34:1922-1928. [PMID: 31103360 DOI: 10.1016/j.arth.2019.04.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/30/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study aimed at evaluating changes in posterior tibial slope angle (PTSA) and the anterior cruciate ligament (ACL) before and after medial open-wedge high tibial osteotomy (MOWHTO) through 2-staged arthroscopic findings and verified whether the ACLs would be affected by the changed PTSA. We also evaluated which predisposing factors could influence ACL changes after MOWHTO. METHODS From July 2010 to March 2016, 164 knees that could follow the second-look arthroscopy at the time of plate removal were enrolled. Radiologically, preoperative and postoperative hip-knee-ankle angle, femorotibial angle, medial proximal tibial angle, and PTSA were evaluated. Based on our previous study, we assessed the ACL using the macroscopic grading system (normal, abnormal degenerative, and partially ruptured ACL) by first- and second-look arthroscopy and compared it before and after HTO. The correlation between changes in PTSA (△PTSA) and ACL was evaluated. We also assessed predisposing factors that might affect ACL changes. RESULTS Mean age at the time of osteotomy was 57.2 ± 5.1 years and time interval between the 2-stage arthroscopies was 26.3 ± 4.0 months. PTSA significantly increased after MOWHTO (P < .001). ACL stage at second-look arthroscopy was significantly progressed compared to first-look findings (P < .001). △PTSA was larger in the progressed group (2.1°; P < .001). Multivariate logistic regression indicated that greater body mass index (odds ratio, 1.2; P = .029) and larger △PTSA (odds ratio, 1.3; P = .008) were predisposing factors. CONCLUSION Increased posterior tibial slope following MOWHTO may result in degenerative ACL changes. Greater body mass index and larger △PTSA were predisposing factors for ACL degeneration after MOWHTO.
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Affiliation(s)
- Gi Beom Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Republic of Korea; Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Sang Jun Song
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Sang Hak Lee
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Republic of Korea; Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
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Krause M, Drenck TC, Korthaus A, Preiss A, Frosch KH, Akoto R. Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc 2018; 26:1859-1866. [PMID: 28417183 DOI: 10.1007/s00167-017-4548-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/10/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The primary purpose of the study was to gain insight into geometric changes of the patellar height (PH) and posterior tibial slope (PTS) after a biplanar ascending medial open-wedge high tibial osteotomy (HTO) compared to biplanar descending medial open-wedge HTO in patients with genu varum. METHODS Sixty-four patients (mean age 45.2 ± 8.7 years, females n = 24, males n = 40) with varus malalignment and medial gonarthrosis were retrospectively studied. Patients received either a biplanar ascending or descending medial open-wedge HTO. Radiographic analysis included the assessment of standing total leg axis, PH, and PTS prior to and after surgery. RESULTS In the ascending HTO group, PH decreased significantly by 4.0% (p = 0.037, Caton-Deschamps index) after an average leg axis valgus-producing correction of 7.1° ± 2.8°. In the descending HTO group, with an average leg axis correction of 7.0° ± 3.7°, there were no significant PH changes. There were no significant differences between the ascending and descending HTO groups regarding PTS or leg axis. The mean post-operative leg axis between ascending (1.6° ± 1.9°) and descending HTO (1.9° ± 2.4°) was not significantly different. CONCLUSION Compared to the biplanar ascending medial open-wedge HTO, the descending HTO did not influence patella height or increase the posterior tibial slope. In order to respect patellofemoral and slope-related knee kinematics, a biplanar descending medial open-wedge HTO has proven useful to control patella height and posterior tibial slope. These findings underscore the importance of the preoperative patella height assessment in the osteotomy planning and subsequent choice of the biplanar osteotomy direction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthias Krause
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
| | - Tobias Claus Drenck
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
| | - Alexander Korthaus
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
| | - Achim Preiss
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
| | - Karl-Heinz Frosch
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany.
| | - Ralph Akoto
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
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Moghtadaei M, Otoukesh B, Bodduhi B, Ahmadi K, Yeganeh A. Evaluation of Patellar Position before and After Medial Opening Wedge High Tibial Osteotomy: Radiographic and Computed Tomography Findings. Med Arch 2018; 70:293-295. [PMID: 27703292 PMCID: PMC5034988 DOI: 10.5455/medarh.2016.70.293-295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/05/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction: Genovarum is a common orthopedic problem. Its optimal prompt treatment is an issue of importance. Aim: This study was conducted to determine the radiographic changes in patella bone before and after open wedge high tibial osteotomy. Material and Methods: In this quasi-experimental study, 43 patients were enrolled and underwent open wedge high tibial osteotomy and the radiographic and CT-scan indices including Q-Angle, Congruence Angle, Insall-Salvati index, and TTTG were measured and compared before and after surgery. Results: The result revealed that all indices including Q-Angle, Congruence Angle, Insull-Salvati index, and TTTG were not significantly differed across the study (P > 0.05). There was no difference between DLFA values before and after the operation (P> 0.05), while MPTA values were significantly different before and after operation (p <0.001). Conclusions: Totally it may be concluded that imaging indices are not differed after open wedge high tibial osteotomy and monitoring for them is not necessary and they would have no prognostic role.
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Affiliation(s)
- Mehdi Moghtadaei
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Babak Otoukesh
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Bahram Bodduhi
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Keyvan Ahmadi
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Ali Yeganeh
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
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Takeuchi R, Woon-Hwa J, Ishikawa H, Yamaguchi Y, Osawa K, Akamatsu Y, Kuroda K. Primary stability of different plate positions and the role of bone substitute in open wedge high tibial osteotomy. Knee 2017; 24:1299-1306. [PMID: 29033262 DOI: 10.1016/j.knee.2017.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 06/08/2017] [Accepted: 07/26/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare the mechanical fixation strengths of anteromedial and medial plate positions in osteotomy, and clarify the effects of bone substitute placement into the osteotomy site. METHODS Twenty-eight sawbone tibia models were used. Four different models were prepared: Group A, the osteotomy site was open and the plate position was anteromedial; Group B, bone substitutes were inserted into the osteotomy site and the plate position was anteromedial; Group C, the osteotomy site was open and the plate position was medial; and Group D, bone substitutes were inserted into the osteotomy site and the plate position was medial. The loading condition ranged from 0 to 800N and one hertz cycles were applied. Changes of the tibial posterior slope angle (TPS), stress on the plate and lateral hinge were measured. RESULTS The changes in the TPS and the stress on the plate were significantly larger in Group A than in Group C. These were significantly larger in Group A than in Group B, and in Group C than in Group D. There was no significant difference between Group B and Group D, and no significant difference between knee flexion angles of 0° and 10°. Stress on the lateral hinge was significantly smaller when bone substitute was used. CONCLUSIONS A medial plate position was biomechanically superior to an anteromedial position if bone substitute was not used. Bone substitute distributed the stress concentration around the osteotomy gap and prevented an increase in TPS angle regardless of the plate position.
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Affiliation(s)
- Ryohei Takeuchi
- Joint Surgery Center, Yokosuka City Hospital, Kanagawa, Japan.
| | - Jung Woon-Hwa
- Department of Orthopaedic Surgery, Murup Hospital, Changwon, South Korea
| | | | | | - Katsunari Osawa
- Joint Surgery Center, Yokosuka City Hospital, Kanagawa, Japan
| | - Yasushi Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Koichi Kuroda
- Olympus Terumo Biomaterials Corporation, Tokyo, Japan
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Sagittal osteotomy inclination in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:823-831. [PMID: 27056696 DOI: 10.1007/s00167-016-4115-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Unlike postoperative changes in posterior tibial slope after medial open-wedge high tibial osteotomy, sagittal osteotomy inclination has not been examined. It has been recommended that the osteotomy line in the sagittal plane be parallel to the medial posterior tibial slope. The purpose of this study was to determine the frequency of parallel osteotomy in medial open-wedge high tibial osteotomy. METHODS To determine the sagittal osteotomy inclination, the angle between the medial joint line and the osteotomy line was measured in the lateral radiograph. A positive angle value indicates that the osteotomy is anteriorly inclined relative to the medial posterior tibial slope. Correlation between the sagittal osteotomy inclination and posterior tibial slope was also evaluated. RESULTS The mean sagittal osteotomy inclination was 15.1 ± 7.5°. The majority 87.1 % of knees showed an anterior-inclined osteotomy. There was a significantly positive correlation between the postoperative posterior tibial slope and the sagittal osteotomy inclination (r, 0.33; 95 % confidence interval (CI) 0.19-0.46; P < 0.001). The postoperative change in posterior tibial slope also showed a significantly positive correlation with the sagittal osteotomy inclination (r, 0.35; 95 % CI 0.21-0.47; P < 0.001). CONCLUSION Although parallel osteotomy in the sagittal plane relative to the medial joint line was planned, only 12.9 % of cases achieved osteotomy parallel to the medial posterior tibial slope in the sagittal plane. Because of high rate of the anterior-inclined osteotomy and their correlations with posterior tibial slope, surgeons should make all efforts to perform parallel osteotomy relative to medial posterior tibial slope. LEVEL OF EVIDENCE IV.
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Nha KW, Kim HJ, Ahn HS, Lee DH. Change in Posterior Tibial Slope After Open-Wedge and Closed-Wedge High Tibial Osteotomy: A Meta-analysis. Am J Sports Med 2016; 44:3006-3013. [PMID: 26872893 DOI: 10.1177/0363546515626172] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is unclear whether open- or closed-wedge high tibial osteotomy (HTO) results in significant changes in posterior tibial slope, with no consensus on the magnitude of such changes. Furthermore, methods of measuring posterior tibial slope differ among studies. This meta-analysis was therefore designed to evaluate whether posterior tibial slope increases after open-wedge HTO and decreases after closed-wedge HTO and to quantify the magnitudes of the slope changes after open- and closed-wedge HTO using various methods of measuring posterior tibial slope. HYPOTHESIS Posterior tibial slope increases after open-wedge and decreases after closed-wedge HTO. The magnitude of change is similar for the 2 methods, and the value obtained for posterior tibial slope change is affected by the method of measurement. STUDY DESIGN Meta-analysis. METHODS Multiple comprehensive databases, including MEDLINE, EMBASE, the Cochrane Library, and KoreaMed, were searched for studies that evaluated the posterior slope of the proximal tibia in patients who had undergone open- and/or closed-wedge HTO. Studies were included that compared pre- and postoperative posterior tibial slopes, regardless of measurement method, including anterior and posterior tibial cortex or tibial shaft axis as a reference line, in patients who underwent open- or closed-wedge HTO. The quality of each included study was appraised with the Newcastle-Ottawa Scale. RESULTS Twenty-seven studies were included in the meta-analysis. Pooled data, which included subgroups of 3 methods, showed that posterior tibial slope increased 2.02° (95% CI, 2.66° to 1.38°; P = .005) after open-wedge HTO and decreased 2.35° (95% CI, 1.38° to 3.32°; P < .001) after closed-wedge HTO. CONCLUSION This meta-analysis confirmed that posterior tibial slope increased after open-wedge HTO and decreased after closed-wedge HTO when the results of a variety of measurement methods were pooled. The magnitude of change after open- and closed-wedge HTO was similar and small (approximately 2°), suggesting that both osteotomy techniques may have little effect on the biomechanics of the cruciate ligaments.
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Affiliation(s)
- Kyung-Wook Nha
- Department of Orthopaedic Surgery, Ilsanpaik Hospital, Inje University College of Medicine, Goyangsi, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyeong-Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lustig S, Scholes CJ, Costa AJ, Coolican MJ, Parker DA. Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21:32-8. [PMID: 23052121 DOI: 10.1007/s00167-012-2229-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 09/20/2012] [Indexed: 01/22/2023]
Abstract
PURPOSE In contrast to radiographic measurements, MRI provides multiple slices of the knee joint in the sagittal plane, making it possible to assess the medial and lateral tibial slope separately. The purpose of this study is to investigate the effect of medial open-wedge high tibial osteotomy (MOWHTO) on bony and meniscal slope in the medial and lateral tibiofemoral compartments. It was hypothesised that greater changes on the medial tibial plateau would be observed compared with the lateral one. METHODS A retrospective analysis of prospectively collected data was performed on pre- and post-operative MRIs from 21 patients (17 men and 4 women; age 52 ± 9 years). Inclusion criteria were varus alignment, medial compartment osteoarthritis and election for a primary MOWHTO. Each patient had a preoperative and a post-operative high-resolution MRI (3Tesla, Magnetom Trio, Siemens AG) at an average follow-up of 2.1 years. A previously published method was used to measure bony and meniscal slope for each compartment. The difference between pre- and post-operative tibial slope for both compartments was calculated and associated with the amount of frontal correction. RESULTS There was a significant increase in bony tibial slope in both compartments following MOWHTO. When a change in bony tibial slope was detected in an individual patient, the change was larger in the medial compartment, with the average change also significantly greater (p < 0.01) in the medial compartment (2.4° ± 1.3°) compared with the lateral compartment (0.9° ± 1.1°). There was also a significant increase (p < 0.01) in the lateral tibial meniscal slope of 0.9° ± 1.4°, which was equivalent to the change in the bony lateral slope. The amount of frontal correction was not significantly associated with the amount of change in slope. CONCLUSIONS The results suggest that the modification of the bony slope is larger in the medial compartment after MOWHTO, which is likely related to the location of the hinge on the lateral tibial cortex. These findings suggest that consideration of the medial and lateral tibial slope intra-operatively could be important to identify the optimal location of the hinge. However, further studies are required before recommending any modification to the surgical technique, as the potential clinical consequences of tibial slope alterations remain unknown. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S Lustig
- Sydney Orthopaedic Research Institute, Level 1, The Gallery 445 Victoria Avenue, Chatswood, NSW, 2067, Australia.
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Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X, Zayni R, Bonnin M, Jalil R, Amzallag J, Rosset P, Servien E, Gaudot F, Judet T, Catonné Y. Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study. Orthop Traumatol Surg Res 2012; 98:68-74. [PMID: 22244250 DOI: 10.1016/j.otsr.2011.08.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 07/18/2011] [Accepted: 08/23/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Valgus high tibial osteotomy is considered to be an effective treatment for unicompartmental medial osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. However, the effects on posterior tibial slope of closing- or opening-wedge osteotomies remain controversial. HYPOTHESIS We analyzed the modifications of tibial slope after opening- and closing-wedge high tibial osteotomies and compared the results of these two procedures. We hypothesized that there was no difference in postoperative tibial slope between opening and closing-wedge osteotomies. PATIENTS AND METHODS This prospective consecutive nonrandomized multicenter study was conducted between January 2008 and March 2009 and included 321 patients: 205 men and 116 women. A total of 224 patients underwent an opening-wedge high tibial osteotomy and 97 a closing-wedge osteotomy. The mean age was 52 years ± 9 and the mean body mass index was 28kg/m(2) ± 5. The main etiology was primary arthritis. Posterior tibial slope was measured preoperatively and at the last follow-up on a lateral radiograph in relation to the posterior tibial cortex. RESULTS In the opening-wedge group, a definite 0.6° increase in tibial slope (P=0.016) was observed. In the closing-wedge group, a definite 0.7° decrease in tibial slope (P=0.02) was found. Fourteen percent of the opening-wedge osteotomies increased tibial slope by 5° or more versus only 2% of the closed-wedge osteotomies (P<0.001). Twelve percent of the closing-wedge high tibial osteotomies led to a decrease of 5° or more of the tibial slope versus 7% of the opening-wedge osteotomies (P<0.02). DISCUSSION AND CONCLUSION These results confirm what is generally reported in the literature, i.e., an increase in tibial slope in opening-wedge high tibial osteotomy and a decrease in the slope in closing-wedge osteotomies. These tibial slope changes appear to be very limited in this series, less than 1° on average. However, there was a bias since the open-wedge technique was preferred in cases with substantial varus deformity. We emphasize the importance of surgical technique to avoid alteration of the tibial slope, particularly in opening-wedge high tibial osteotomy for which we recommend a release of posterior soft tissue and a complete osteotomy of the posterior cortex of the tibia. LEVEL OF EVIDENCE III. Prospective consecutive nonrandomized multicenter study.
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Affiliation(s)
- A Ducat
- Department of Orthopaedic Surgery and traumatology, Pierre et Marie-Curie Paris VI University, Paris, France.
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Is there a correlation between posterior tibial slope and non-contact anterior cruciate ligament injuries? Knee Surg Sports Traumatol Arthrosc 2011; 19 Suppl 1:S109-14. [PMID: 21607739 DOI: 10.1007/s00167-011-1547-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 05/05/2011] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study was (1) to determine differences in posterior tibial slope (PTS) between subjects who underwent ACL reconstruction following a non-contact ACL injury and a matched control uninjured group and (2) to investigate gender differences between ACL-injured subjects and gender-matched controls. METHODS A retrospective chart review was conducted of all 316 ACL-deficient patients at a large regional academic teaching hospital. A control group was established searching the database of the same hospital for subjects who underwent knee radiographs for acute knee complaints with no ACL injury. Subjects (n = 272; males n = 199; females n = 73) were included if a non-contact mechanism could be established. Exclusion criteria included previous ipsilateral knee injury and/or knee previous surgery. PTS was measured on a digitalized lateral radiograph using the axis of the posterior tibial cortex as a reference. RESULTS There was a significant difference (P = 0.008) within the ACL injury group between males and females. There was no significant difference in the PTS angle between those patients with an ACL injury (5.8 ± 3.5 degrees) and the uninjured control group (5.6 ± 3.2 degrees), or between the male ACL injury patients (5.5 ± 3.4) and their control group (5.8 ± 3.1). However, there was a significant difference between the female ACL injury patients (6.7 ± 3.7) and their uninjured control group (5.0 ± 3.4) (P = 0.004). CONCLUSION The results of this study suggest that increased posterior tibial slope appears to contribute to non-contact ACL injuries in females, but not in males.
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Hinterwimmer S, Beitzel K, Paul J, Kirchhoff C, Sauerschnig M, von Eisenhart-Rothe R, Imhoff AB. Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 2011; 39:851-6. [PMID: 21212305 DOI: 10.1177/0363546510388929] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Valgus-producing open-wedge high tibial osteotomy is an established treatment for varus malalignment and medial osteoarthritis, with reproducible results in the frontal plane. However, an undesirable but often accepted increase in posterior tibial slope and decrease in patellar height are still routinely seen. PURPOSE To evaluate the influence of valgus open-wedge high tibial osteotomy on posterior tibial slope and patellar height when special techniques are used to minimize unwanted changes. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twenty-five patients, 3 women and 22 men (mean age, 40.2 years), underwent valgus open-wedge high tibial osteotomy. Several technical steps were taken to prevent an increase in posterior tibial slope during the osteotomy. To minimize patellar height changes, the tibial tuberosity was left on either the proximal or distal fragment, depending on the desired patellofemoral effect. The medial and lateral posterior slope was measured using the proximal posterior cortex as a reference; the patellar height was assessed with the Caton-Deschamps Index and compared on preoperative and postoperative radiographs. RESULTS No significant posterior tibial slope changes were observed. Patellar height increased with both types of tibial tuberosity osteotomy. With the proximal osteotomy, the Caton-Deschamps Index increased from 0.95 to 0.97; with the distal osteotomy, it increased from 0.89 to 0.95. The change was not significant with either osteotomy. The posterior tibial slope did not change on the medial side, measuring 4.2 preoperatively and postoperatively. The lateral slope decreased from 5.4 to 5.1. There was no correlation between the correction in the coronal plane and the changes in the sagittal plane. CONCLUSION Open-wedge high tibial osteotomy can be performed without significant changes in patellar height or posterior tibial slope if specific intraoperative methods are used to prevent their occurrence. Analysis and control of sagittal changes in valgus open-wedge high tibial osteotomy should reduce the incidence of unwanted changes in patellar height and posterior tibial slope.
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Affiliation(s)
- Stefan Hinterwimmer
- Abteilung für Sportorthopädie, Technische Universität München, Munich, Germany
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