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Kumaki D, Tensho K, Iwaasa T, Maezumi Y, Yoshida K, Koyama S, Shimodaira H, Hiriuchi H, Takahashi J. Postoperative patient-reported outcome measures after medial open-wedge high tibial osteotomy was improved by decreased joint line convergence angle. Knee Surg Sports Traumatol Arthrosc 2024; 32:2129-2140. [PMID: 38813913 DOI: 10.1002/ksa.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To evaluate the relationship between pre- and postoperative joint line convergence angle (JLCA) changes and patient-reported outcome measures related to medial open-wedge high tibial osteotomy (MOWHTO). METHODS Sixty-one patients (71 knees) who underwent MOWHTO were examined. Preoperative and 2-year postoperative radiographic parameters (hip-knee-ankle angle, weight-bearing line ratio, medial proximal tibial angle and JLCA) were measured, and knee injury and osteoarthritis outcome scores (KOOS) were assessed. Patients were divided into two groups: group D (decreased JLCA compared with preoperative status) included 44 knees with a ΔJLCA < 0° and group I (increased JLCA and no-change JLCA compared with preoperative status) included 27 knees with a ΔJLCA ≥ 0°. KOOS sub-scores and the proportion of patients whose improvement exceeded the minimum clinically important difference (MCID) were compared between both groups using Student's t tests, Mann-Whitney U tests and chi-square tests. Multiple regression analysis was performed to determine the factor that had an influential effect on the postoperative KOOS total. RESULTS Significant differences in 2-year postoperative KOOS were observed between the two groups, including total, symptom, pain and activities of daily living scores. Group D had significantly more patients who achieved MCID for both KOOS symptoms and pain scores than group I did. Multivariate analysis indicated that JLCA change and body mass index were significantly associated with the postoperative KOOS total. CONCLUSION Patients with decreased JLCA had better 2-year post-MOWHTO KOOS and better symptom and pain improvements. Therefore, strategies that reduce JLCA are crucial to improving clinical outcomes, and efforts should be made to improve JLCA in surgical techniques. LEVEL OF EVIDENCE Level Ⅳ, Case series.
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Affiliation(s)
- Daiki Kumaki
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yusuke Maezumi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kazushige Yoshida
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroshi Hiriuchi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Ozeki N, Koga H, Nakamura T, Katagiri H, Nakagawa Y, Hoshino T, Katakura M, Amemiya M, Yoshihara A, Katano H, Mizuno M, Endo K, Masumoto J, Sekiya I. Cartilage thickness in the medial compartment of the knee joint evaluated by MRI three-dimensional analysis correlates with weight-bearing line ratio and joint line convergence angle. J Orthop Sci 2024:S0949-2658(24)00142-8. [PMID: 39068097 DOI: 10.1016/j.jos.2024.07.002] [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: 01/22/2024] [Revised: 06/20/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE The correlation between cartilage thickness evaluated by 3D MRI and knee alignment has not been elucidated. The study's purpose was to retrospectively verify whether average cartilage thickness calculated by the automatic MRI 3D analysis system for each subregion was correlated with knee alignment. METHODS A total of 53 patients underwent medial meniscus repair or high tibial osteotomy for medial knee osteoarthritis. Cartilage thickness was automatically calculated using 3D MRI software. Knee alignment, weight-bearing line ratio (WBLR), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were calculated on a weight-bearing long-leg radiograph using digital planning software. The association between knee alignment and the average cartilage thickness at 18 subregions in the medial femoral condyle (MFC) and medial tibial plateau (MTP) was evaluated using Spearman's rank correlation coefficient. RESULTS Cartilage thickness of the MFC had moderately positive correlations with WBLR at four subregions and weak correlations at two subregions. Cartilage thickness of the MTP had moderately positive correlations with WBLR at four subregions. Cartilage thickness of the MFC had moderately negative correlations with JLCA at six subregions. Cartilage thickness of the MTP had moderately negative correlations with JLCA at four subregions and a weak correlation at one subregion. Conversely, cartilage thickness had weak correlations with MPTA or LDFA. CONCLUSIONS In knees with pathological conditions in the medial compartment, cartilage thicknesses by 3D MRI had positive correlations with WBLR and JLCA at almost all subregions of the MFC and at the anterior-middle and central-external of the MTP. Treatment strategies should be considered in light of these regions. LEVEL OF EVIDENCE Cross-sectional study (diagnosis); Level of evidence, 2.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yusuke Nakagawa
- Department of Cartilage Regeneration, Tokyo Medical and Dental University, Japan
| | - Takashi Hoshino
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University Hospital of Medicine, Japan
| | - Mai Katakura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Masaki Amemiya
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University Hospital of Medicine, Japan
| | - Aritoshi Yoshihara
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hisako Katano
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| | - Mitsuru Mizuno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| | - Kentaro Endo
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Japan
| | | | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Japan.
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Jung SJ, Kang JH, Rhee SJ, Moon SW, Wang L, D’Lima DD. Difference in Correction Power between Hybrid Lateral Closed-Wedge High Tibial Osteotomy and Medial Open-Wedge High Tibial Osteotomy was Associated with Severity of Varus Deformity and Different Hinge Distance from Center of Deformity. Diagnostics (Basel) 2024; 14:1137. [PMID: 38893663 PMCID: PMC11171834 DOI: 10.3390/diagnostics14111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Hybrid lateral closed-wedge high tibial osteotomy (HBHTO) carries certain advantages over medial open-wedge high tibial osteotomy (OWHTO). We investigated the potential difference in the required correction angle between HBHTO and OWHTO to achieve an equal amount of whole lower-extremity alignment correction, retrospectively analyzing the preoperative plain radiographic images of 100 patients. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical lateral distal femoral angle (mLDFA), hip-knee-ankle axis (HKA), length of the tibia, width of the tibial plateau, length of the lower limb (leg length), and location of the center of deformity (CD) were measured. Differences in the required correction angle at the hinge point between the two techniques (CAD) were compared, and correlation analysis was performed to reveal the influential factors. The mean difference in CAD between HBHTO and OWHTO was 0.78 ± 0.22 (0.4~1.5)°, and mean WBL position change per correction angle was 3.9 ± 0.3 (3.0~4.6)% in HBHTO and 4.1 ± 0.3 (3.1~4.7)% in OWHTO. Correlation analysis revealed a strong positive correlation between CAD and HKA. mLDFA, JLCA, MPTA, leg length, OWCD, HBCD, and HCD were also significantly correlated with CAD. HBHTO required a 5.6% larger correction angle at the hinge point to achieve the same amount of alignment correction as OWHTO.
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Affiliation(s)
- Seok Jin Jung
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Jun Ho Kang
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Sang Won Moon
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Busan 48108, Republic of Korea
| | - Lih Wang
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan 49201, Republic of Korea
| | - Darryl D D’Lima
- Department of Molecular Medicine, Scripps Research, La Jolla, CA 92037, USA
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, La Jolla, CA 92121, USA
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Takagawa S, Kobayashi N, Yukizawa Y, Hirotomi K, Higashihira S, Inaba Y. Hybrid Closed Wedge High Tibial Osteotomy Maintains the Leg Length After Surgery Compared With Open Wedge High Tibial Osteotomy. Cureus 2024; 16:e57953. [PMID: 38738055 PMCID: PMC11082916 DOI: 10.7759/cureus.57953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND This study aimed to assess the changes in leg length following open wedge high tibial osteotomy (OWHTO) and hybrid closed wedge high tibial osteotomy (h-CWHTO) and whether the change in leg length was associated with preoperative radiographic factors and the change in planned opening or closing width. METHODS We retrospectively evaluated the data of patients who underwent OWHTO (n=57) and h-CWHTO (n=31) between 2016 and 2019. Standing full-length anteroposterior radiographs were obtained preoperatively and one year postoperatively. Changes in the lower leg and tibial length were measured using radiography, and the planned opening or closing width was decided via operative planning. Flexion contracture was examined preoperatively and one year postoperatively using a goniometer, and the correlation factors and changes in leg length were analyzed using Spearman's rank correlation. RESULTS In the OWHTO group, the lower leg was significantly longer by a mean of 6.0±8.7 mm compared to that preoperatively (p<0.01); however, no significant difference was observed in the h-CWHTO group (mean, -0.56±11.6 mm) (p=0.788). In the OWHTO group, flexion contracture did not improve after surgery, however, in the h-CWHTO group, flexion contracture significantly improved from -7.1±7.0 degrees to -4.7±6.2 degrees postoperatively (p<0.01). No radiographic factors or bone opening or closing width were associated with changes in leg length in both groups. CONCLUSION OWHTO led to a significant elongation of the lower leg while leg length was maintained post-h-CWHTO. However, the changes in leg length following both OWHTO and h-CWHTO were not predictable from preoperative radiographic factors or changes in bone width.
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Affiliation(s)
- Shu Takagawa
- Orthopaedics Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Naomi Kobayashi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Yohei Yukizawa
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Kunihito Hirotomi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shota Higashihira
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Yutaka Inaba
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
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Jung SH, Jung M, Chung K, Kim S, Kang KT, Park J, Sim W, Choi CH, Kim SH. Preoperative joint line obliquity, a newly identified factor for overcorrection, can be incorporated into a novel preoperative planning method to optimise alignment in high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2024; 32:64-77. [PMID: 38226764 DOI: 10.1002/ksa.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The aim of this study was to analyse the factors associated with additional postoperative alignment changes after accurate bony correction by selecting only patients with well-performed bony correction as planned and develop a method of incorporating significant factors into preoperative planning. METHODS Among 104 consecutive patients who underwent medial open wedge high tibial osteotomy (MOWHTO) between October 2019 and July 2022, 61 with well-performed bony corrections were retrospectively reviewed. The major criterion for well-performed bony correction was a difference of <1° between the simulated medial proximal tibial angle (MPTA) and the actual postoperative MPTA as measured in three dimensions. Radiographic parameters, such as the joint line convergence angle (JLCA) and joint line obliquity (JLO), were measured preoperatively and postoperatively, utilising standing and supine whole lower extremity anteroposterior, valgus and varus stress radiographs. Multiple linear regression analysis identified the factors affecting alignment changes, and a prediction model was developed. A method for applying this prediction model to preoperative planning was proposed. RESULTS Preoperative JLCA on standing (preJLCAstd ), preoperative JLCA on 0° valgus stress radiograph (vgJLCA0 ), and preoperative JLO (preJLO) were significantly correlated with JLCA change (∆JLCA) (p < 0.001, p < 0.001, p = 0.006). The prediction model was estimated as ∆JLCA = 0.493 × (vgJLCA0 ) - 0.727 × (preJLCAstd ) + 0.189 × (preJLO) - 1.587 in. (R = 0.815, modified R2 = 0.646, p < 0.001). The proposed method resulted in a reduced overcorrection rate (p = 0.003) and an improved proportion of acceptable alignments (p = 0.013). CONCLUSION PreJLCAstd , vgJLCA0 and preJLO can be used to estimate ∆JLCA. PreJLO was recently identified as a significant factor associated with additional alignment changes. Utilising the proposed preoperative planning and a prediction model with these factors shows promise in calibrating postoperative alignment after MOWHTO. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Se-Han Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
- Skyve R&D LAB, Seoul, Republic of Korea
| | - Jisoo Park
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woongseob Sim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Mabrouk A, An JS, Glauco L, Jacque C, Kley K, Sharma A, Ollivier M. The joint line convergence angle (JLCA) correlates with intra-articular arthritis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5673-5680. [PMID: 37884727 DOI: 10.1007/s00167-023-07616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Knees with unicompartmental varus osteoarthritis (OA) usually display a combination of tibiofemoral bony deformity and increased joint line convergence angle (JLCA). The JLCA is a product of intra-articular deformity and lateral soft tissue laxity. This study aims to define the correlation between the JLCA and progression of OA. METHODS A retrospective radiological analysis of 501 patients, who underwent either high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA), was performed. The preoperative OA grade was reported based on the Ahlbäck and the Kellgren-Lawrence (KL). The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the mechanical lateral distal femoral angle (mLDFA) and the joint line convergence angle (JLCA) were recorded. The primary outcome was the relationship between the JLCA values and the OA grade. The secondary outcomes were comparing the JLCA and other alignment parameter values between HTO and UKA groups. RESULTS A total of 501 (59.3% females n = 297) cases were included, comprising 293 cases of HTO and 208 cases of UKA. Patients had a mean age of 57.63 ± 8.97 years, a mean BMI of 28.37 ± 7.39 kg/m2. Patients with Ahlbäck grade 2 represented 49.3% of all patients (n = 247) and patients with KL grade 3 represented 54.7% of all patients (n = 274). A high JLCA was observed in both groups. The reported mean JLCA in the UKA group was 3.69 ± 2.1°, and in the HTO group was 2.93 ± 1.82. There was a significant association between the increase in the JLCA and the progression of OA based on both the Ahlbäck and KL grades (both p values < 0.001). The mean JLCA in patients with Ahlbäck grades 1 and 4 was 1.48 ± 1.32°, and 7 ± 0.93°, respectively. The mean JLCA in patients with KL grades 1 and 4 was 1.77 ± 1.42°, and 4.89 ± 1.73°, respectively. The mean recorded preoperative HKA angle in the UKA group was 175.06 ± 3.08°, and in the HTO group was 173.26 ± 3.02°, whereas the mean MPTA was 88.63 ± 1.72° for the UKA group and 89.31 ± 2.29° for the HTO group. CONCLUSION The JLCA progressively increases with osteoarthritis progression in patients with unicompartmental varus knee osteoarthritis. The JLCA can potentially be used as a grading parameter for osteoarthritis progression akin to Ahlbäck and Kellgren-Lawrence grading systems.
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Affiliation(s)
- Ahmed Mabrouk
- Mid Yorkshire Teaching Hospitals, Yorkshire, UK
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Jae-Sung An
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Loddo Glauco
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Christophe Jacque
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | | | | | - Matthieu Ollivier
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France.
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Capella M, Sabatini L, Bosco F, Barberis L, Giustra F, Risitano S, Camazzola D, Massè A. A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies. Arch Orthop Trauma Surg 2023; 143:6685-6693. [PMID: 37505270 PMCID: PMC10541832 DOI: 10.1007/s00402-023-04997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Precise preoperative planning is mandatory when a double-level osteotomy (DLO) is required to correct a severe knee deformity. Literature does not report a validated planning method regarding DLO that could be performed directly on digital radiographs using simple measurement tools. This study aims to validate a novel DLO planning method called New Mikulicz-Joint Line (NM-JL) based on essential measurement tools, in which the correction angles are induced by the predicted post-operative joint line obliquity (JLO). METHODS Twenty-three patients who satisfied the inclusion criteria were enrolled. NM-JL planning method was performed using basic measurement tools to detect corrective angles and gaps. The correction was then simulated using a Virtual Segmentation Software method to obtain the osteotomy fragments. Both planning procedures were performed independently and later repeated by two orthopaedic surgeons to assess the inter and intra-observer reliability. RESULTS The intraclass correlation coefficient (ICC) regarding corrective angles and gaps showed a significant positive correlation between the values determined using the two procedures by both raters (p < 0.05). Pearson's correlation analysis revealed a significant correlation between the measured results of the two planning methods. (p < 0.05). Finally, the Bland-Altman analysis showed an excellent agreement (p < 0.05) for all measurements performed. CONCLUSIONS The NM-JL method showed high values of intra and inter-rater reliability. The procedure is built up starting from the predicted value of post-operative joint line obliquity, allowing to maintain this parameter fixed. Other advantages include the quickness, adaptability, and possibility to be performed on any Digital Imaging and Communication in Medicine (DICOM) viewer. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
| | - Luca Barberis
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Daniele Camazzola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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Van Genechten W, Van Haver A, Bartholomeeusen S, Claes T, Van Beek N, Michielsen J, Claes S, Verdonk P. Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study. J Exp Orthop 2023; 10:24. [PMID: 36917322 PMCID: PMC10012299 DOI: 10.1186/s40634-023-00593-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Contemporary medial opening wedge high tibial osteotomy (MOWHTO) still seems to struggle with inconsistent accuracy outcomes. Our objective was to assess surgical accuracy and short-term clinical outcomes when using 3D planning and a patient-specific instrumentation (PSI) kit to prepare customized bone allografts. METHODS Thirty subjects (age 48y ± 13) were included in a double-center prospective case series. A low-dose CT-scan was performed to generate 3D bone models, a MOWHTO was simulated, and PSI was designed and 3D printed based on the complementary negative of the planned osteotomy gap. Clinical outcome was assessed at two, four, 12 weeks and one year using NRS, KOOS, UCLA activity score, EQ-5D and anchor questions. A linear-mixed model approach was implemented for data analysis. RESULTS Preoperative 3D values were 175.0° ± 2.2 mechanical tibiofemoral angle (mTFA), 85.0° ± 3.0 medial proximal tibial angle (MPTA), and 94.1° ± 3.4 medial posterior tibial slope (MPTS). Target planning ranged from slight varus to the lateral tibial spine (slight valgus). Postoperative 3D analysis showed an accuracy of 1.1° ± 0.7 ΔMPTA (p = 0.04) and 1.2° ± 1.2 ΔMPTS (p = 0.11). NRS decreased from baseline 6.1 ± 1.9 to 2.7 ± 1.9 at four weeks (p < 0.001) and 1.7 ± 1.9 at one year (p < 0.001). KOOS increased from 31.4 ± 17.6 to 50.6 ± 20.6 at 12 weeks (p < 0.001) and to 71.8 ± 15.6 at one year (p < 0.001). CONCLUSION The study suggests that 3D printed instrumentation to personalize structural bone allograft is a viable alternative method in MOWHTO that has the benefit of optimizing surgical accuracy while providing early and consistent pain relief after surgery.
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Affiliation(s)
- Wouter Van Genechten
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium. .,More Institute, Antwerp, Belgium. .,Orthopedic Department, AZ Herentals, Herentals, Belgium.
| | | | | | - Toon Claes
- Orthopedic Department, AZ Herentals, Herentals, Belgium
| | | | - Jozef Michielsen
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium
| | | | - Peter Verdonk
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium.,More Institute, Antwerp, Belgium.,ORTHOCA, Antwerp, Belgium
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Hybrid Lateral Closed-Wedge High Tibial Osteotomy Showed Similar Accuracy in Angular Correction and Reduction of Posterior Tibial Slope Compared to Opening-Wedge High Tibial Osteotomy: A Correction Angle Matched Cohort Study. J Arthroplasty 2023:S0883-5403(23)00135-3. [PMID: 36805113 DOI: 10.1016/j.arth.2023.02.027] [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: 09/15/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND We aimed to compare the accuracy of applied correction angle between hybrid lateral closed wedge high tibial osteotomy (hybrid HTO) and medial open wedge high tibial osteotomy (OWHTO), and verify previous reports on hybrid HTO by matching correction angle between groups. Change in various radiological parameters including union rate were also compared. METHODS A total of 50 OWHTO patients were selected for 2:1 propensity matching with 25 hybrid HTO patients. Rate of correction error was calculated by dividing the difference between the change in medial proximal tibial angle and preoperatively planned correction angle (PRD) by planned correction angle. Accuracy of angular correction was assessed using PRD and correction error rates. Hip-knee-ankle axis, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle, and length of the entire lower limb and tibia were measured. The Caton-Deschamps index (CDI) was used to assess change in patellar height. Serial postoperative radiographic analysis was performed to assess the union rate. RESULTS The discrepancy between planned correction angle and real correction angle was 0.8 ± 2.3° in hybrid HTO and 1.1 ± 3.4° in OWHTO (P > .05), and the rate of error in osteotomy was similar between the groups approximately 6%. Postoperatively, posterior tibial slope (PTS) (P < .001), tibia length, and CDI (P < .001) were significantly different between groups. The amount of change in PTS (P < .001), tibia length in hybrid HTO (P < .001), and CDI (P < .001) were significantly different between groups. Union rate of osteotomy site was significantly faster in hybrid HTO than in OWHTO (P < .001). CONCLUSION Hybrid HTO showed similar accuracy in angular correction compared to correction angle-matched OWHTO. Reduction in PTS, tibial shortening, maintained patellar height relative to the proximal tibia, and faster osteotomy site union were also confirmed in hybrid HTO.
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Hasegawa M, Naito Y, Tone S, Sudo A. High rates of outliers in computer-assisted high tibial osteotomy with excellent mid-term outcomes. Knee Surg Sports Traumatol Arthrosc 2023; 31:399-405. [PMID: 34738158 DOI: 10.1007/s00167-021-06788-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/23/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The primary aim was to evaluate the accuracy of navigation in opening wedge high tibial osteotomy (HTO). The secondary aim was to examine mid-term outcomes after HTO. METHODS Inclusion criteria were patients with medial compartment knee osteoarthritis who underwent computer-assisted HTOs. Mechanical axis (MA), percentage MA (%MA), and change in posterior tibial slope (ΔPTS) were displayed on the navigation screen. Radiographic examinations included hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and PTS. Preoperative and 5 weeks postoperative standing radiographs of the whole lower extremity and knee were used. Clinical evaluations were performed using American Knee Society knee score and function score both preoperatively and at last follow-up. Radiographic evaluations were performed by orthopedic surgeons. Intraoperative navigation after osteotomy and postoperative standing radiograph were compared. MA (HKA), %MA, and ΔPTS were compared. Outliers were defined as > 3° in MA, > 10% in %MA, and > 10° in ΔPTS. Outlier and non-outlier groups were compared. The rate of conversion to arthroplasty was examined. RESULTS This study involved 38 patients (44 knees) and last follow-up was at a mean of 5 years (range, 1-9 years). Mean American Knee Society knee score and function score improved significantly from 59 to 69 preoperatively to 95 and 85 at last follow-up, respectively. Absolute values of mean errors for MA, %MA, and ΔPTS were 2.1°, 9.3%, 1.2°, respectively. Outlier rates were 18% in MA, 39% in %MA, and 5% in ΔPTS. No significant factors were found in MA and ΔPTS. In %MA, preoperative JLCA was significantly higher in the outlier group compared to the non-outlier group. No knees underwent conversion to total knee arthroplasty. No differences in outcomes were found between outlier and non-outlier groups. CONCLUSION Although rates of outlier values in computer-assisted opening wedge HTO were high, mid-term outcomes were excellent. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Femoral morphology affects postoperative alignment of the lower extremities in hybrid closed-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:3675-3685. [PMID: 34061210 DOI: 10.1007/s00402-021-03974-1] [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: 02/21/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed to determine correction error predictors of lower extremitiy alignment after hybrid closed-wedge high tibial osteotomy (HCWHTO). MATERIALS AND METHODS From 2011 to 2015, 102 knees in 75 patients with medial compartment knee osteoarthritis of the knee and varus knee deformities who underwent HCWHTO were evaluated in this retrospective study with a minimum 2-year follow-up. Preoperative radiological parameters including weight-bearing line ratio (WBL ratio), mechanical leg axis angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and JLCA under varus or valgus stress were measured. The knees were divided into the following three groups based on the WBL ratio on average 54 months after procedure: acceptable (WBL crossing the tibial plateau between 50 and 70%), under-correction (< 50%), and overcorrection (> 70%). A multiple regression analysis was performed to evaluate predictors that could influence postoperative WBL ratio and cut-off values of predictive preoperative factors was analysed. RESULTS Significant differences in pre- and postoperative WBL ratios and mechanical leg axis angles were found. Preoperative mLDFA in the under-correction group (89.4° ± 2.1°) was significantly higher than that in the overcorrection group (87.4° ± 2.2°) (p = 0.015), while other preoperative parameters revealed no significant differences. The postoperative MPTA in the under-correction group (92.1° ± 3.7°) was significantly lower than that in the other two groups (p = 0.005 and p = 0.0001, respectively), while there was no significant change between the acceptable (94.6° ± 3.4°) and the overcorrection (96.7° ± 3.2°) groups. Multiple regression analysis revealed that mLDFA (β = - 0.316; p = 0.010) had a significant impact on postoperative WBLR. The cut-off value for under-correction of mLDFA was 89.5°and sensitivity and specificity were 53.6 and 71.6%, respectively (p = 0.014). CONCLUSIONS Preoperative mLDFA is significantly associated with postoperative alignment in HCWHTO. While postoperative MPTA is important, disregarding the preoperative mLDFA may bears a high risk of malcorrection. Varus alignment of the knee with larger mLDFA may be an indication for not only HCWHTO, but also for distal femoral osteotomy.
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H, Inaba Y. Surgical planning of osteotomies around the knee differs between preoperative standing and supine radiographs in nearly half of cases. BMC Musculoskelet Disord 2022; 23:497. [PMID: 35619060 PMCID: PMC9134639 DOI: 10.1186/s12891-022-05461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the difference in surgical planning of osteotomies around the knee between preoperative standing and supine radiographs and to identify risk factors for discrepancies in surgical planning. Methods This study included 117 knees of 100 patients who underwent osteotomies around the knee for knee osteoarthritis with genu varum. Surgical planning was performed so that the target point of the postoperative weight-bearing line (WBL) ratio was 62.5% in preoperative standing and supine radiographs. If the opening gap would be > 13 mm in open-wedge high tibial osteotomy (OWHTO), closed-wedge HTO (CWHTO) was planned. If the postoperative mMPTA would be > 95° in isolated HTO, double-level osteotomy (DLO) was planned. In DLO, lateral closed-wedge distal femoral osteotomy was performed so that the postoperative mechanical lateral distal femoral angle (mLDFA) was 85°, and any residual varus deformity was corrected with HTO. Results Surgical planning differed between standing and supine radiographs in 43.6% of cases. In all knees for which surgical planning differed between standing and supine radiographs, a more invasive type of osteotomy was suggested by standing radiographs than by supine radiographs. The risk factors for discrepancies in surgical planning were a lower WBL ratio in standing radiographs and a lower joint line convergence angle in supine radiographs. Conclusions Surgical planning of DLO, CWHTO and OWHTO, in standing radiographs differed from that in supine radiographs in nearly half of the cases. Surgical planning based on standing radiographs leads to more invasive surgical procedures compared to supine radiographs.
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Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Dan Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Hironori Yamane
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
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Ryu DJ, Lee SS, Jung EY, Kim JH, Shin TS, Wang JH. Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy. Orthop J Sports Med 2021; 9:23259671211034151. [PMID: 34631902 PMCID: PMC8495530 DOI: 10.1177/23259671211034151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Soft tissue laxity around the knee joint has been recognized as a crucial factor affecting correction error during medial open-wedge proximal tibial osteotomy (MOWPTO). Medial laxity in particular, which represents the changes in joint-line convergence angle (JLCA), affects soft tissue correction. Purpose: The purpose of this study was to quantify medial laxity and develop a preoperative planning method that considers medial laxity. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed 139 knees in 117 patients who underwent navigation-assisted MOWPTO from January 2014 to July 2019 for symptomatic medial compartment osteoarthritis with varus alignment >5°. We compared the results of 2 preoperative planning methods: conventional Miniaci (n = 47) and latent medial laxity reduction (LMLR) (n = 92). We evaluated the incidence of undercorrection, acceptable correction, and overcorrection. The radiologic parameters were analyzed using multiple linear regression with a stepwise selection model to establish an equation for the optimal preoperative planning method. The intraclass correlation coefficients (ICCs) of intraobserver, interobserver, and intermethod reliability were calculated. Results: The Miniaci method showed a higher incidence of overcorrection (55.3%) than the LMLR method (22.8%) at postoperative 6 months (P = .0006). Multiple linear regression with a stepwise selection model revealed a high correlation coefficient (R2 = 0.888) for the following equation: Adjusted planned correction angle = 0.596 + 0.891 × Target correction angle – 0.255 × ΔJLCAvalgus. Upon simplification, the following equation showed the highest intermethod ICC value (0.991): Target correction angle – ⅓ΔJLCAvalgus, while the Miniaci method showed a relatively low ICC value of 0.875. Conclusion: There was a risk of overcorrection after MOWPTO using the conventional Miniaci method. An equation that considers medial laxity may help during preoperative planning for optimal correction during MOWPTO.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Republic of Korea
| | - Eui Yub Jung
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Joo Hwan Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Soo Shin
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Joon Ho Wang, MD, PhD, Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea ()
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Evaluation of Accuracy of Preoperative Planning of the Femurofibular Angle in Open-Wedge High Tibial Osteotomy for Mild Medial Knee Osteoarthritis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8813300. [PMID: 33791382 PMCID: PMC7985241 DOI: 10.1155/2021/8813300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/23/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022]
Abstract
Objective The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. Methods Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. Results The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02% to a postoperative value of 56.19 ± 0.10% from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08% at the final follow-up (P < 0.01). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values (P > 0.05). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63° to a postoperative week-one valgus of 2.37 ± 0.28°, and it had a valgus of 2.48 ± 0.39° at the final follow-up (P < 0.01). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26° (P > 0.05). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53° and 90.33 ± 1.52°, respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72° and the intraoperative setting value of 90.25 ± 1.67° (P > 0.05). All corrected values were within the acceptable range of preoperative planning. Conclusion Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.
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Managing intra-articular deformity in high Tibial osteotomy: a narrative review. J Exp Orthop 2020; 7:65. [PMID: 32902758 PMCID: PMC7481321 DOI: 10.1186/s40634-020-00283-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022] Open
Abstract
The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee. The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery. The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome. This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA. We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy. Level of clinical evidence IV, narrative review.
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