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Chen R, Yu C, Peng H, Chen J, Zhang Y, Yu T. Osteotomy Correction Angle Cut-off Points Can Guide the Operation to Prevent a Significant Decrease in Patella Height. Orthop Surg 2024; 16:628-636. [PMID: 38326241 PMCID: PMC10925517 DOI: 10.1111/os.14000] [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: 03/27/2023] [Revised: 11/25/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE Patients who undergo a biplanar ascending medial open-wedge high tibial osteotomy with an excessive correction angle might experience patella infera and even knee pain after surgery. The purpose of this study was to identify the cut-off points for the degree of knee varus correction of open-wedge high tibial osteotomy, which is related to the symptomatic patellar position change. METHODS This retrospective study included 124 patients (mean age 61.69 ± 6.28 years; 78 women, 46 men) with varying degrees of varus knee osteoarthritis. All patients had undergone standard biplanar medial open-wedge high tibial osteotomy. They were divided into nine groups according to the change in hip-knee-ankle angle. Plain radiographs and three-dimensional CT images were obtained preoperatively and 18 months postoperatively. Patellar height was assessed using the Caton-Deschamps index, the Insall-Salvati index, and the Blackburne-Peel index. The patellofemoral index and patellar tilt were used to evaluate the degree of horizontal displacement of the patella. The varus correction, medial-proximal tibial angles, joint line convergence angles, and hip-knee-ankle angles were also measured. The subjective score was evaluated using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). RESULTS There were significant changes in patella indexes in each group after surgery, among which there was no significant difference in patellar height changes for Groups A to F (p > 0.05), which were significantly lower than those in Group G, H, and I (p < 0.001). The patellar tilt and patellofemoral index also followed the same trend. The improvement in WOMAC scores for Groups G, H, and I was also significantly less for Groups A to F (p < 0.001). CONCLUSION The patellar height, patellar tilt, and patellofemoral index all changed significantly in parallel with increasing degrees of osteotomy correction. The cut-off points for correction angle are 12.5° to 13.4°. When the correction angle is larger than this range, the patellar position can be significantly affected. Postoperative patellofemoral joint pain may be related to the changes in patella position.
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Affiliation(s)
- Renjie Chen
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Department of Clinical MedicineQingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
- Department of Sports MedicineBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Chenghao Yu
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Department of Clinical MedicineQingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
| | - Haining Peng
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Department of Clinical MedicineQingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
| | - Jinli Chen
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
| | - Yi Zhang
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
| | - Tengbo Yu
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
- Department of Orthopedic SurgeryQingdao Municipal HospitalQingdaoChina
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Matache BA, Jean PO, Pelet S, Roger MÈ, Dartus J, Belzile EL. Lateral knee laxity increases the risk of excessive joint line obliquity after medial opening-wedge high tibial osteotomy. Orthop Traumatol Surg Res 2024; 110:103717. [PMID: 37863189 DOI: 10.1016/j.otsr.2023.103717] [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: 02/14/2022] [Revised: 06/04/2023] [Accepted: 07/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Medial opening-wedge high tibial osteotomy (HTO) is a well-recognized treatment for patient with varus knee osteoarthritis. Joint line obliquity has recently been suggested to negatively impact clinical outcomes following HTO, but little is known about what factors lead to increased joint line obliquity. The purpose of the current study was (1) to evaluate whether increased preoperative lateral knee laxity, represented by the joint line convergence angle, results in increased joint line obliquity in a consecutive series of patients treated with HTO and (2) to determine the effect of advanced arthritic changes on joint line obliquity. HYPOTHESIS Increased joint line convergence angle would be associated with increased joint line obliquity. PATIENTS AND METHODS All HTOs performed at our center between 2010-2017 were retrospectively reviewed. Patients were excluded if pre- and postoperative standing alignment radiographs were not available. Varus-producing osteotomies were excluded. Patients were subdivided according to their preoperative joint line convergence angle (≤3° or >3°) and the degree of radiographic arthritic change. The primary outcome measure was the postoperative joint line obliquity. Categorical variables were compared using the paired samples t-test. Survival analysis was performed for failure and overall rate of reoperation. RESULTS During the study period, 90 HTO were performed, and 38 patients (42 knees; M/F: 32/6; mean age: 41.6; mean follow-up: 4.72 years) met the inclusion criteria. The most common surgical indications were varus knee osteoarthritis (n=27, 64.3%) and osteochondritis dissecans (n=7, 8.2%). Patients with a preoperative joint line convergence angle >3° demonstrated significantly greater joint line obliquity postoperatively as compared to those with a joint line convergence angle ≤3° (6.4°±4.6° vs. 2.5°±5.7°, respectively; p=0.02). Patients with advanced arthritic changes had significantly lower preoperative (-3°±3.4° vs. -5.6°±4.1°; p=0.03) and greater postoperative (5.8°±4° vs. 2.2°±6.4°; p=0.04) joint line obliquity as compared to those with minimal arthritic changes. There were 12 complications among the 42 procedures: one conversion to total knee replacement (TKR), one hardware failure (fixation revised), one infection, and 9 hardware removals. Overall survival using conversion to TKR was 96.23% (95% CI 0.92-1.0) at 10 years. DISCUSSION Lateral knee laxity, as defined by a preoperative joint line convergence angle >3°, and advanced arthritic changes are associated with increased postoperative joint line obliquity following medial opening-wedge high tibial osteotomy. Soft-tissue adaptation should be accounted for in order to avoid excessive joint line obliquity following high tibial osteotomy, and the planned correction should be reduced by 25% in patients with a preoperative joint line convergence angle >3° when templating using standing alignment radiographs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Bogdan A Matache
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada.
| | - Pierre-Olivier Jean
- Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada
| | - Stéphane Pelet
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada
| | - Marie-Ève Roger
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada
| | - Julien Dartus
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada; Lille University School of Medicine, 1, avenue Eugène Avinée, 59120 Lille, France
| | - Etienne L Belzile
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada
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Müller S, Frosch KH, Frings J, Berninger M, Krause M. Biplanar high tibial osteotomy for the combined correction of varus and posterior tibial slope malalignment. Orthop Traumatol Surg Res 2022; 109:103339. [PMID: 35643363 DOI: 10.1016/j.otsr.2022.103339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023]
Abstract
Varus malalignment combined with an increased posterior tibial slope (PTS) in the ACL deficient knee is a frequent pathology; yet, treatment for this condition remains challenging. The presented biplanar osteotomy technique allows to simultaneously address both components of malalignment in a single step. A detailed preoperative planning is best achieved by means of a digital planning software and constant intraoperative imaging is performed to verify the correction angle. A bony wedge is resected along with the extension osteotomy according to the preoperative planning and the medial-opening tibial osteotomy site is filled with bone allograft. Two bicortical lag screws are placed in anterior-posterior direction to secure the extension osteotomy, whereas a plate fixation is used for the medial-open osteotomy.
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Affiliation(s)
- Sebastian Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Trauma and Orthopaedic Surgery, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Jannik Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
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