1
|
Kayaalp ME, Apseloff NA, Lott A, Kaarre J, Hughes JD, Ollivier M, Musahl V. Around-the-knee osteotomies part 1: definitions, rationale and planning-state of the art. J ISAKOS 2024; 9:645-657. [PMID: 38460600 DOI: 10.1016/j.jisako.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
Knee osteotomies are essential orthopedic procedures with the ability to preserve the joint and correct ligament instabilities. Literature supports the correlation between lower limb malalignment and outcomes after knee ligament reconstruction and cartilage procedures. Concepts such as joint line obliquity, posterior tibial slope angle, and intra-articular deformity correction are integral components of both preoperative planning and postoperative evaluations. The concept of preserving and/or restoring joint line congruence during simultaneous correction of varus or valgus deformity can be achieved through several different approaches. With advancements in osteotomy research and surgical planning technology, the surgical decision-making has increased in complexity. Based upon a patient's specific deformity, decisions need to be made whether to perform a single-level (proximal tibia or distal femur) versus double-level (both proximal tibia and distal femur) osteotomy, and whether to correct deformity in a single plane (coronal or sagittal) or perform a biplanar osteotomy, correcting two of the malalignments in either coronal, sagittal, or axial planes. Osteotomy procedures prioritize safety, reproducibility, precision, and meticulous planning. Equally important is the proactive management of possible complications and the implementation of preventive strategies for complications such as hinge fractures and unintentional changes to alignment in other planes. This review navigates the intricate landscape of lower limb alignment, commencing with foundational definitions and rationale for performing osteotomies, progressing through the planning phase, and addressing the critical aspect of complication prevention, all while looking ahead to anticipate future advancements in this field. However, rotational osteotomies and tibial tubercle osteotomies in isolation or as an adjunct procedure are beyond the scope of this review.
Collapse
Affiliation(s)
- M Enes Kayaalp
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department Orthopaedics and Traumatology, Istanbul Kartal Training and Research Hospital, Istanbul, 34865, Turkiye
| | - Nicholas A Apseloff
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Ariana Lott
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 41345, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, 41345, Sweden
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Matthieu Ollivier
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, 13009, France
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA.
| |
Collapse
|
2
|
Jung SH, Jung M, Chung K, Kim S, Park J, Lee JH, Lee SH, Choi CH, Kim SH. Factors Causing Unintended Sagittal and Axial Alignment Changes in High Tibial Osteotomy: Comparative 3-Dimensional Analysis of Simulation and Actual Surgery. Am J Sports Med 2024; 52:1543-1553. [PMID: 38616541 DOI: 10.1177/03635465241241539] [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] [Indexed: 04/16/2024]
Abstract
BACKGROUND Unintended secondary changes in the posterior tibial slope (PTS) and tibial torsion angle (TTA) may occur after medial open-wedge high tibial osteotomy (MOWHTO). In surgical procedures using patient-specific instruments (PSIs), it is essential to reproduce the PTS and TTA that were planned in simulations. PURPOSE To analyze the factors causing unintended sagittal and axial alignment changes after MOWHTO. STUDY DESIGN Case series; Level of evidence, 4. METHODS Overall, 63 patients (70 knees) who underwent MOWHTO using a PSI between June 2020 and June 2023 were retrospectively reviewed. Preoperative and postoperative computed tomography scans were 3-dimensionally reconstructed. Simulated osteotomy was performed so that the weightbearing line could pass through the target point. A PSI gapper was 3-dimensionally printed to fit the posteromedial corner of the osteotomy gap in the simulated HTO model. After MOWHTO using the PSI gapper, the actual postoperative model was compared with the preoperative or simulation model. This assessment included PTS, TTA, hinge axis, and osteotomy-related parameters. Cortical breakage around the lateral hinge was evaluated to assess stability. RESULTS The mean PTS and TTA did not change in the simulation. However, significant changes were observed in the actual postoperative PTS and TTA (change, -2.4°± 2.2° and -3.9°± 4.7°, respectively). The PTS was reduced, while the TTA decreased with internal rotation of the distal fragment. The difference in the axial hinge axis angle (AHA) between the simulation and actual surgery was the factor most correlated with the difference in the PTS (r = 0.625; P < .001). In regression analysis, the difference in the AHA was the only factor associated with the difference in the PTS (β = 0.558; P = .001), and there were no factors that showed any significant associations with the difference in the TTA. In subgroup analyses for the change in the TTA, the correction angle and anterior osteotomy angle were significantly higher in the more internal rotation group (P = .023 and P = .010, respectively). The TTA change was significantly higher in the unstable group with lateral cortical breakage (P = .018). The unstable group was more likely to show an internal rotation of ≥5° (odds ratio, 5.0; P = .007). CONCLUSION The AHA was associated with a difference in the PTS between the simulation and actual surgery. The change in the TTA was caused by a combination of multiple factors, such as a large correction angle and anterior osteotomy angle, but mainly by instability of the lateral cortical hinge.
Collapse
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
| | - 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
| | - Ju-Hyung Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So-Heun Lee
- Department of Medical Device Engineering and Management, 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
| |
Collapse
|
3
|
Cho JH, Nam HS, Ho JPY, Tu NT, Lee YS. Retro-tubercular Biplanar Medial Opening-Wedge High Tibial Osteotomy Results in Superior Patellofemoral Alignment Versus Supra-tubercular Osteotomy. Arthroscopy 2024; 40:1206-1219. [PMID: 37597702 DOI: 10.1016/j.arthro.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 08/05/2023] [Accepted: 08/06/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To compare the changes in patellofemoral (PF) joint alignment, focusing on multiple planes, between two different types of biplanar medial opening-wedge high tibial osteotomy (OWHTO). METHODS Patients who underwent biplanar OWHTO between July 2017 and May 2021 were retrospectively evaluated. They were allocated to either the supra-tubercular (ST)- or retro-tubercular (RT)-OWHTO group. The following radiologic parameters were compared between the two groups: 1) weight-bearing line ratio (WBLR), 2) patellar height, 3) posterior tibial slope (PTS), 4) tibial tubercle-trochlear groove (TT-TG) distance, 5) TT-TG angle, and 6) femoral shaft-patellar tendon (FS-PT) angle. Clinical outcomes and the minimal clinically important difference (MCID) were also evaluated. RESULTS In total, 104 knees that underwent ST-OWHTO and 105 knees that underwent RT-OWHTO were evaluated. The patellar height significantly decreased only after ST-OWHTO (P < .001). The TT-TG distance and FS-PT angle significantly increased, more after ST-OWHTO than RT-OWHTO (mean change value: 5.72 mm vs 1.91 mm; P < .001 for TT-TG distance; and 4.72° vs 1.80°; P < .001 for FS-PT angle). The TT-TG angle increased significantly after ST-OWHTO (mean change value: 7.62°; P < .001) but decreased after RT-OWHTO mean change value: -4.30°; P < .001). The PTS more increased after RT-OWHTO than after ST-OWHTO (mean change value: 0.91° vs 1.69°; P = .003). Clinical outcomes in both groups improved postoperatively, and no significant differences were observed between the groups. CONCLUSIONS RT-OWHTO resulted in lesser changes in multiplane PF joint alignment than ST-OWHTO. However, no difference was observed in clinical outcomes between both groups, and PTS increased after RT-OWHTO. Therefore, these aspects of RT-OWHTO should also be considered. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Joon Hee Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seoul, South Korea
| | - Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seoul, South Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seoul, South Korea
| | - Nguyen Thanh Tu
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seoul, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seoul, South Korea.
| |
Collapse
|
4
|
Jing L, Zhao X, Wang W, Yu L, Yang J, Wang J. Osseous factors influencing distal tibial rotation in biplane medial opening wedge high tibial osteotomy. INTERNATIONAL ORTHOPAEDICS 2024; 48:465-471. [PMID: 37707599 DOI: 10.1007/s00264-023-05968-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE There is a lack of studies investigating the distal tibial rotation (DTR) during medial opening wedge high tibial osteotomy (MOWHTO). This study was designed to evaluate osseous factors influencing DTR in patients who underwent biplane MOWHTO. METHODS A total of 106 knee joints in 69 patients who underwent surgery for varus malalignment of knee were reviewed. Based on several software, standard and actual hinge positions were defined in pre-operative and post-operative CT data. Pearson's correlation and Spearman's correlation analysis were performed with DTR change as the dependent variable. Independent variables included angles between standard and actual hinge in the sagittal (ASAHS) and axial (ASAHA) planes, pre-operative and post-operative medial proximal tibial angle, opening width (OW), tuberosity osteotomy angle, flange angle (FA), gap ratio, and hinge fracture. RESULTS The distal tibia rotated approximately 0.35° internally. Pearson's and Spearman's correlation analysis showed that DTR change was associated with ASAHS, OW, and FA. Larger OW and FA resulted in higher external rotation angles. CONCLUSIONS DTR change was significantly associated with ASAHS, followed by OW and FA rather than ASAHA if only considering osseous factors in biplane MOWHTO. The distal tibia tended to rotate externally when the actual hinge was inclined posteriorly to the standard hinge in the sagittal planes, but rotate externally or internally when the actual hinge was inclined anteriorly.
Collapse
Affiliation(s)
- Lizhong Jing
- Department of Orthopaedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong Province, China
- Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China
| | - Xia Zhao
- Department of Radiology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China
| | - Weiguo Wang
- Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China
| | - Le Yu
- Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China
| | - Jiushan Yang
- Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China.
| | - Jian Wang
- Department of Orthopaedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong Province, China.
| |
Collapse
|
5
|
Li K, Sun FL, Guo HB, Shi ZJ, Yao R, Zhang H. Comparison of the plantar pressure distribution and mechanical alignment in patients with varus knee osteoarthritis following high tibial osteotomy. BMC Musculoskelet Disord 2023; 24:479. [PMID: 37312078 DOI: 10.1186/s12891-023-06603-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE The changes in the lower limb alignment were vitally important after high tibial osteotomy (HTO). Therefore, the purpose of present study was to analyze the characteristics of plantar pressure distribution after HTO, and to investigate the effect of plantar pressure distribution on postoperative limb alignment. METHODS Between May 2020 and April 2021, varus knee patients undergoing HTO were evaluated in the present study. The peak pressure of plantar regions, medial-lateral pressure ratio (MLPR), foot progression angle (FTA), anteroposterior COP (AP-COP), lateral symmetry of COP (LS-COP), and the radiographic parameters were evaluated preoperatively and at the final follow-up. Compared among the slight valgus (SV), moderate valgus (MV) and large valgus (LV) groups at the final follow-up, the peak pressure of HM, HC and M5 regions, and the MLPR were compared; the Knee Injury and Osteoarthritis Outcome Score4 (KOOS4) including four subscales, and the American of orthopedic foot and ankle society (AOFAS) were evaluated. RESULTS The WBL%, HKA and TPI angle changed significantly after HTO (P < 0.001). The preoperative group exhibited a lower peak pressure in the HM region (P < 0.05) and higher peak pressure in the M5 region (P < 0.05); the pre- and postoperative groups exhibited a lower peak pressure in the HC region (P < 0.05); the rearfoot MLPR was significantly lower and LS-COP was significantly higher in the preoperative group (P = 0.017 in MLPR and 0.031 in LS-COP, respectively). Comparison among the SV, MV and LV groups, the SV group indicated a lower peak pressure in the HM region (P = 0.036), and a lower MLPR in the rearfoot (P = 0.033). The KOOS Sport/Re score in the MV and LV groups increased significantly compared with the SV group (P = 0.042). CONCLUSION Plantar pressure distribution during the stance phase in patients with varus knee OA following HTO exhibited a more medialized rearfoot plantar pressure distribution pattern than that before surgery. Compared with the small valgus alignment, a moderate to large valgus alignment allows patients to walk with a more even medial and lateral plantar pressure distribution, which is more similar to healthy adults.
Collapse
Affiliation(s)
- Ke Li
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou Road, Baiyun District, Guangzhou, Guangdong Province, 510515, China
| | - Feng-Long Sun
- Second Department of Orthopaedics, Capital Medical University affiliated Beijing Rehabilitation Hospital, Beijing, 100144, China
| | - Heng-Bing Guo
- Second Department of Orthopaedics, Capital Medical University affiliated Beijing Rehabilitation Hospital, Beijing, 100144, China
| | - Zhan-Jun Shi
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou Road, Baiyun District, Guangzhou, Guangdong Province, 510515, China.
| | - Ran Yao
- Second Department of Orthopaedics, Capital Medical University affiliated Beijing Rehabilitation Hospital, Beijing, 100144, China
| | - Hao Zhang
- Second Department of Orthopaedics, Capital Medical University affiliated Beijing Rehabilitation Hospital, Beijing, 100144, China
| |
Collapse
|
6
|
Hayashi S, Tsukisaka K, Okuhara A, Tsuyuguchi Y, Goto K, Hashiguchi N. Inverted V-Shaped High Tibial Osteotomy Decreases the Posterior Tibial Slope More but Shortens the Tibia Less Than Closed-Wedge High Tibial Osteotomy. Arthroscopy 2022; 38:1956-1965. [PMID: 34920007 DOI: 10.1016/j.arthro.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the postoperative anatomical changes in the lower extremity after inverted V-shaped high tibial osteotomy (IVHTO) using 3-dimensional (3D) computed tomography (CT) bone models and compare those changes after closed-wedge high tibial osteotomy (CWHTO). METHODS Preoperative and 3-week postoperative CT scanning of the lower extremity were obtained from patients who underwent IVHTO and CWHTO between October 2019 and March 2021. 3D CT bone models were reconstructed using ZedKnee software. The postoperative changes (Δ) in (1) posterior tibial slope (PTS), (2) knee rotation angle (KRA), (3) tibial torsional angle (TTA), (4) patella tilt (PT), (5) Insall-Salvati ratio (ISR), and (6) tibial length (TL) were compared between IVHTO and CWHTO. RESULTS Thirty-seven knees (18 IVHTO and 19 CWHTO) in 34 patients were retrospectively enrolled in this study. ΔPTS at the medial and lateral tibial plateau in the IVHTO group (-6.5° and -5.0°) was larger compared with that in the CWHTO group (-3.3° and -2.0°; P = .024 and P = .002, respectively). No significant differences exist between the IVHTO and CWHTO groups in ΔKRA (0.8 ± 4.5° and -1.5 ± 6.5°; P = 0.631), ΔTTA (-3.9 ± 6.2° and -4.1 ± 7.3°; P = .951), ΔPT (-2.0 ± 4.8° and -0.6 ± 4.1°; P = .353), and ΔISR (0.0 and 0.0; P = .829). ΔTL in the IVHTO group (-1.6 ± 2.3 mm) was smaller compared with that in the CWHTO group (-4.1 ± 1.6 mm; P < .001). CONCLUSIONS (1) The postoperative PTS in the IVHTO group was further decreased compared to the CWHTO group; (2) no significant differences in ΔKRA, ΔTTA, ΔPT, and ΔISR exist between the 2 groups; and (3) the ΔTL in the IVHTO group was significantly smaller compared with the CWHTO group. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Seiju Hayashi
- Department of Orthopaedic Surgery, Mazda Hospital, Hiroshima, Japan; Department of Orthopaedic Surgery, Yawatahama City General Hospital, Ehime, Japan.
| | | | - Atsushi Okuhara
- Department of Orthopaedic Surgery, Mazda Hospital, Hiroshima, Japan; Department of Orthopaedic Surgery, AkiOta Hospital, Hiroshima, Japan
| | | | - Kanji Goto
- Department of Orthopaedic Surgery, Mazda Hospital, Hiroshima, Japan
| | | |
Collapse
|
7
|
Nejima S, Kumagai K, Kobayashi H, Fujimaki H, Yamada S, Sotozawa M, Hisatomi K, Inaba Y. Medialization of the mechanical axis of the tibia is related to lateralization of the tibial tuberosity in knee osteoarthritis. Knee 2021; 30:134-140. [PMID: 33895612 DOI: 10.1016/j.knee.2021.03.023] [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: 01/16/2021] [Revised: 02/24/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether medialization of the proximal tibia due to a varus deformity is related to lateralization of the tibial tuberosity in varus knee osteoarthritis (OA). METHODS A total of 120 knees that underwent osteotomies around the knee for varus knee OA were enrolled. Mechanical medial proximal tibial angle (mMPTA) was measured on radiographs. The angle between the mechanical and anatomical axes of the tibia (angle MA) and the distance between the centre of the tibial plateau and the anatomical axis (distance MA) were measured in the coronal plane on computed tomography images. The tibial tuberosity-posterior cruciate ligament (TT-PCL) distance, the distance between the midpoint of the tibial tuberosity and the centre of the tibial plateau (TT-centre distance), and the angle between the line through the midpoint of the tibial tuberosity and the centre of the tibial plateau and the anteroposterior axis (TT-centre angle) were measured in the axial plane. The correlations of these parameters were evaluated. RESULTS mMPTA correlated negatively with angle MA (r = -0.37, P < 0.01) and distance MA (r = -0.55, P < 0.01). Angle MA and distance MA correlated with TT-PCL distance (r = 0.39, P < 0.01, r = 0.42, P < 0.01), TT-centre distance (r = 0.35, P < 0.01, r = 0.38, P < 0.01) and TT-centre angle (r = 0.36, P < 0.01, r = 0.36, P < 0.01). CONCLUSIONS Medialization of the proximal tibia due to a varus deformity may induce lateralization of the tibial tuberosity.
Collapse
Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, International University of Health and Welfare Atami Hospital, Atami, Japan
| | - Hiroshi Fujimaki
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kensuke Hisatomi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| |
Collapse
|
8
|
Hodel S, Zindel C, Jud L, Vlachopoulos L, Fürnstahl P, Fucentese SF. Influence of medial open wedge high tibial osteotomy on tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 2021; 31:1500-1506. [PMID: 33891162 DOI: 10.1007/s00167-021-06574-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Medial open wedge high tibial osteotomy (MOWHTO) is an effective treatment option for realignment of a varus knee. However, a simple supra-tuberositary osteotomy can lead to patella baja and potentially increases the tibial tuberosity-trochlear groove distance (TTTG). The purpose of this study was to quantify the influence of MOWHTO on TTTG. METHODS Three-dimensional (3D) surface models of five lower extremities with a varus hip-knee-ankle angle (HKA) and a borderline TTTG (≥ 15 mm), five lower extremities with a varus HKA and a normal TTTG (< 15 mm) and a 3D statistical shape model (SSM) of a neutrally aligned healthy knee were analysed by simulating MOWHTO with a stepwise increment of one degree of valgisation from the preoperative coronal deformity (0°-15°) for each patient, resulting in a total of 165 simulations. Postoperative 3D TTTG and tibial torsion (TT) were measured for each simulation. A mathematical formula was developed to calculate the increase of TTTG after MOWHTO. Mean differences between simulated and calculated TTTG were analysed. RESULTS Mean preoperative HKA was 6.5 ± 3.0° varus (range 0.8°-11.5°). Mean TTTG increased from 14.2 ± 3.2 mm (range 9.6-19.1) preoperatively to 18.8 ± 3.8 mm (range 14.5-25.0) postoperatively (p = 0.001). TTTG increased approximately linear by + 0.5 ± 0.2° (range 0.3-0.8) per 1° of valgisation with a high positive correlation (0.99, p = 0.001) from 0° to 15°. Mean difference between simulated and calculated TTTG was 0.03 ± 0.02 mm (range 0.01-0.07) per 1° of valgisation (p < 0.001). CONCLUSION MOWHTO results in an approximately linear increase in TTTG of + 0.5 mm per 1° of valgisation in the range from 0° to 15° and the lateralisation of the tibial tuberosity can be calculated reliably using the described formula. Preoperative analysis of TTTG in patients undergoing MOWHTO may prevent unintentional patellofemoral malalignment. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Sandro Hodel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| |
Collapse
|