Ueda D, Yasuda K, Kaibara T, Yabuuchi K, Yamaguchi J, Onodera J, Iwasaki N, Yagi T, Kondo E. High Rate of Radiographic Union at the Fibular Osteotomy Site With No Complications After an Acute Oblique Osteotomy and Ligation Procedure to Shorten the Fibula in High Tibial Osteotomy.
Orthop J Sports Med 2022;
10:23259671221117480. [PMID:
35990872 PMCID:
PMC9382075 DOI:
10.1177/23259671221117480]
[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: 04/09/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background:
A fibular shortening osteotomy is needed to perform lateral closing-wedge
high tibial osteotomy (LCW-HTO). To achieve this shortening, we have
recently developed an acute oblique osteotomy and ligation (AO/L) procedure
for the center of the fibular shaft, based on the AO procedure.
Purpose:
To compare the 2-year follow-up outcomes between the AO/L procedure and the
AO procedure.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
A prospective comparative cohort study was conducted involving 83 patients
(83 knees) who underwent shortening osteotomy of the fibula in LCW-HTO
between April 2017 and March 2019. The first consecutive 41 knees (AO group)
underwent fibular osteotomy with the AO procedure. The remaining 42 knees
(AO/L group) underwent fibular osteotomy with the AO/L procedure. All of the
patients were evaluated for at least 2 years postoperatively via clinical
and radiological assessments. To determine the time needed for complete
union at the osteotomy site, we evaluated the radiographs using a
radiographic union score for tibial fractures, which was modified for
fibular osteotomy. Comparison of outcomes between the 2 groups was performed
using the Student t test for continuous variables and the
Mann-Whitney U test or Fisher exact test for discrete
variables.
Results:
Around the fibular osteotomy site, no perioperative complications were found
in either group. The radiographic union score was significantly higher in
the AO/L group than in the AO group (P < .0001 at 2, 3,
and 6 months; P = .0290 at 12 and 24 months). The union
rate at the fibular osteotomy site was significantly higher in the AO/L
group (97.6%) than in the AO group (82.9%) at 12 months (P
= .0290).
Conclusion:
The AO/L procedure significantly accelerated the formation of bridging callus
at the fibular osteotomy site and provided a significantly higher union rate
compared with the AO procedure. Both AO/L and AO procedures were free from
perioperative complications. These results suggest that the AO/L procedure
is clinically useful as an osteotomy procedure to shorten the fibula in
LCW-HTO.
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