Editorial Commentary: Posterolateral Malposition of the Cortical Hinge During Medial Open-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope: Incomplete Posterior Osteotomy May Shift the Hinge From Lateral to Posterolateral

Ryu, Dong Jin; Wang, Joon Ho

doi:10.1016/j.arthro.2021.03.003

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…The main osteotomy procedure was performed according to the guide pins using an oscillating saw and chisel; and opened using an opener until reaching the aimed alignment and maintained using a spreader. To minimize changes in PTS, the surgeon attempted to ensure an appropriate lateral hinge position with proper posterior cortical osteotomy [15, 18, 23]. Clamping was performed between the anterior cortex of the proximal fragment and the posteromedial cortex of the distal fragment to achieve bony contact in the descending osteotomy plane (Fig.…”

Section: Methodsmentioning

confidence: 99%

Additional anteromedial staple fixation prevents changes in the posterior tibial slope in retrotuberosity bi-planar open-wedge high tibial osteotomy

Yoon

Song

Hwang

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeTo compare the changes in posterior tibial slope (PTS) between retrotuberosity biplane open‐wedge high tibial osteotomies (RT‐OWHTOs) with and without additional anteromedial staple fixation. MethodsSeventy‐nine and 77 cases of RT‐OWHTOs without (Group N) and with (Group S) additional staple fixation, respectively, were retrospectively reviewed. All procedures were performed using a locking spacer plate. Demographics and preoperative knee condition were similar between the groups. Clinically, the Western Ontario and McMaster Universities Arthritis Index and range of motion were evaluated preoperatively and 2 years postoperatively. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and PTS were evaluated preoperatively and within 2 years postoperatively. Hinge fractures were investigated using computed tomography at 2 weeks postoperatively. PTS loss was defined as the difference between the corresponding values at 2 weeks and 2 years postoperatively. The incidence of PTS failure (PTS loss ≥ ± 3°) was also investigated. ResultsThe clinical results were not significantly different between groups N and S preoperatively and 2 years postoperatively. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively; changes in these variables did not differ significantly between the groups. The incidence of hinge fractures, all of which were categorized as Takeuchi type 1, did not differ significantly. PTS loss within 2 years postoperatively was significantly greater in group N than in group S (1.0° vs. 0.1°; p < 0.01). The incidence of the PTS failure was 16.5% (13/79) and 2.6% (2/77) in groups N and S, respectively (p < 0.01). ConclusionAdditional anteromedial staple fixation could prevent changes in the PTS in RT‐OWHTO. It is a simple method for preventing an increase in the PTS after RT‐OWHTO. Level of evidenceIII.

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Section: Methodsmentioning

confidence: 99%

Additional anteromedial staple fixation prevents changes in the posterior tibial slope in retrotuberosity bi-planar open-wedge high tibial osteotomy

Yoon

Song

Hwang

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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show abstract

“…The osteotomy site was opened using an opener until reaching the aimed alignment and maintained using a spreader. To minimize changes to the PTS, the surgeon tried to make an appropriate lateral hinge position and a proper posterior cortical osteotomy [21][22][23] . A medial locking anatomical plate (Nowmedipia, Seoul, Korea) with three proximal and four distal locking holes with a metal wedge spacer was used for fixation (Fig.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Use of Grafts on an Open Gap Is Advantageous for Preventing Correction Loss in 1-Week Staged Bilateral Open-Wedge High Tibial Osteotomies

et al. 2022

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One-week staged bilateral open-wedge high tibial osteotomies (OWHTOs) can be a safe procedure, with the added advantage of fast functional recovery, cost saving, and reduced hospital stay. However, there can be concerns about correction loss after one-week staged OWHTOs because high loading is inevitably applied to osteotomy sites during postoperative weight bearing. Although leaving the osteotomy site with no grafts is possible in OWHTOs, use of grafts can provide additional stability to the osteotomy site and prevent correction loss. We compared the amount and incidence of correction loss between one-week staged bilateral OWHTOs with and without allogenic bone grafts. Seventy-five patients who underwent one-week staged bilateral OWHTOs with a locking spacer plate (Nowmedipia, Seoul, Korea) by a single surgeon were retrospectively reviewed. Allogenic cancellous bone grafts were applied in 53 patients (Group G; 106 knees, operated consecutively between 2012 and 2017), but not in 22 patients (Group N; 44 knees, operated consecutively between 2017 and 2019). Demographics were similar between the groups. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated preoperatively and within 1 year postoperatively. Unstable hinge fracture was investigated using computer tomography in all cases. The incidence of correction loss (MPTA loss ≥ 3°) was determined. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively. The incidence of unstable hinge fractures did not differ. The losses in MA, MPTA, and PTS during the first postoperative year were significantly greater in group N than in group G (MA, -5.5° vs. -2.3°; MPTA, -3.0° vs. 0°; PTS, -2.0° vs. -0.7°; p < 0.05° on all parameters). The correction loss incidence was 6.6% (7/106) and 31.8% (14/44) in groups G and N, respectively (p < 0.001). Appropriate treatment is necessary to prevent correction loss in one-week staged bilateral OWHTOs. Grafting, which provides additional stability to the osteotomy site, is a recommended method.

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Opening-Wedge High Tibial Osteotomy With High Hinge Position Risks Lateral Hinge Fracture in Men With Posterolateral Tibial Condyle Protrusion

Morita

Kuriyama

Yamawaki

et al. 2023

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Editorial Commentary: Posterolateral Malposition of the Cortical Hinge During Medial Open-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope: Incomplete Posterior Osteotomy May Shift the Hinge From Lateral to Posterolateral

Cited by 3 publications

References 18 publications

Additional anteromedial staple fixation prevents changes in the posterior tibial slope in retrotuberosity bi-planar open-wedge high tibial osteotomy

Additional anteromedial staple fixation prevents changes in the posterior tibial slope in retrotuberosity bi-planar open-wedge high tibial osteotomy

Use of Grafts on an Open Gap Is Advantageous for Preventing Correction Loss in 1-Week Staged Bilateral Open-Wedge High Tibial Osteotomies

Opening-Wedge High Tibial Osteotomy With High Hinge Position Risks Lateral Hinge Fracture in Men With Posterolateral Tibial Condyle Protrusion

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