Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy

Lee, Dae-Hee; Park, Sung-Chul; Park, Hyung-Joon; Han, Seung-Beom

doi:10.1007/s00167-015-3682-9

Cited by 130 publications

(170 citation statements)

References 34 publications

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“…We suppose that patients with severe varus deformity, as evidenced by high correction and HKA angles, have medial soft tissue tightness. Previous studies reported that the preoperative degree of soft tissue laxity in the knee joint was significantly related to the degree of postoperative alignment correction . Based on this finding, we consider that opening from the anteromedial direction is more likely to result in insufficient postoperative correction in cases in which the medial soft tissue is tight due to severe varus deformity.…”

Section: Discussionsupporting

confidence: 52%

Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy

Kuriyama

Morimoto²,

Shimoto

et al. 2019

Journal Orthopaedic Research

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Increases in posterior tibial slope (PTS) with open‐wedge high tibial osteotomy (OWHTO) are often related to two surgical errors: Symmetric opening of the osteotomy gap and a tendency to open the gap from the anteromedial direction. The study objective was to define trends in these two errors using computer simulation and clinical effects of their countermeasures. First, 60 knees with varus deformity were assessed with three‐dimensional (3D) planning using computed tomography to allow for the mechanical axis to pass through a point at 62.5% of the width of the tibial plateau, defined as the weight‐bearing line percentage (WBL%). Anterior and posterior widths of the opening gap to maintain PTS were measured. The effect on PTS when osteotomy gaps were opened from the anteromedial direction up to 30° was evaluated. Mean anterior width (y) was 6.6 mm (range, 2.2–10.9) and mean posterior width (x) was 9.1 mm (range, 3.9–15.7), which can be expressed as y = 0.75x − 0.24. Opening gaps from the anteromedial direction at 10°, 20°, and 30° led to a mean PTS increase of 1.9°, 3.9°, and 5.6°, respectively. In most cases, WBL% with anteromedial opening at 30° passed through a point at less than 60%. In 47 knees that underwent OWHTO using 3D planning, postoperative coronal and sagittal bone corrections were mostly accurate. However, postoperative WBL% was negatively correlated with correction angle because of difficulties in predicting medial joint tightness. Preoperative 3D planning for OWHTO can reduce surgical errors, but postoperative WBL% remains variable. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussionsupporting

confidence: 52%

Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy

Kuriyama

Morimoto²,

Shimoto

et al. 2019

Journal Orthopaedic Research

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“…JLCA and min‐JSW were measured for they were evaluation indicators of the relaxation of supporting structures and degeneration of articular cartilage.…”

Section: Discussionmentioning

confidence: 99%

“…Among radiologic parameters, FBA, mMDFA, and DFVRA were the morphological indicators of the femur, MPTA was the morphological indicator of the tibia, and min‐JSW and JLCA were the indicators of cartilage and soft tissue. All angles were showed in Figure .…”

Section: Methodsmentioning

confidence: 97%

Relationships between Morphological Changes of Lower Limbs and Gender During Medial Compartment Knee Osteoarthritis

Yang

Zheng

et al. 2019

Orthopaedic Surgery

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ObjectivesTo evaluate the dynamic changes of key morphology indicators of the lower extremities in the coronal plane with progressing medial compartment knee osteoarthritis (KOA) with an emphasis on gender‐dependent regional differences.MethodsThe radiographs of patients with non‐traumatic knee pain and varying degrees of genu varus were reviewed. Radiographs were studied in 1538 lower limbs of 883 consecutive patients who visited our hospital from January to July 2017; all patients had long‐standing anteroposterior image‐splicing radiographs taken of their lower limbs. Morphological indicators of bones and joints that can change the alignment of lower limbs or reflect cartilage wear and soft‐tissue relaxation were selected and measured with the help of picture archiving and communication systems. After comparing the data of different genders, the data of males and females was separated into three age groups, <40 years, 40–60 years, >60 years respectively, and then compared among age groups using the Kruskal‐Wallis and Mann–Whitney U tests. Scatterplots of age and all the measurements were drawn to determine the strength of the relations. The Pearson correlation test was performed to reveal correlations of measurements and age.ResultsFemoral bowing angle (FBA) and joint line convergence angle (JLCA) have obvious differences between different genders (P = 0.001, 0.000, respectively). This suggests that females have greater femoral curvature and joint space angle than males. Significant differences were found in hip‐knee‐ankle angle (HKA), FBA, distal femoral valgus resection angle (DFVRA), medial proximal tibial angle (MPTA), JLCA, and minimum joint space width (min‐JSW) by age groups in females (P = 0.000, 0.000, 0.000, 0.000, 0.003, 0.002, respectively). The difference of mechanical medial distal femoral angle (mMDFA) was significant with P values less than 0.05 deemed significant (P = 0.030). Significant correlations were found between age and all measurements (r = −0.166, 0.253, 0.270, −0.147, 0.089, −0.105, −0.076, respectively, P < 0.01). Whereas, the difference in min‐JSW by age group was the only significant one in males (P = 0.001), and no significant correlation was found between age and measurements (r = −0.107, 0.041, 0.134, −0.067, 0.079, −0.134, −0.098, respectively, P > 0.01).ConclusionsAs KOA progressed, both dynamic deformation of lower extremities and degeneration of articular cartilage could be found in females, while no obvious dynamic deformations were found in males. Dynamic deformation of lower extremities was the important feature and the major causative factor of KOA in females.

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“…8,17,20,46,47 Meanwhile, Marti et al 48 proposed that the correction angle should be planned according to the cartilage width on the standing whole-leg radiograph. If onethird of the thickness of the medial cartilage was lost, the mechanical axis was planned to pass lateral to the center of the knee at the 10% position.…”

Section: Discussionmentioning

confidence: 99%

“…Our results are in agreement with the contention that postoperative valgus alignment with medial laxity can be aggravated in the standing position. 8,47,49,50 The combined CTbased and image-free navigation system enabled acquisition of an accurate osteotomy and simultaneous control of the FTA and TPS in both planes. However, the discrepancy in the medial opening between the supine and standing positions remained.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Opening-Wedge High Tibial Osteotomy With and Without a Combined Computed Tomography–Based and Image-Free Navigation System

Akamatsu

Kobayashi

Kusayama

et al. 2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy

Abstract: II.

Cited by 130 publications

References 34 publications

Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy

Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy

Relationships between Morphological Changes of Lower Limbs and Gender During Medial Compartment Knee Osteoarthritis

Comparative Study of Opening-Wedge High Tibial Osteotomy With and Without a Combined Computed Tomography–Based and Image-Free Navigation System

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