Effect of the Osteotomy Length on the Change of the Posterior Tibial Slope With a Simple Distraction of the Posterior Gap in the Uni- and Biplanar Open-Wedge High Tibial Osteotomy

Lee, Yong Seuk; Kang, Jung Mook; Lee, Myung Chul; Oh, Won Seok; Elazab, Ashraf; Song, Min Kyu

doi:10.1016/j.arthro.2015.07.018

Cited by 22 publications

(16 citation statements)

References 17 publications

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“…After release of the superior border of the pes anserinus and the anterior border of the medial collateral ligament, horizontal osteotomy was performed, and an additional biplanar anterior osteotomy was performed. The gradual distraction was performed at the most posterior portion of the osteotomy gap until the target limb alignment was obtained [21]. The osteotomized bone was fixed with a long locking plate (DWLP, TDM, Seongnam, Korea).…”

Section: Methodsmentioning

confidence: 99%

Comparison of the regeneration of cartilage and the clinical outcomes after the open wedge high tibial osteotomy with or without microfracture: a retrospective case control study

Lee

Mok

et al. 2019

BMC Musculoskelet Disord

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Background It is unclear whether postoperative outcomes are associated with the cartilage regeneration after open wedge high tibial osteotomy (OWHTO) combined with microfracture. The purpose of this study was to evaluate the regeneration of the articular cartilage, radiologic, and clinical outcomes after OWHTO with and without microfracture. Methods Eighty-seven patients who underwent OWHTO from 2014 to 2015 were retrospectively included in this study. Fifty-seven OWHTOs with microfracture on medial femoral condyle (MFC) (group 1) and 30 OWHTOs without microfracture (group 2) were compared at a mean 2-year follow-up. The regeneration of the articular cartilage was evaluated using International Cartilage Repair Society (ICRS) grade on the second-look arthroscopy and the magnetic resonance observation of cartilage repair tissue (MOCART) score on magnetic resonance imaging (MRI). The weight-bearing line (WBL) ratio, hip-knee-ankle (HKA) angle, joint line convergence angle (JLCA) and Ahlbäck grade were evaluated. The clinical outcomes were evaluated using the Western Ontario and McMaster University (WOMAC) scores and the Knee Society (KS). Results The articular cartilage in the MFC were regenerated in 67.8% of group 1 (43/57) and 58.6% of group 2 (16/30), respectively ( p = 0.014). However, change of the ICRS grades of the medial tibial plateau, lateral and patellofemoral compartments showed no statistical difference between the groups. Total MOCART score in group 1 was superior to that in the group 2 at postoperative 2 years (41.8 ± 18.6 vs. 31.8 ± 19.8, p = 0.023). Regarding MOCART score, microfracture was only effective in the defect filling and integration to the border zone of the MFC ( p < 0.001 and p = 0.035, respectively). Other radiologic and clinical outcomes showed no statistical differences between the groups. Conclusion Microfracture of the MFC during OWHTO only helped the filling of the degenerative cartilage defect and the integration of the cartilage with adjacent cartilage. However, the clinical and radiologic outcome could not be improved by mircrofracture in the OWHTO.

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Section: Methodsmentioning

confidence: 99%

Comparison of the regeneration of cartilage and the clinical outcomes after the open wedge high tibial osteotomy with or without microfracture: a retrospective case control study

Lee

Mok

et al. 2019

BMC Musculoskelet Disord

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“…The distraction was performed gradually at the most posterior gap until the target mechanical axis was obtained. 27 The osteotomy site was fixed with a long locking plate (DWLP, TDM, Seongnam, Korea).…”

Section: Surgical Techniquementioning

confidence: 99%

Comparison of the Radiologic, Arthroscopic, and Clinical Outcomes between Repaired versus Unrepaired Medial Meniscus Posterior Horn Root Tear During Open Wedge High Tibial Osteotomy

Lee

2019

J Knee Surg

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The efficacy and outcomes for the concurrent repair of medial meniscus posterior horn root tear (MMPHRT) during open wedge high tibial osteotomy (OWHTO) are unclear. This study compared the radiologic, arthroscopic, and clinical outcomes between repaired and unrepaired MMPHRT during OWHTO. Fifty-seven patients were prospectively enrolled from 2014 to 2016. The radiologic, arthroscopic, and clinical outcomes were compared between 25 patients who underwent OWHTO with all-inside repair of MMPRT using FasT-Fix (repaired group) and 32 patients who underwent OWHTO without repair of MMPRT (unrepaired group) with a mean 2-year follow up in both groups. The meniscal healing status was classified as complete, partial, or no healing, according to second-look arthroscopic findings. The medial meniscal extrusion (MME) was evaluated using magnetic resonance imaging. The width of medial joint space, joint line convergence angle (JLCA), posterior tibial slope (PTS), Kellgren–Lawrence (KL) grade, hip-knee-ankle angle, and weight-bearing line ratio was evaluated on simple standing. The clinical outcomes were evaluated using the Knee Society score and the Western Ontario and McMaster University score. Healing rates (partial and complete) of the MMPHRT showed a statistical difference between the two groups (repaired group vs. unrepaired group, 19/25 (76%) vs. 13/32 (40.6%), p = 0.008). The postoperative MME showed no statistical differences between groups (repaired versus unrepaired group: 4.5 ± 1.3 mm vs. 4.5 ± 2.1 mm, p = 0.909). The postoperative width of medial joint space, JLCA, PTS, and KL grade all showed no statistical differences between groups after 2 years of OWHTO. Other radiologic parameters and clinical outcomes showed no statistical differences between groups. Repair of the MMPHRT during OWHTO showed a superior healing rate to the unrepaired MMPHRT. However, repair of the MMPHRT was not related to the radiologic and clinical outcomes. Therefore, there is no clear evidence of the need for the MMPHRT repair during OWHTO.

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“…1,3,4 In addition, the knee is sometimes forcefully extended and compressed at the anterior gap to maintain the proper ratio between the anterior and posterior gap (approximately two-thirds). 1,5,6 Some surgeons also keep the knee extended for the anterior and retrotubercular gap compression during biplanar…”

Section: See Related Article On Page 2181mentioning

confidence: 99%

“…Among these factors, proper posterior cortical osteotomy is the first step to prevent increased tibial slope in OWHTO. 5,9,10 If an incomplete osteotomy is performed on the posterolateral side, the hinge point would move to the posterolateral side, and the opening gap is dominantly increased at the anterior side, leading to an unnecessary increase of the posterior slope. 10 In the case of biplanar osteotomy, retrotubercular osteotomy should be performed on the plane close to the patellar tendon, and it should not be advanced to the posterolateral side of the hinge.…”

Section: Seoul National University College Of Medicine and Seoul National University Bundang Hospitalmentioning

confidence: 99%

Editorial Commentary: Tibial Slope Should Be Naturally Maintained by Proper Posterior Cortical Osteotomy and Gap Distraction in Open-Wedge High Tibial Osteotomy

Effect of the Osteotomy Length on the Change of the Posterior Tibial Slope With a Simple Distraction of the Posterior Gap in the Uni- and Biplanar Open-Wedge High Tibial Osteotomy

Cited by 22 publications

References 17 publications

Comparison of the regeneration of cartilage and the clinical outcomes after the open wedge high tibial osteotomy with or without microfracture: a retrospective case control study

Comparison of the regeneration of cartilage and the clinical outcomes after the open wedge high tibial osteotomy with or without microfracture: a retrospective case control study

Comparison of the Radiologic, Arthroscopic, and Clinical Outcomes between Repaired versus Unrepaired Medial Meniscus Posterior Horn Root Tear During Open Wedge High Tibial Osteotomy

Editorial Commentary: Tibial Slope Should Be Naturally Maintained by Proper Posterior Cortical Osteotomy and Gap Distraction in Open-Wedge High Tibial Osteotomy

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