Opening gap width influences distal tibial rotation below the osteotomy site following open wedge high tibial osteotomy

Kim, Junho; Kim, Hoon-Young; Lee, Daehee

doi:10.1371/journal.pone.0227969

Cited by 6 publications

(12 citation statements)

References 25 publications

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“…Clinically, Kim et al [8] found that the degree of DTR was not related to the amount of coronal correction after MOWHTO. Kim et al [15] reported that the correction angle was the only predictor of DTR, with a larger correction angle observed in the group with distal tibial rotation > 3° compared to the group with rotation ≤ 3°. Lee et al [17] found a positive correlation between the hinge axis angle and internal rotation of the distal tibia when the hinge axis was positioned more posterolaterally, while the gap ratio was negatively correlated.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is a lack of relevant studies investigating the axial rotation of the distal tibia relative to the proximal tibia during MOWHTO, and the conclusions drawn from existing studies are controversial. Some studies have reported internal rotation, while others have reported external rotation of the distal tibia [9,10,[15][16][17]. Factors in uencing tibial rotation have also been reported, including tuberosity osteotomy angle [9,15], ange angle [16], hinge axis angle in axial plane [17] and correction angle [9,15,16], but a consensus has yet to be reached.…”

Section: Introductionmentioning

confidence: 99%

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Effects of different hinge positions and coronal correction angle on tibial rotation in uniplanar medial opening wedge high tibial osteotomy with three-dimensional tibial models

Jing,

Chen,

Wang

et al. 2023

Preprint

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Purpose: There is a lack of studies investigating the distal tibial rotation (DTR) during medial opening wedge high tibial osteotomy (MOWHTO). The purpose of the present study was to evaluate the impacts of different hinge positions in the sagittal and axial planes and coronal correction angle on the axial rotation of tibia in uniplanar MOWHTO with three-dimensional tibial models. Methods: Preoperative CT data from 30 knee joints in 30 patients who underwent surgery for varus malalignment of knee were included. 1 standard hinge position (0°), 6 axial planes (±5°, ±10°, ±15°), and 6 sagittal planes (±5°, ±10°, ±15°) hinge positions were defined and virtual osteotomy was performed. The correction angle of each model was generated using Fujisawa’s point. The correction angle, preoperative medial proximal tibial angle, and DTR were measured. Results: A significant linear correlation was observed between changes in hinge position in the sagittal plane and DTR. The changes in DTR were the smallest when the hinge position was at 5°, where internal or external rotation of the DTR may occur. When the front aspect of hinge axis rotated distally, DTR tended towards internal. Meanwhile, when the front aspect of hinge axis rotated proximally, DTR tended towards external. There were no correlations with every hinge axis position in the axial plane. There were linear correlations between the correction angle and DTR in varying degrees dependent on different hinge positions. Conclusions: Both hinge position and coronal correction angle resulted in tibial rotation in uniplanar MOWHTO. In the sagittal plane, every change in hinge position was significantly linearly correlated with tibial rotation. However, no linear correlations were observed between every hinge position change in the axial plane. In addition, there were linear correlations between the coronal correction angle and tibial rotation in varying degrees dependent on the different hinge positions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of different hinge positions and coronal correction angle on tibial rotation in uniplanar medial opening wedge high tibial osteotomy with three-dimensional tibial models

Jing,

Chen,

Wang

et al. 2023

Preprint

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“…Changes in KJLO after MOWHTO are usually less than the amount of change in the anatomical geometry of the proximal tibia (change in MPTA), which is a direct result of MOWHTO procedures [9, 10, 24]. A plausible explanation for the relative mitigation of increasing postoperative KJLO was the postoperative change of ankle valgus and hindfoot varus to restore neutral hip–knee–ankle coronal plane alignment [19].…”

Section: Discussionmentioning

confidence: 99%

Changes in ankle and hip joints following medial opening‐wedge high tibial osteotomy affect knee joint line obliquity

Kim,

Jun,

Bae

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose This study aimed to measure the change in knee joint line obliquity (KJLO) and the changes in radiologic parameters of the ankle and hip joints after medial opening-wedge high tibial osteotomy (MOWHTO), and to evaluate the correlation and causal relationship between these parameters. Methods This study evaluated 109 patients who underwent MOWHTO between April 2015 and December 2021. Radiologic parameters, including KJLO, medial proximal tibial angle (MPTA), ankle joint line obliquity (AJLO), and hip abduction angle (HAA), were analysed before and 1 year after MOWHTO. Multiple linear regression analysis was used to identify independent variables that significantly affected the change in KJLO after MOWHTO. Receiver operating characteristic (ROC) analysis was used to evaluate the cutoff value for a change in KJLO that exceeded 5° postoperatively, and the predicting values of radiologic parameters. Results Multiple linear regression analysis showed that changes in MPTA, AJLO, and HAA (β = 0.440, P < 0.001; β = − 0.310, P < 0.001; β = 0.164, P = 0.035, respectively) were predictors of the change in KJLO after MOWHTO. ROC analysis showed that the threshold value for a change in KJLO which exceeded 5° postoperatively was 4.6° (66.7% sensitivity, 63.8% specificity, P = 0.025). Moreover, ROC curves for predicting a change in KJLO of > 4.6° showed that the AUC was significantly higher for the change in MPTA than that of the other two parameters (P = 0.011 for AJLO and P < 0.001 for HAA). Conclusion MOWHTO increases the KJLO by valgization of the proximal tibia and causes hip adduction and ankle valgization. The postoperative ankle valgization after MOWHTO could reduce the increase in KJLO, counteracting the effects of proximal tibial valgization and hip adduction. Therefore, the effects of the hip and ankle joints should be considered to achieve an optimal KJLO and satisfactory clinical outcomes after MOWHTO. Level of studyCohort study, IV. Keywords Knee • Medial opening-wedge high tibial osteotomy • Knee joint line obliquity • Hip abduction angle • Ankle joint line obliquity Sang-Gyun Kim and June-Bum Jun contributed equally to this work and should be considered as co-first authors.

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“…Therefore, the different management of these key structures around the knee joint during surgery might lead to various rotational changes after HTO. [13] In recent biomechanical research, Yazdi et al [24] reported that with 15˚ of external rotation for the distal tibia, the medial compartment contact pressure was decreased by 11% compared to that in the neutral position. However, in order to facilitate external tibial rotation, a tibia shaft and fibulectomy were simultaneously performed.…”

Section: Discussionmentioning

confidence: 99%

Effect of tibial rotation after uniplane medial open-wedge high tibial osteotomy in genu varum patients: An observational study

Zhang

Sun

et al. 2023

Medicine

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The change in axial tibial rotation after uniplane medial open-wedge high tibial osteotomy (uniplane OWHTO) and its relevant influence factor is not known. Therefore, the aim of this study was to evaluate the change in axial tibial rotation after uniplane OWHTO, and the factors affecting tibia rotational change were analyzed. Between January 2022 and April 2022, the study was retrospectively conducted on genu varum patients who underwent uniplane OWHTO. In the weight-bearing anteroposterior long leg view, the hip-knee-ankle angle and medial proximal tibial angle (MPTA) were evaluated. The posterior tibial slope were measured from the lateral view. A CT scan of the knee joint was performed to evaluate the distal tibial rotation angle (TRA), femorotibial rotation angle and tibial tuberosity-trochlear groove distance. In addition, the foot morphology was assessed by the ankle deformity angle and ankle rotation angle using an angle measuring instrument. All parameters were measured preoperatively and 14 days after surgery. The mean change in hip-knee-ankle, MPTA was 10.5°±2.9°, 8.8°±2.6°. The mean preoperative and postoperative TRA were 25.1°±6.9° and 22.2°±6.2° respectively (P = .007). Thus, the mean ∆TRA was −3.0°±3.4° (IR) with a range of −9.6° to +2.8° after surgery. No significant differences were found in the femorotibial rotation angle and tibial tuberosity-trochlear groove distance before and after surgery (P > .05). The postoperative ankle rotation angle and ankle deformity angle changed significantly compared with preoperative values (P < .001). In the multiple regression analysis, ∆MPTA was the only predictor of distal tibial rotation (β = 0.667, P = .003). The current study confirms an unintended internal rotation in the distal tibia following uniplane MOWHTO and the rotation in the distal tibia was influenced by the opening width. Surgeron should keep in mind to avoid the osteotomy complication leading to excessive rotation change during surgery.

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Opening gap width influences distal tibial rotation below the osteotomy site following open wedge high tibial osteotomy

Cited by 6 publications

References 25 publications

Effects of different hinge positions and coronal correction angle on tibial rotation in uniplanar medial opening wedge high tibial osteotomy with three-dimensional tibial models

Effects of different hinge positions and coronal correction angle on tibial rotation in uniplanar medial opening wedge high tibial osteotomy with three-dimensional tibial models

Changes in ankle and hip joints following medial opening‐wedge high tibial osteotomy affect knee joint line obliquity

Effect of tibial rotation after uniplane medial open-wedge high tibial osteotomy in genu varum patients: An observational study

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