Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

Ogino, Tomoaki; Kumagai, Ken; Yamada, S.; Akamatsu, Tomotaka; Nejima, Shuntaro; Sotozawa, Masaichi; Inaba, Yutaka

doi:10.1186/s12891-020-03703-6

Cited by 10 publications

(6 citation statements)

References 39 publications

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“…Furthermore, we were able to benchmark these three planning protocols against the 3D OA. It is known that the relationship between the 3D OA and the achieved surgical correction does not follow a strict 1:1 geometric relationship [ 28 ]. This difference can be accentuated due to intraarticular degeneration and joint laxity.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Three-Dimensional Weight-Bearing Measurement Protocol for Medial Open-Wedge High Tibial Osteotomy

Hodel,

Hasler,

Roth

et al. 2024

JCM

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Three-dimensional (3D) deformity assessment and leg realignment planning is emerging. The aim of this study was to (1) validate a novel 3D planning modality that incorporates the weight-bearing (WB) state (3D WB) by comparing it to existing modalities (3D non-weight-bearing (NWB), 2D WB) and (2) evaluate the influence of the modality (2D vs. 3D) and the WB condition on the measurements. Three different planning and deformity measurement protocols were analyzed in 19 legs that underwent medial open-wedge high tibial osteotomy (HTO): (1) a 3D WB protocol, after 2D/3D registration of 3D CT models onto the long-leg radiograph (LLR) (3D WB), (2) a 3D NWB protocol based on the 3D surface models obtained in the supine position (3D NWB), and (3) a 2D WB protocol based on the LLR (2D WB). The hip–knee–ankle angle (HKA), joint line convergence angle (JLCA), and the achieved surgical correction were measured for each modality and patient. All the measurement protocols demonstrated excellent intermodal agreement for the achieved surgical correction, with an ICC of 0.90 (95% CI: 0.76–0.96)) (p < 0.001). Surgical correction had a higher mean absolute difference compared to the 3D opening angle (OA) when measured with the WB protocols (3D WB: 2.7 ± 1.8°, 3D NWB: 1.9 ± 1.3°, 2D WB: 2.2 ± 1.3°), but it did not show statistical significance. The novel planning modality (3D WB) demonstrated excellent agreement when measuring the surgical correction after HTO compared to existing modalities.

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Section: Discussionmentioning

confidence: 99%

Validation of a Three-Dimensional Weight-Bearing Measurement Protocol for Medial Open-Wedge High Tibial Osteotomy

Hodel,

Hasler,

Roth

et al. 2024

JCM

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“…An anteroposterior (AP) view of the long length roentgenogram of the lower limb (standing position) was performed for the radiological evaluation. The percentage of mechanical axis deviation (%MAD), 16 medial plateau opening angle (MPOA), medial plateau angle (MPA), and lateral plateau opening angle (LPOA) were measured to evaluate the alignment and articular shape of the knee joint before and after TCVO. ( Fig.…”

Section: Methodsmentioning

confidence: 99%

“…1 ) %MAD was defined as the ratio of the distance from the medial border of the proximal tibia to the mechanical axis of the lower limb to the width of the proximal tibia. 16 The varus stress angle and valgus stress angle were measured as the angle between the tangential line of the medial femoral condyle and the lateral femoral condyle and the articular surface of the tibial plateau in varus and valgus stress radiographs under the image intensifier with the knee extended and flexed at 10° before and after TCVO. The total amplitude of the varus stress angle and valgus stress angle was identified as the knee joint instability angle (KJIA).…”

Section: Methodsmentioning

confidence: 99%

Tibial condylar valgus osteotomy (TCVO): Surgical technique and clinical results for knee osteoarthritis with varus deformity

Teramoto

Harada

Takenaka

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Tibial condylar valgus osteotomy (TCVO) is an intra-articular proximal tibial osteotomy developed in 1989 and has since been used for the treatment of knee osteoarthritis (OA) associated with genu varum. This article describes the surgical technique and clinical results of TCVO. TCVO can be used for all grades of varus knee OA in patients of any age. he preoperative range of movement should be at least 90 . Preoperative screening showed varus-valgus instability due to an intra-articular deformity of the proximal tibia. Using intraoperative image intensification, a sagittally oriented "L"-shaped osteotomy is made from the medial to the tibial tuberosity to the center of the tibial plateau between the medial and lateral tibial spines. The separation of the osteotomy using the lamina spreader is gradually increased using an image intensifier guidance until the articular surface of the lateral tibial plateau comes in contact with the articular surface of the lateral femoral condyle. Adequate correction is indicated by parallelism of the lateral tibial plateau and a line tangential to the distal convexity of the lateral femoral condyle on an anteroposterior (AP) image and the elimination of the valgus instability with the knee in extended position. A "T"-plate (locking or non-locking plate or circular external fixator) is used to fix the osteotomy in the corrected position. Synthetic or autologous bone grafts can be used. We used the Japanese Orthopaedic Association score to evaluate the patient's function and also measured the %MAD, medial plateau opening angle, medial plateau angle, and lateral plateau opening angle on an AP view of the long length roentgenogram of the lower limb (standing position). The JOA score, radiologically measured values, and instability of the knee joint remarkably improved.

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“…The decision for either technique was made preoperatively according to the correction angle based on our institutional protocol. [14][15][16] That is, OWHTO (Figure 1(A)) was performed in knees with a correction angle of 15 or less, and CWHTO (Figure 1(B)) was performed in knees with a correction angle of greater than 15 .…”

Section: Surgical Procedures and Postoperative Managementmentioning

confidence: 99%

No differences in clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomies at short-term follow-up: A retrospective case series analysis

Akamatsu

Kumagai

Yamada

et al. 2021

J Orthop Surg (Hong Kong)

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Purpose: The aim of this study was to assess differences in clinical outcomes and postoperative cartilage repair between opening wedge high tibial osteotomy (OWHTO) and closed wedge HTO (CWHTO) for medial osteoarthritis (OA) of the knee. Methods: A total of 90 knees of 76 patients who underwent OWHTO (45 knees of 40 patients) and CWHTO (45 knees of 36 patients) was followed-up for 2 years. Cartilage repair at the medial compartment was arthroscopically classified into the following stages: Stage 1 (no reparative change); Stage 2 (partial coverage with white cartilaginous tissue); and Stage 3 (full coverage with white cartilaginous tissue). Clinical outcomes were assessed using Knee Society scores, and radiographic assessment was carried out by anatomical femorotibial angle (aFTA). Results: Regarding preoperative OA grade, varus alignment, and function score, CWHTO patients showed more advanced OA status than OWHTO patients. Knee scores and function scores were significantly improved after surgery with both HTO procedures (P < 0.05), with no significant difference between the two procedures. Cartilage repair of stage 2 or 3 was found in more than 80% of the subjects in the medial femoral condyle and more than 60% in the medial tibial condyle. However, there were no significant differences between the two HTO procedures. Multivariate logistic regression analysis showed that preoperative International Cartilage Repair Society (ICRS) grade was the only factor affecting cartilage repair. Conclusions: CWHTO improved clinical outcomes and cartilage status as much as OWHTO. Although the effects of cartilage repair on clinical outcomes are unknown, HTO is an effective treatment option even for severe medial OA of the knee.

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Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

Cited by 10 publications

References 39 publications

Validation of a Three-Dimensional Weight-Bearing Measurement Protocol for Medial Open-Wedge High Tibial Osteotomy

Validation of a Three-Dimensional Weight-Bearing Measurement Protocol for Medial Open-Wedge High Tibial Osteotomy

Tibial condylar valgus osteotomy (TCVO): Surgical technique and clinical results for knee osteoarthritis with varus deformity

No differences in clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomies at short-term follow-up: A retrospective case series analysis

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