The Coronal Plane High Tibial Osteotomy. Part II: A Comparison of Axial Rotation with the Opening Wedge High Tibial Osteotomy

Abstract

The amount of axial rotation in the tibia caused by high tibial osteotomy is relatively unknown. The authors hypothesize that the coronal plane high tibial osteotomy, a novel technique used to treat varus malalignment, alters the axial rotation of the tibia less than the opening wedge high tibial osteotomy. Eight, embalmed, stripped cadaveric tibia-fibula constructs with intact interosseous membranes were randomized to either opening wedge or coronal plane high tibial osteotomies. Sequential valgus corrections of 5-, 10-, and 15-were performed. The Qualisys Track Manager motion capture system was used to measure axial rotation. Student_s t test was used to compare axial rotation between the two groups. A p value of 0.05 was determined to be significant. The coronal plane technique produced rotations about the tibial axis that were statistically significantly smaller than those of the opening wedge technique for all correction angles (1.2-internal rotation (IR) vs 16-external rotation (ER), respectively, at 5-correction; p = 0.02) (3.5-IR vs 21.2-ER at 10-correction; p = 0.04) (4.5-IR vs 23.0-ER at 15-correction; p = 0.01). The coronal plane high tibial osteotomy alters axial rotation of the tibia significantly less than the opening wedge high tibial osteotomy.

Risk of patella baja after opening-wedge high tibial osteotomy

“…Axial change after OWHTO has been discussed and is still controversial. [30][31][32] The increased external rotation after OWHTO is likely due to the intact fibula and tibiofibular 30 ; on the other hand, an unintentional increase of internal rotation had occurred at the distal tibia after OWHTO. 32 In the current study, axial changes after OWHTO were determined by TT-TG and patellar tilt, as TT-TG might be considered to deteriorate the patellofemoral congruity and subsequently alter patellar tilt.…”

Rotational Changes in the Distal Tibial Fragment Relative to the Proximal Tibial Fragment at the Osteotomy Site after Open-Wedge High-Tibial Osteotomy

“…There are some possible factors that affect rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the osteotomy site. Once the osteotomy site was spread open, tension could develop around the intact fibular or tibiofibular joints [ 26 ]. Unless the fibular or tibiofibular joints were disrupted, rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the osteotomy site would inevitably develop to some extent to relieve that tension by opening the osteotomy site gap.…”

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

“…Firstly, once the osteotomy site was spread open, tension could occur around the intact fibular or tibiofibular joint. [7] Unless the fibular or tibiofibular joint was disrupted, tibial rotation would inevitably develop to some extent in order to relieve that tension by opening the osteotomy site gap. The direction of the rotation of the distal tibial fragment could be determined by the tension in the soft tissue envelope of the proximal tibia, such as the hamstring tendon, medial collateral ligament (MCL), or joint capsule.…”

“…[2] The alignment change of the coronal plane could lead to unintended consequences in the sagittal and axial planes because of the three-dimensional (3-D) characteristics of the proximal tibia. [7][8][9] The change of the posterior tibial slope in the sagittal plane, which is one of the unintended consequences of open wedge HTO, is now well known to orthopedic surgeons, and could be used as another treatment modality for knee instability by intentional control of the posterior tibial slope change. [10] Unlike the posterior tibial slope change, the rotation of the distal portion of the tibia under the osteotomy gap has not been well studied [11] although it also inevitably changes in the axial plane in open wedge HTO.…”