Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy

Lee, Byung‐Hoon; Ha, Chul‐Won; Moon, Sang Won; Chang, Moon Jong; Kim, Hun Yeong; Park, Sin Hyung; Wang, Joon Ho

doi:10.1016/j.knee.2016.11.010

Cited by 20 publications

(25 citation statements)

References 23 publications

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“…They also noted that the hinge axis must be considered an important independent variable for limiting unintended axial rotation change as well as secondary PTS change. 43 Jang et al also found an unintended tendency of increased internal rotation of the distal tibia after biplanar medial OWHTO. 44 The internal rotation of the distal tibia also related to the decrease in LPT which is in accordance with our observation.…”

Section: Discussionmentioning

confidence: 94%

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

et al. 2019

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The objectives of our study were to evaluate (1) patellar height changes when the knee axis correction was < 15 degrees and (2) the clinical effect after open wedge high tibial osteotomy (OWHTO). Sixty-nine patients (69 knees) undergoing OWHTO between January 2016 and June 2017 were enrolled in this prospective study. All patients underwent OWHTO using a three-dimensional (3D)-printed patient-specific instrument. We used X-ray and lower-limb computed tomography scan to measure the osteotomy angle, patellar height, and other patellofemoral joint indices. We used the hospital for special surgery knee (HSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Kujala's scores to evaluate the clinical outcome. All knee axis corrections were less than 15 degrees. The change in posterior tibial slope (PTS) did not show a statistically significant difference. We observed that the patellar height was not altered when we used femur referenced measurement method. The change in modified Miura–Kawamura index (MKI) and Femoral patellar height index (FPHI) did not show a statistically significant difference. The differences in Blackburne–Peel index (BPI) and Caton–Deschamps index (CDI) were statistically significant, decreasing from 0.91 ± 0.12 and 1.06 ± 0.11 preoperatively to 0.79 ± 0.13 and 0.95 ± 0.11 postoperatively, respectively. In the axial plane, we did not observe a change in lateral patellar shift (LPS), but we found that lateral patellar tilt (LPT) showed a significant decrease from 8.67 ± 2.60 degrees preoperatively to 6.13 ± 2.30 postoperatively, respectively. The tuberositas tibae–trochlear groove (TT–TG) distance showed a significant decrease after OWHTO from 14.30 ± 4.10 mm preoperatively to 11.52 ± 3.63 mm postoperatively. The clinical score showed a significant increase after OWHTO, and all patients were satisfied with the outcome. After OWHTO, the patellar height was not altered when the knee axis correction was < 15 degrees. It was also found that there was still lateral displacement of the patella. Internal rotation of the distal tibia is an important cause of LPT reduction. After OWHTO, all patients achieved satisfactory clinical outcomes. At 1-year short-term follow-up, patients did not report discomfort in the patellofemoral joint. The Level of Evidence for this study was IV.

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Section: Discussionmentioning

confidence: 94%

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

et al. 2019

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“…After the true lateral view was completed, this view was captured because these two lines could not be located on the same plane. The posterior tibial slope was measured on the captured 3D true lateral view as previously described [ 25 , 26 ]. The line perpendicular to the bisecting line of the tibial shaft and the medial tibial plateau line were drawn.…”

Section: Methodsmentioning

confidence: 99%

Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis

Chung

Choi

Kim

et al. 2021

JCM

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The posterior tibial slope of the tibiofemoral joint changes after medial open wedge high tibial osteotomy (MOWHTO), but little is known about the effect of the sagittal osteotomy inclination angle on the change in the posterior tibial slope of the tibiofemoral joint. The purpose of this study was to investigate the effect of the osteotomy inclination angle in the sagittal plane on changes in the posterior tibial slope after MOWHTO by comparing how anterior and posterior inclination affect the posterior tibial slope of the tibiofemoral joint. The correlation between the osteotomy inclination angle and the postoperative posterior tibial slope angle was also assessed. Between May 2011 and November 2017, 80 patients with medial compartment osteoarthritis who underwent MOWHTO were included. The patients were divided into two groups according to the sagittal osteotomy inclination angle on the 3D reconstructed model. Patients with an osteotomy line inclined anteriorly to the medial tibial plateau line were classified into group A (58 patients). Patients with posteriorly inclined osteotomy line were classified as group P (22 patients). In the 3D reconstructed model, the preoperative and postoperative posterior tibial slope, osteotomy inclination angle relative to medial tibial plateau line in sagittal plane, and gap distance and ratio of the anterior and posterior osteotomy openings were measured. The preoperative and postoperative hip-knee-ankle angle, weight-bearing line ratio, and posterior tibial slope were also measured using plain radiographs. In the 3D reconstructed model, the postoperative posterior tibial slope significantly increased in group A (preoperative value = 9.7 ± 2.9°, postoperative value = 10.7 ± 3.0°, p < 0.001) and decreased in group P (preoperative value = 8.7 ± 2.7°, postoperative value = 7.7 ± 2.7°, p < 0.001). The postoperative posterior tibial slope (group A = 10.7 ± 3.0°, group P = 7.7 ± 2.7°, p < 0.001) and posterior tibial slope change before and after surgery (group A = 1.0 ± 0.8°, group P = −0.9 ± 0.8°, p < 0.001) also differed significantly between the groups. The Pearson correlation coefficient was 0.875 (p < 0.001) for the osteotomy inclination angle, and multivariate regression analysis showed that the only significant factor among the variables was the sagittal osteotomy inclination angle (β coefficient = 0.216, p < 0.001). The posterior tibial slope changed according to the osteotomy inclination angle in the sagittal plane after MOWHTO. The postoperative posterior tibial slope tended to increase when the osteotomy line was inclined anteriorly with respect to the medial tibial plateau line but decreased when the osteotomy line was inclined posteriorly. To avoid inadvertent change of posterior tibial slope, close attention needs to be paid to maintaining the sagittal osteotomy line parallel to the medial joint line during MOWHTO.

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“…There may be several factors for such changes, including the tension of soft tissue around the knee joint, 18 bony geometry, 36 and hinge axis angle. 27 Hinterwimmer et al 18 pointed out that the medial soft tissue tension would be one of the major factors that cause the rotation during HTO because some patients in their series who underwent hamstring grafting for anterior cruciate ligament reconstruction showed small degrees of rotation. In CWHTO, because the medial soft tissue tension including the pes anserinus was not violated, the internal rotation of the distal fragment occurred under the osteotomy site.…”

Section: Discussionmentioning

confidence: 99%

Rotational Changes in the Tibia After High Tibial Valgus Osteotomy: A Comparative Study of Lateral Closing Versus Medial Opening Wedge Osteotomy

Kim

Han

et al. 2020

Am J Sports Med

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Background: After high tibial valgus osteotomy (HTO), rotational changes in the tibia may occur, which can affect the biomechanics of the patellofemoral joint and may lead to anterior knee pain. Purpose: To compare the rotational changes in the tibia between closing wedge HTO (CWHTO) and opening wedge HTO (OWHTO). Study Design: Cohort study; Level of evidence, 3. Methods: Among the patients who underwent HTO between May 2012 and August 2015, 53 (28 CWHTO and 25 OWHTO) who had computed tomography scans before and at 1 year after the HTO were included. The following parameters were compared between CWHTO and OWHTO: (1) tibial torsion angle, (2) knee rotation angle, and (3) tibial tuberosity–trochlear groove (TT-TG) distance. During the last follow-up, patients were asked to rate their anterior knee pain when climbing the stairs, using the visual analog scale. Results: The tibial torsion angle significantly decreased (internal rotation of the distal fragment) after CWHTO (mean ± SD, –2.1°± 4.1°; P = .019) and OWHTO (–1.8°± 3.3°; P = .029). The knee rotation angle significantly decreased (external rotation of the proximal fragment) after OWHTO (–1.8°± 3.4°; P = .039) but was not changed after CWHTO (0.1°± 3.1°; P = .859). The mean TT-TG distance significantly decreased after CWHTO (–3.1 ± 3.0 mm; P < .001) but increased after OWHTO (2.0 ± 4.3 mm; P = .012). At the final follow-up (minimum, 4 years), the visual analog scale pain score during stair climbing was significantly higher after OWHTO than after CWHTO (3.1 ± 1.4 vs 2.2 ± 1.3, P = .024). Conclusion: Internal rotation of the distal fragment occurred after both CWHTO and OWHTO. However, external rotation of the proximal fragment and increased TT-TG distance occurred after OWHTO. Because such rotational changes could affect anterior knee pain, further studies are warranted to investigate the definite relationship between tibial rotational changes and anterior knee pain after HTO.

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Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy

Cited by 20 publications

References 23 publications

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis

Rotational Changes in the Tibia After High Tibial Valgus Osteotomy: A Comparative Study of Lateral Closing Versus Medial Opening Wedge Osteotomy

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