1
|
Şahbat Y, Chou TFA, An JS, Gülağacı F, Ollivier M. CPAK classification detect the real knee joint apex position in less than half of the knees. Knee Surg Sports Traumatol Arthrosc 2024; 32:1548-1556. [PMID: 38613184 DOI: 10.1002/ksa.12175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Accurate assessment of the knee joint line is essential for surgeries involving the knee. The knee joint line obliquity (KJLO) is a radiological measurement that evaluates the position of the knee joint relative to the ground and is frequently used in preoperative planning and clinical follow-up. On the other hand, coronal plane alignment of the knee (CPAK) classifications assesses the joint line as the summation of the medial proximal tibial angle (MPTA) and mechanical lateral distal femoral angle (mLDFA). The purpose of this study is to determine the concordance of these two measurement techniques. METHODS This cross-sectional study evaluated the long-leg standing radiographs (LSRs) of 164 healthy knees. The extremity KJLO and CPAK classification JLO were measured twice by two observers at 8-week intervals. The knee joint line apex positions (proximal, neutral and distal) of the two measurement techniques are compared (concordance or discordant). The intraobserver and interobserver reliability were examined using the intraclass correlation coefficient (ICC). Possible causes of the discordant were evaluated with univariate and multivariate logistic regression analysis. RESULTS CPAK classification detected the KJLO apex position in 70 extremities (42.7%) only. Subgroups CPAK JLO detected 13.6% of the proximal apex, 20.4% of the neutral, and 90.7% of the distal apex (p < 0.01). Upon multivariate logistic regression analysis, the variable KJLO apex position (proximal, neutral vs. distal, odds ratio (OR) = 10.291, 95% confidence interval [CI] = 2.225-25.656, and (p < 0.01) was determined as a risk factor for discordant. CONCLUSION The CPAK JLO measurement technique can be misleading in defining the KJLO apex position and the concordance between them is less than 50%. It has a high tendency to misleadingly predict proximal and neutral apex positions, which can potentially have negative implications for assessing the joint line. LEVEL OF EVIDENCE Level I.
Collapse
Affiliation(s)
- Yavuz Şahbat
- Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
- Erzurum Regional Training and Research Hospital, Department of Orthopaedics and Traumatology, Erzurum, Turkey
| | - Te-Feng Arthur Chou
- Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
- Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Jae-Sung An
- Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fırat Gülağacı
- Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Matthieu Ollivier
- Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| |
Collapse
|
2
|
Kikuchi K, Kumagai K, Yamada S, Nejima S, Choe H, Ike H, Kobayashi N, Inaba Y. Difference in the anterior displacement of the tibial tuberosity relative to the proximal tibial fragment between opening wedge and closed wedge high tibial osteotomies. SICOT J 2024; 10:21. [PMID: 38819291 PMCID: PMC11141518 DOI: 10.1051/sicotj/2024020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/04/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION This study aimed to investigate the anterior-posterior (AP) displacement of the tibial tuberosity (TT) and to assess the difference between closed wedge and opening wedge high tibial osteotomies (OWHTO and CWHTO). METHODS One hundred consecutive knees with osteoarthritis that underwent OWHTO (50 knees) or CWHTO (50 knees) were investigated retrospectively. The femorotibial angle (FTA) was measured on AP radiographs of the knee. AP displacement of the TT, posterior tibial slope (PTS), the modified Blackburne-Peel index (mBPI), and the modified Caton-Deschamps index (mCDI) were measured on lateral radiographs of the knee. RESULTS Patients had a mean correction angle of 12.58 ± 2.84° and 18.98 ± 5.14° (P < 0.001), with a mean AP displacement of TT of 0.84 ± 2.66 mm and 7.78 ± 3.41 mm (P < 0.001) in OWHTO and CWHTO, respectively. The AP displacement of the TT per correction of 1° was significantly greater in CWHTO than in OWHTO (P < 0.001). A significant correlation was found between the correction angle and AP displacement of the TT in CWHTO (r = -0.523, P < 0.001), but not in OWHTO. The change of PTS per correction of 1° was significantly greater in OWHTO than in CWHTO (P < 0.001). The changes of mBPI and mCDI per correction of 1° were significantly greater in CWHTO than in OWHTO (P < 0.001 and P < 0.001, respectively). CONCLUSIONS There was greater anterior displacement of the TT in CWHTO than in OWHTO, which was correlated with the correction angle. The results suggested that CWHTO would be better than OWHTO when a concomitant anteriorization of TT is required.
Collapse
Affiliation(s)
- Kentaro Kikuchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Yokohama 236-0004 Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Yokohama 236-0004 Japan
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Yokohama 236-0004 Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Yokohama 236-0004 Japan
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Yokohama 236-0004 Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Yokohama 236-0004 Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center Yokohama 232-0024 Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University Yokohama 236-0004 Japan
| |
Collapse
|
3
|
Takagawa S, Yukizawa Y, Hirotomi K, Hiagashihra S, Inaba Y, Kobayashi N. Comparison of the indications for high tibial osteotomy and double-level osteotomy for the correction of diverse lower-leg deformities in an Asian population with medial compartment osteoarthritis: a retrospective observational study. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06218-0. [PMID: 38758493 DOI: 10.1007/s00264-024-06218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Double-level osteotomy (DLO) for knee osteoarthritis is becoming increasingly popular to achieve superior anatomical correction. This study aimed to compare the indication for open-wedge high tibial osteotomy (OWHTO) and DLO and to investigate preoperative bone morphology. METHODS Data of 166 knees treated with osteotomy were evaluated. The weight-bearing line ratio, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured. Bone deformity assessment and osteotomy simulation were conducted. Normal values of mLDFA and mMPTA were defined as 85-90°. Bone deformity was classified into four patterns: femoral, tibial, both, and no deformity. Simulation was performed to achieve a postoperative weight-bearing line ratio of 62%. Distal femoral osteotomy (DFO) or OWHTO was performed to achieve an mLDFA of 85° or mMPTA of up to 95°. If the postoperative parameter remained outside the correctable limit, DLO was performed. Cases were classified according to the corrective surgery performed, and those that could not be corrected after DLO were classified into the uncorrectable group. RESULTS Femoral, tibial, both, and no deformities were observed in 14.2%, 37.8%, 10.7%, and 33.9% of cases, respectively. No cases were classified into the DFO group; however, 53.6%, 38.1%, and 8.3% were classified into the OWHTO, DLO, and uncorrectable groups, respectively. CONCLUSION Bone deformity differed among cases, and only one-third had tibial deformity. OWHTO and DLO were indicated in approximately 50% and 40% of cases, respectively. Our study results reinforce the importance of evaluating leg morphology before surgical planning to achieve acceptable alignment.
Collapse
Affiliation(s)
- Shu Takagawa
- Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan
| | - Yohei Yukizawa
- Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan
| | - Kunihito Hirotomi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan
| | - Shota Hiagashihra
- Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan
| | - Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
| | - Naomi Kobayashi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan.
| |
Collapse
|
4
|
Choi YS, Chang MJ, Lee JH, Lee JH, D'Lima DD, Kim TW, Chang CB, Kang SB. Repair of medial meniscus posterior root tear is effective for root healing and cartilage regeneration in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:5799-5811. [PMID: 37940662 DOI: 10.1007/s00167-023-07637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE This study aimed to determine whether the repair of a medial meniscus posterior root tear (MMPRT) is effective for MMPRT healing, cartilage regeneration, and clinical outcomes in opening wedge high tibial osteotomy (OWHTO). METHODS This retrospective study included 80 patients who underwent OWHTO and subsequent second-look arthroscopy. The patients were divided into OWHTO-with-MMPRT-repair (n = 40) and OWHTO alone (n = 40) groups, and the healing rates (complete/partial/failure) were compared. Each group was further divided into over- and under-corrected subgroups to compare healing rates. The International Cartilage Repair Society (ICRS) grade, cartilage defect size, Koshino stage, ICRS cartilage repair assessment score of the medial femoral condyle (MFC), and International Knee Documentation Committee (IKDC) scores between the OWHTO-with-MMPRT-repair and OWHTO alone groups were compared according to whether microfracture was performed on the MFC. RESULTS The overall healing rate of the MMPRT was higher in the OWHTO-with-MMPRT-repair group than that in the OWHTO alone group (P < 0.001). In addition, in the subgroup analysis, no difference in the MMPRT healing rate between the over-correction and under-correction groups when MMPRT repair was performed (n.s). In contrast, without MMPRT repair, the healing rate was lower in the under-correction group than that in the over-correction group (P = 0.03). Cartilage regeneration of the OWHTO-with-MMPRT-repair group was superior to that of the OWHTO alone group (P < 0.05). The IKDC subjective scores of the OWHTO-with-MMPRT-repair and OWHTO alone groups were 34.5 and 33.1 before surgery (n.s) and 50 and 47.2 at one year after surgery, respectively (n.s). These differences between the two groups for cartilage regeneration and IKDC subjective scores showed the same pattern regardless of microfractures. CONCLUSIONS MMPRT repair during OWHTO might improve MMPRT healing, even with under-correction, and cartilage regeneration of MFC, regardless of microfracture. However, OWHTO with MMPRT repair might not improve short-term clinical outcomes compared to OWHTO alone. Further randomized clinical trials are necessary. LEVEL OF EVIDENCE III, Retrospective cohort study.
Collapse
Affiliation(s)
- Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Ji Han Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jae Hee Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea.
| |
Collapse
|
5
|
Tomiyama Y, Mochizuki T, Tanifuji O, Nishino K, Tanaka M, Omori G, Yamamoto N, Koga H, Koga Y, Kawashima H. Normal coronal kinematics of dynamic alignment and bony positions relative to the ground in three-dimensional motion analysis during gait: A preliminary study. Biomed Mater Eng 2023; 34:37-49. [PMID: 35694913 DOI: 10.3233/bme-211383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND During gait, healthy knee coronal kinematics of each bony axis and lower extremity alignment are important because they could be useful as reference data for several surgeries and provide clarification of the etiology of diseases around the knee in healthy participants; however, it remains unknown. OBJECTIVE The objective of this study was to clarify the kinematics of lower extremity alignment and the bony axes relative to the ground during gait, focused on the coronal plane, in healthy individuals by applying our unique three-dimensional (3D) motion analysis. METHODS The study included 21 healthy individuals, including 9 healthy females and 12 healthy males with an average age of 36 ± 17 years. Knee kinematics were calculated in a gait analysis by combining the data from a motion-capture system and a 3D lower-extremity alignment assessment system on biplanar long-leg radiographs by using a 3D-2D registration technique. The main kinematic parameters were the dynamic position change relative to the ground, applying the femoral anatomical axis (FAA), tibial anatomical axis (TAA), and dynamic alignment in the coronal plane during the stance phase of gait. RESULTS The average changes in FAA, TAA, and dynamic varus alignment were 3.7° ± 1.2°, 3.5° ± 0.8°, and 3.0° ± 1.2°, respectively. The TAA tilted laterally during the loading response and a plateau area appeared afterwards; the FAA gradually inclined laterally until the terminal stance phase, and the dynamic alignment showed varus angular change during the loading response. CONCLUSIONS The tibia and femur were found to change approximately 2-5° of the position of the bony axes relative to the ground. In terms of clinical relevance, our findings can be used to clarify the etiology of diseases around the knee joint and as reference data for surgeries.
Collapse
Affiliation(s)
- Yasuyuki Tomiyama
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.,Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niitaga, Japan
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | | | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Noriaki Yamamoto
- Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niitaga, Japan
| | - Hiroshi Koga
- Division of Musculoskeletal Science for Frailty, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopaedic Surgery, Nioji Onsen Hospital, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| |
Collapse
|
6
|
Opening Wedge High Tibial Osteotomy with Combined Use of Patient-Specific 3D-Printed Plates and Taylor Spatial Frame for the Treatment of Knee Osteoarthritis. Pain Res Manag 2021; 2021:8609921. [PMID: 34900072 PMCID: PMC8654534 DOI: 10.1155/2021/8609921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
Background High tibial osteotomy (HTO) is used to treat medial degeneration of the osteoarthritis (OA) knee. However, shortcomings still exist in the current procedure, like unprecise creation, inability to correct knee rotation, and internal fixed failure. Here, we reported a novel procedure: patient-specific 3D-printed plates for opening wedge high tibial osteotomy (OWHTO) combined with Taylor spatial frame (TSF). The detailed technique was described, and the clinical outcomes were evaluated. Methods We prospectively evaluate outcomes of patient-specific 3D-printed plates for OWHTO with use of TSF in 25 patients with knee OA and varus alignment. Postoperative efficacy was evaluated using the HSS knee score, pain visual simulation score (VAS), and knee joint motion (ROM), and lower limb alignment was evaluated by measuring femorotibial angle (FTA) and hip-knee-ankle (HKA). Results and Conclusion. All patients did not experience complications such as wound infection, nerve damage, or bone amputation. 25 patients were followed up for 6–18 months. The bony union at bone amputation was achieved in 3 months after surgery, and the pain symptoms were significantly alleviated or disappeared. The VAS score was significantly reduced in 6 months after surgery compared with preoperative; the HSSS score was significantly added in 6 months after surgery compared with preoperative. The ROM of knee joint increased significantly 6 months after operation compared with that before operation, and the difference was statically significant (P < 0.05). The FTA and HKA after operation were significantly superior to that before operation, and the difference was statically significant (P < 0.01). Conclusions Our study showed that patient-specific 3D-printed plates for HTO with the use of TSF have the advantages of small trauma, few complications, simple operation, and fast recovery in treating knee OA and varus alignment.
Collapse
|
7
|
Akamatsu T, Kumagai K, Yamada S, Nejima S, Sotozawa M, Ogino T, Inaba Y. 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. J Orthop Surg (Hong Kong) 2021; 29:23094990211020366. [PMID: 34165004 DOI: 10.1177/23094990211020366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Tomotaka Akamatsu
- Department of Orthopaedic Surgery, 13155Yokohama City University, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, 13155Yokohama City University, Yokohama, Japan
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, 13155Yokohama City University, Yokohama, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, 13155Yokohama City University, Yokohama, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, 13155Yokohama City University, Yokohama, Japan
| | - Takahiro Ogino
- Department of Orthopaedic Surgery, 13155Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, 13155Yokohama City University, Yokohama, Japan
| |
Collapse
|
8
|
Lateral tibial intercondylar eminence is a reliable reference for alignment correction in high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2021; 31:1515-1523. [PMID: 34491381 DOI: 10.1007/s00167-021-06736-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study is to determine whether the lateral tibial intercondylar eminence (LTIE) is a reliable reference for alignment correction in high tibial osteotomy (HTO). METHODS A total of 1954 consecutive standing whole-leg radiography (WLR) examinations of 1373 adult patients with knee osteoarthritis between 2012 and 2019 were reviewed retrospectively; 145 patients were included, 53 males and 92 females, with a mean age of 63.3 years. Virtual simulation of HTO was performed to measure weight-bearing line (WBL) percentages and hip-knee-ankle (HKA) angles when the WBL passed through the Fujisawa, top, bottom, upper 1/3, and middle points of the lateral slope of the LTIE, and the positional relationship between the Fujisawa point and the lateral slope of the LTIE was determined. RESULTS When the WBL passed through the top, bottom, upper 1/3, and middle points of the lateral slope of the LTIE, the mean WBL percentages were 57.7% ± 2.1%, 74.6% ± 3.3%, 63.4% ± 2.1%, and 66.2% ± 2.3%, respectively, and the mean HKA angles were 182.1° ± 0.5°, 185.9° ± 0.8°, 183.3° ± 0.5°, and 184.0° ± 0.5°, respectively. When the WBL passed through the Fujisawa point, it was passing through 28.6% ± 12.7% of the width of the lateral slope (the top and bottom points were defined as 0% and 100%, respectively). When the WBL passed through the middle and upper 1/3 points of the lateral slope of the LTIE, the majority of cases (96.1%-100%) were within the limits of acceptability, as defined by the widely accepted standard of a postoperative HKA angle ranging from 183° to 186°. CONCLUSION The upper 1/3 and middle points of the lateral slope of the LTIE are reliable references for guiding the alignment correction in HTO. In clinical application, if 62%-66% of the postoperative WBL percentage is the acceptable target range, the upper 1/3 point of the lateral slope of the LTIE may be a better alternative than the midpoint. If the postoperative HKA angle between 183° and 186° is acceptable, the midpoint of the lateral slope of the LTIE may be better than the upper 1/3 point. These findings are crucial for the accuracy of the traditional intraoperative alignment assessment techniques. LEVEL OF EVIDENCE IV.
Collapse
|