Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy

Abstract

PurposeThe purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO).Materials and MethodsThis study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border.ResultsThe weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group.ConclusionsIn HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.

Disparity between Preoperative Target Correction Amount and Postoperative Correction Amount in Open Wedge High Tibial Osteotomy

“…Surgeons recommend that the osteotomy gap according to the planned correction amount should be adjusted intraoperatively based on the status of the medial compartment and the goal of the osteotomy in OWHTO 19 , 20) . Despite delicate preoperative planning and intraoperative adjustment, the postoperative correction amount could be different from that preoperatively planned 21 , 22) It is because preoperative planning for OWHTO is mostly conducted in 2 dimensions, while correction of the varus deformity is a 3 dimensional task. We observed the tendency of mismatch between the preoperatively planned correction amount and the actual correction amount after OWHTO was more prominent when a large amount of correction was required.…”

Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study

“…Conventional methods use standard instrumentation to open the osteotomy [ 5 , 6 ]. Frontal correction can then be managed intraoperatively by measuring the opening angle or opening gap and comparing it to the preoperative plan [ 8 – 10 ], or by using a radiopaque cable under fluoroscopy to control lower limb alignment [ 9 , 11 – 13 ]. The control of the correction for both the frontal and the sagittal planes at the same time with standard instrumentations remains challenging [ 14 – 16 ].…”

HKA Angle—A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs

“…The currently accepted error range in clinical practice is AE 1.5 degrees of the HKA angle or AE 5% of the WBL percentage. 12,19 Aiming at these targets, the Miniaci angle should be controlled to an accuracy of AE 1.63 and AE 1.18 degrees for HKA-and WBL-based planning, respectively. The Miniaci method, commonly applied on standing WLRs, yielded high intra-rater reliability in the current study regarding the measurements of the preoperative HKA angle, the preoperative WBL percentage, the preoperative MPTA, mLDFA, JLCA, and the Miniaci angle.…”