Difference of preoperative varus–valgus stress radiograph is effective for the correction accuracy in the preoperative planning during open-wedge high tibial osteotomy

Abstract

Purpose This study aimed to evaluate (1) the eicacy of varus-valgus stress radiographs to adjust the preoperative softtissue imbalance and (2) ascertain whether varus-valgus stress radiographs are efective for the correction accuracy in the preoperative planning of the opening wedge high tibial osteotomy (OWHTO). Methods From February 2017 to December 2018, a total of 121 consecutive knees that underwent bi-planar OWHTO were enrolled in this retrospective analysis. Preoperative planning was performed using a weight-bearing line (WBL). Target WBL was determined according to the status of the medial compartments such as cartilage, meniscus, and preoperative arthritic grade. Preoperative varus-valgus stress radiographs were used to assess the preoperative mediolateral ligament imbalance. The inal target correction length of the opening gap was determined by subtracting the diference between the varus-valgus stress radiographs (VVD). All patients were divided into two groups according to the preoperatively planned correction degree: (group A), smaller than average; (group B), larger than average. Patients were also divided into two other groups (VVD adjusted and neglected groups). Results Groups A and B were 56 and 54 knees, respectively. The preoperatively planned correction lengths of the opening gap were 9.33 ± 1.5 and 14.16 ± 3.96 mm, respectively (p < 0.01). Mean values of the VVD were 0.85 ± 0.72, and 1.27 ± 1.78 mm, respectively (p < 0.01). Correction errors were 2.17 ± 2.06 and 3.52 ± 2.16%, respectively (p < 0.01). Planned and inal correction degrees were also signiicantly larger (p < 0.01, and p < 0.01, respectively), because the preoperative WBL ratio was signiicantly smaller in the VVD adjusted group (p < 0.01). ConclusionThe VVD values could reproduce the preoperative soft-tissue imbalance and it was more prominent as the correction degree increased. The strategy of subtracting the VVD as assumed soft-tissue imbalance in the preoperative planning worked well for the correction accuracy during OWHTO. Level of evidence Level IV, retrospective study.

Alignment adjustment using the Valgus stress technique can increase the surgical accuracy of novice surgeons during medial opening-wedge high Tibial osteotomy

“…It has been reported that joint laxity, especially on the lateral side, could affect lower-extremity alignment following HTO [ 2 , 14 ]. The surgical pearls for successful MOWHTO include representation of weight-bearing alignment of the patient, who is in the supine position during surgery [ 2 , 14 , 36 , 37 ]. In fact, there have been many studies examining the relationship between factors related to joint laxity, including JLCA, to predict the actual standing alignment of MOWHTO patients [ 2 , 14 , 36 , 37 ].…”

“…The surgical pearls for successful MOWHTO include representation of weight-bearing alignment of the patient, who is in the supine position during surgery [ 2 , 14 , 36 , 37 ]. In fact, there have been many studies examining the relationship between factors related to joint laxity, including JLCA, to predict the actual standing alignment of MOWHTO patients [ 2 , 14 , 36 , 37 ]. However, there continue to be limitations to the prediction of postoperative alignment through radiation measurements related to joint laxity before surgery [ 2 , 14 , 36 , 37 ].…”

“…In fact, there have been many studies examining the relationship between factors related to joint laxity, including JLCA, to predict the actual standing alignment of MOWHTO patients [ 2 , 14 , 36 , 37 ]. However, there continue to be limitations to the prediction of postoperative alignment through radiation measurements related to joint laxity before surgery [ 2 , 14 , 36 , 37 ]. Therefore, it is necessary to reproduce the alignment of the standing position while reflecting the joint laxity that differs for each individual in the actual surgical field.…”

“…The soft tissue imbalance through valgus-varus stress was imaged before surgery. The degree of soft tissue imbalance through preoperative stress images could be useful to predict joint laxity before surgery [ 29 , 38 – 40 ]. The advantage of applying valgus stress intraoperatively is to estimate the weight-bearing alignment after correction.…”

Digital Preoperative Planning for High Tibial Osteotomy using 2D Medical Imaging

“…The intersection of these straight lines involves mechanical [14], [15] or anatomical axes [16] It is also influenced by the need or regulation of the osteotomy itself i.e. varus gene defect [14], valgus [17] or recurvatum [18]. This selection also depends on the selection of wedges to be used that is whether open wedge, closed, dome and also a combination.…”