Editorial Commentary: Anterolateral Hinge Position Decreases the Slope in Opening-Wedge High Tibial Osteotomy: A Key Point in Treating an Anterior Cruciate Ligament–Deficient, Varus Knee

Martinez-Cano, Juan Pablo

doi:10.1016/j.arthro.2021.01.050

Cited by 1 publication

(2 citation statements)

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“…2 Thus, the coronal and sagittal planes should be considered together in evaluation of the postoperative change in OWHTO. Previous studies have shown that the hinge position 22,25 and the sagittal osteotomy inclination 19,26 affect the postoperative PS. To avoid the change in PS, the sagittal osteotomy inclination should be parallel to PS.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Increase in Posterior Slope After Medial Open-Wedge High Tibial Osteotomy

Song

Bin

Kim

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Whether lateral hinge fracture (LHF) after open-wedge high tibial osteotomy (OWHTO) is associated with the change in tibial posterior slope (PS) has not been determined. Risk factors for PS increase are still unknown. Hypothesis: There will be no difference in patient characteristics and radiographic factors when stratified by change in tibial PS (ΔPS). Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of 148 patients who underwent OWHTO with locking-plate fixation from 2010 to 2016. Included were those with a minimum 2-year follow-up and true lateral radiographs before and at 1 year after surgery. ΔPS was defined as a difference between preoperative and 1-year postoperative PS, with positive values indicating PS increase. ΔPS was classified into <3°, 3° to <6°, and ≥6°. Any LHFs were grouped by Takeuchi classification as stable (type 1) or unstable (types 2 and 3). Risk factors for PS increase were evaluated using ordinal logistic regression analyses. Clinical outcomes according to ΔPS were evaluated using the Hospital for Special Surgery score. Results: There were 79 (53.4%) patients with ΔPS <3°, 44 (29.7%) with 3° ≤ ΔPS < 6°, and 25 (16.9%) with ΔPS ≥6°. LHFs were observed in 41 (27.7%) patients: 32 with type 1 and 7 and 2 with types 2 and 3, respectively. Results of the multivariate ordinal logistic regression analysis indicated that ΔPS was associated with unstable LHF ( P = .005, exp[β] = 6.34), preoperative PS ( P = .028, exp[β] = 0.90), and correction angle ( P = .037, exp[β] = 1.09). ΔPS ≥6° was seen in 4 of 9 (44.4%) patients with unstable LHF, 9 of 32 (28.1%) with stable LHF, and 12 of 107 (11.2%) with no LHF ( P = .017). The mean correction angle was 11.3° ± 3.6° in patients with ΔPS ≥6°, 9.4° ± 4.6° in cases of 3° ≤ ΔPS < 6°, and 8.8° ± 3.6° in cases of ΔPS <3° ( P = .019). Hospital for Special Surgery scores did not differ according to ΔPS. Conclusion: LHF type and correction angle were associated with ΔPS after OWHTO, and unstable LHF and large correction angle were risk factors for PS increase. There was no significant difference in clinical outcomes according to ΔPS.

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Section: Discussionmentioning

confidence: 99%

“…First, there may be selection bias attributed to the retrospective nature of this study. Second, already known factors that can affect the postoperative PS were not investigated, such as the hinge position 22 , 25 and the sagittal osteotomy inclination. 19 , 26 These factors would reflect the change in PS more directly.…”

Section: Discussionmentioning

confidence: 99%