Effect of Increased Coronal Inclination of the Tibial Plateau After Opening-Wedge High Tibial Osteotomy

Akamatsu, Yasushi; Kumagai, Ken; Kobayashi, Hideo; Tsuji, Masaki; Saito, T.

doi:10.1016/j.arthro.2018.01.055

Cited by 114 publications

(130 citation statements)

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“…Saragaglia et al 18 showed excellent results among 42 double-level osteotomy cases when the JLO was restricted to <5°. However, Akamatsu et al 1 recently found that in cases of medial proximal tibial angle (MPTA) ≥95°, which corresponded to JLO of 5° in their study, no difference was seen in cartilage findings during second-look arthroscopy at 1 year postoperatively.…”

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confidence: 69%

“…Currently, the most commonly accepted limit of JLO is 4°; however, literature to support this value is lacking. Adverse effects of JLO have mostly been demonstrated in cases of proximal tibial osteotomy addressing valgus deformity, 5,20 and only finite element analysis 14 or short-term studies 1 have been performed for cases of varus deformity corrected by OWHTO. Thus, the purpose of the present study was to determine the acceptable range of JLO in terms of radiologic and clinical aspects by assessing the midterm outcomes of OWHTO according to JLO.…”

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confidence: 99%

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What Is An Acceptable Limit of Joint-Line Obliquity After Medial Open Wedge High Tibial Osteotomy? Analysis Based on Midterm Results

et al. 2020

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Background: Although joint-line obliquity (JLO) after open-wedge high tibial osteotomy (OWHTO) is commonly encountered, especially in cases of overcorrection, its effect has not been fully elucidated or has been assessed only in the short term. The acceptable range of JLO, often recognized as ≤4°, has not been determined as per the midterm outcomes of OWHTO. Hypothesis: Joint-line obliquity exceeding the acceptable limit after OWHTO would accelerate cartilage degeneration and adversely affect midterm clinical outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 109 patients who underwent OWHTO between 2010 and 2015 with a mean follow-up period of 55.0 months (range, 24-102 months) were reviewed. JLO was defined as the angle between the lines parallel to the floor and to the tibial plateau on a long-standing hip-to-ankle radiograph. For radiologic evaluation according to JLO, the medial joint space width (JSW) was measured on a standing 45° flexion posteroanterior view and standardized with the width of the tibial plateau as reference, after which changes in JSW (ΔJSW) between the 6- and 12-month postoperative period and the latest follow-up were calculated. ΔJSW was analyzed according to 2 different cutoff values of JLO: JLO of 4°, which is currently recognized as the acceptable limit, and that derived from the receiver operating characteristic (ROC) curve for the third quartile of ΔJSW. Multivariate regression analysis including JLO as well as other demographic and radiologic factors was performed. Clinical outcomes were evaluated in the same way using Knee Society (KS) objective and functional scores. Results: With a JLO cutoff of 4° in the multivariate regression analysis, JLO was not significantly associated with ΔJSW ( P = .545). However, in the KS objective and functional score analyses, JLO ≥4° was found to be a significant factor ( P = .045 and .005, respectively). The ROC curve showed a cutoff JLO of 6°, which was significantly associated with ΔJSW ( P = .001). JLO ≥6° remained significant in the analyses for KS objective and functional score ( P = .012 and .001, respectively). Conclusion: The adverse effect of JLO on radiologic outcomes was shown when JLO was ≥6°. In clinical aspects, worse outcomes were found in cases of JLO ≥4°.

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confidence: 69%

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What Is An Acceptable Limit of Joint-Line Obliquity After Medial Open Wedge High Tibial Osteotomy? Analysis Based on Midterm Results

et al. 2020

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“…The force value becomes even higher as the obliquity angle increases. Although some studies have shown that there was no difference of short-term outcome with high-degree obliquity [8,23,24], it is reasonable there would be a long-term adverse effect on the articular cartilage [12]. Lee et al found that the change of KJLO was signi cantly less than that of anatomical geometry of the proximal tibia.…”

Section: Discussionmentioning

confidence: 99%

Knee ankle joint line angle: a critical value at 10。 for decompensated knee joint line obliquity in medial opening wedge osteotomy.

Tseng

Hsu

Wang

2020

Preprint

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Background: Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study aimed to investigate the capacity of the compensation by analyzing the correlation of the knee-ankle joint line angle (KAJA) and the knee joint line obliquity (KJLO).Methods: The correlations between postoperative KJLO and body mass index (BMI), correction amount, KAJA, mechanical lateral distal femoral angle (mLDFA), preoperative medial proximal tibia angle (MPTA), ankle joint line obliquity (AJLO), KJLO and mechanical hip-knee-ankle angle (mHKA) were analyzed using Pearson correlation coefficient. The contribution of significant factors was further analyzed using multiple linear regression. The KJLO between ≦ 5。, 5。-10。And ≧ 10。KAJA groups were compared using Kruskal-Wallis test.Results: Postoperative KAJA and preoperative KJLO moderately correlated to postoperative KJLO. Preoperative MPTA, mHKA, AJLO weakly correlated to postoperative KJLO. After multiple linear regression, only postoperative KAJA, preoperative MPTA and mHKA still showed significant contribution, while preoperative KAJA made the greatest contribution. The KJLO was substantial higher in the ≧ 10。KAJA group with a high rate (68%) of high-degree KJLO.Conclusions: 10。postoperative KAJA is a critical value for decompensated KJLO. The results suggest us carefully assess the KAJA intraoperatively. Double osteotomy should be considered if ideal alignment cannot be achieved when the KAJA reach 10。.

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“…Moreover, the mean change in the mechanical axis was 14.6 in the patellofemoral degenerative progression group; I believe that this large correction angle caused abnormal joint line obliquity, which could have resulted in the inferior clinical outcomes in the progression group. Akamatsu et al 10 and Schuster et al 11 reported that overcorrected medial proximal tibial angle exerted a negative impact on the clinical outcomes after OWHTO. Second, patients were divided per their patellofemoral degenerative progression from first to second arthroscopy (mean interval: 21.4 months), not at the final follow-up.…”

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confidence: 99%

Editorial Commentary: Does Patellofemoral Degenerative Progression After Open-Wedge High Tibial Osteotomy Adversely Affect Clinical Outcomes?

Goshima¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Effect of Increased Coronal Inclination of the Tibial Plateau After Opening-Wedge High Tibial Osteotomy

Cited by 114 publications

References 21 publications

What Is An Acceptable Limit of Joint-Line Obliquity After Medial Open Wedge High Tibial Osteotomy? Analysis Based on Midterm Results

What Is An Acceptable Limit of Joint-Line Obliquity After Medial Open Wedge High Tibial Osteotomy? Analysis Based on Midterm Results

Knee ankle joint line angle: a critical value at 10。 for decompensated knee joint line obliquity in medial opening wedge osteotomy.

Editorial Commentary: Does Patellofemoral Degenerative Progression After Open-Wedge High Tibial Osteotomy Adversely Affect Clinical Outcomes?

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