Retro-Tubercle Biplanar Opening Wedge High Tibial Osteotomy Is Favorable for the Patellofemoral Joint But Not for the Osteotomized Tubercle Itself Compared With Supra-Tubercle Osteotomy

Kim, Sang Woo; Lee, Jae Ik; Choi, Han Gyeol; Yoo, Hyun Jin; Jung, Yoojin; Lee, Yong Seuk

doi:10.1016/j.arthro.2021.03.009

Cited by 18 publications

(24 citation statements)

References 29 publications

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“…We assessed 11 retrospective studies [ 24 – 34 ] in this article. The included studies were conducted in 7 countries (Japan, Germany, Korea, Singapore, Canada, Turkey and Netherlands) from 2004 to 2019, and involved 7339 patients (332 patients treated with DTO technique, 407 patients treated with PTO technique) aged 30.5 to 63.0 years.…”

Section: Resultsmentioning

confidence: 99%

“…Among the observational studies, the Newcastle–Ottawa Scale including the exposed cohort, the non-exposed cohort, ascertainment of exposure, outcome of interest, comparability, assessment of outcome, length of follow-up and adequacy of follow-up, was used to assess the risk of bias. The scores of all 11 studies [ 24 – 34 ] were all 6 to 8, indicating a low risk of bias.…”

Section: Resultsmentioning

confidence: 99%

“…Comparison of CDI between DTO and PTO was conducted among the 6 included studies [ 24 – 29 ], which included 522 patients (241 patients receiving DTO and 281 patients receiving PTO), as shown in Fig. 2 .…”

Section: Resultsmentioning

confidence: 99%

“…In Fig. 3 , four included studies [ 24 , 25 , 28 , 32 ] consisting of 315 patients (168 patients received DTO treatment and 147 patients received PTO treatment) investigated BPI. No heterogeneity among studies ( P = 0.43, I 2 = 0%) was found, so we used the fixed-effect model to pool the data.…”

Section: Resultsmentioning

confidence: 99%

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Distal tibial tubercle osteotomy can lessen change in patellar height post medial opening wedge high tibial osteotomy? A systematic review and meta-analysis

et al. 2022

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Objective Medial opening wedge high tibial osteotomy (MOWHTO) is a mainstream surgical method for treating early medial compartment knee osteoarthritis. Undesirable sequelae such as patella infera may happen following tuberosity osteotomy. We conducted this systematic review and meta-analysis to compare the change in patellar position after proximal tibial tubercle osteotomy (PTO) versus distal tibial tubercle osteotomy (DTO) intervention. Methods The 11 studies were acquired from PubMed, Medline, Embase and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences, odds ratios and 95% confidence intervals were calculated. Cochrane Collaboration’s Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess risk of bias. Results Eleven observational studies were assessed. The methodological quality of the trials ranged from moderate to high. The pooled results of postoperative patellar height (Caton-Deschamps index and Blackburne-Peel index) and postoperative complications showed that the differences were statistically significant between PTO and DTO interventions. Patellar index ratios decreased significantly in the PTO groups, and 12 (9.2%) complications under DTO surgery and 2 (1.6%) complications under PTO surgery were reported. The differences of postoperative posterior tibial slope (angle) was not statistically significant, but postoperative posterior tibial slope of both groups increased. Sensitivity analysis proved the stability of the pooled results and the publication bias was not apparent. Conclusions DTO in MOWHTO maintained the postoperative patellar height, and clinically, for patients with serious patellofemoral osteoarthritis, DTO can be preferred. Postoperative complications are easily preventable with caution. In view of the heterogeneity and small sample size, whether these conclusions are applicable should be further determined in future studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Distal tibial tubercle osteotomy can lessen change in patellar height post medial opening wedge high tibial osteotomy? A systematic review and meta-analysis

et al. 2022

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“…7 In the article, "Retro-Tubercle Bi-planar Opening Wedge High Tibial Osteotomy Is Favorable for Patellofemoral Joint But Not for Osteotomized Tubercle Itself Compared With the Supra-Tubercle Osteotomy," Kim, Lee, Choi, Yoo, Jung, and Lee report on MOWHTO in 94 knees using either a supra-tubercle (ST) or retro-tubercle (RT) biplane MOWHTO technique. 8 They reported a statistically significant decrease in patellar height for the ST group, while posterior tibial slope (PTS), retrotuberosity gap distance, and retro-tuberosity tip distance were significantly increased in the RT group. Outcome scores improved significantly in both groups.…”

Section: See Related Article On Page 2567mentioning

confidence: 93%

Editorial Commentary: Uniplane High Tibial Osteotomy Just Below the Metaphyseal Flare Is Preferable to Biplane Opening Wedge High Tibial Osteotomy Distal to the Tuberosity: A Cut Below Our Expectations

Nute¹,

Bottoni²

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Medial opening wedge high tibial osteotomy (MOWHTO) is indicated to correct coronal plane malalignment in a variety of cases, but it carries a high complication profile. Modifications, such as biplane opening wedge high tibial osteotomy distal to the tibial tuberosity have been developed to mitigate consequences, such as loss of patellar height. Unfortunately, biplane osteotomy, which uses a second anterior osteotomy exiting distal to the tibial tubercle, introduces its own set of complications, such as fractures and nonunion of the tibial tubercle, lateral hinge fracture, and increased posterior tibial slope (PTS). Changes in PTS can have significant consequences for patients undergoing anterior cruciate or posterior cruciate ligament reconstruction. Furthermore, the benefit of maintaining patellar height has not been proven. Given the risk of tuberosity-related complications, significant increases in PTS, and no correlation between decreased patellar height and clinical outcomes, surgeons should consider the use of a uniplane, supra-tubercle MOWHTO rather than a biplane technique to correct varus malalignment in the majority of cases. We prefer a uniplane osteotomy starting on the medial cortex just below the metaphyseal flare, aiming the cut in a proximal and lateral direction toward the fibular head. The cut is finished with an osteotome, ending with a 1-cm hinge laterally, and w1.5 cm distal to the articular surface. Our plate is positioned posteromedially to preserve PTS, and we place allograft corticocancellous wedges in the osteotomy site. Why make a complicated procedure more complicated?

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Additional tying on the adjustable-loop device improves the outcomes of anterior cruciate ligament reconstruction using hamstring autograft

Choi

Jeong

Park

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to verify the eicacy of a novel technique for additional tying on the adjustable-loop device to prevent stress concentration on the graft loop end and gradual loop lengthening. Methods A total of 124 patients who underwent anterior cruciate ligament reconstruction using hamstring autografts from 2014 to 2017 were included in this retrospective study. After 1:1 propensity score matching, two groups were formed (group I: 50 patients without tying vs. group II: 50 patients with tying). Anterior laxity was evaluated using side-to-side diferences. Tunnel length, loop length, and graft-tunnel gap were measured using follow-up magnetic resonance imaging. The signal-to-noise ratio was calculated at the loop end, loop inner side, tunnel entrance, and graft mid-substance. The clinical outcomes were assessed using the International Knee Documentation Committee score, Lysholm score, pivot shift test, and Lachman test. ResultsThe average follow-up period was 63.2 ± 4.8 and 53.8 ± 11.9 months in groups I and II, respectively. Anterior laxity showed that side-to-side diferences improved signiicantly 6 months postoperatively in both the groups. Although the anterior laxity improved in group II (2.9 ± 1.0 to 1.6 ± 0.8, p < 0.001), it deteriorated in group I (2.5 ± 1.5 to 3.3 ± 1.3 mm, p < 0.001) at the inal follow-up. The graft-tunnel gap was signiicantly larger in group I (p < 0.001). The signal-to-noise ratios of the loop end and loop inner side were signiicantly higher in group I (p < 0.001 and p = 0.020, respectively). The clinical outcomes at the inal follow-up were not signiicantly diferent between the groups. Conclusion The additional tying on the adjustable-loop device was not superior to the control group in clinical stability examination or outcome. However, it was efective in anterior laxity measured by stress radiographs, preventing stress on the adjustable-loop device, and gradual graft loop lengthening. Level of evidence Level III.

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Retro-Tubercle Biplanar Opening Wedge High Tibial Osteotomy Is Favorable for the Patellofemoral Joint But Not for the Osteotomized Tubercle Itself Compared With Supra-Tubercle Osteotomy

Cited by 18 publications

References 29 publications

Distal tibial tubercle osteotomy can lessen change in patellar height post medial opening wedge high tibial osteotomy? A systematic review and meta-analysis

Distal tibial tubercle osteotomy can lessen change in patellar height post medial opening wedge high tibial osteotomy? A systematic review and meta-analysis

Editorial Commentary: Uniplane High Tibial Osteotomy Just Below the Metaphyseal Flare Is Preferable to Biplane Opening Wedge High Tibial Osteotomy Distal to the Tuberosity: A Cut Below Our Expectations

Additional tying on the adjustable-loop device improves the outcomes of anterior cruciate ligament reconstruction using hamstring autograft

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