Serial Changes in the Joint Space Width and Joint Line Convergence Angle After Closed-Wedge High Tibial Osteotomy

Park, Cheol Hee; Bae, Dae Kyung; Kim, Kang‐Il; Lee, Jong Whan; Song, Sang Jun

doi:10.1177/0363546517729153

Cited by 36 publications

(30 citation statements)

References 42 publications

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“…First, surgeons cannot release the posterior soft tissues sufficiently [12], considering to protect muscles and posterior vessels [16, 22]. The other reason is that the triangular shape of the proximal tibia with the apex directed anteriorly makes the center of rotation angulation slightly posterior in the sagittal plane [8, 37, 56]. The demonstrations above cause a less opened posterior gap after OWHTO and a less touched area of the posterior bone after CWHTO.…”

Section: Discussionmentioning

confidence: 99%

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Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis

et al. 2019

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Background The purpose of this meta-analysis is to examine changes in radiological variables and clinical outcomes between open and closed wedge high tibial osteotomy (OWHTO and CWHTO, respectively), which have ongoing controversial issues in numerous quantitative clinical studies. Methods PubMed, Embase, and the Cochrane Library were systematically searched for suitable controlled trials between Jan 1, 1999, and Feb 2, 2018. The inclusion criteria included studies written in English, studies with a level of evidence of I–IV, and studies presenting comparisons between OWHTO and CWHTO. The main clinical and radiographic results were extracted and pooled using Stata 12.0. Results After searching for and screening trials, 28 trials involving 2840 knees were eligible for the meta-analysis. After OWHTO or CWHTO, clinical scores, including the American Knee Society Score, Hospital for Special Surgery Knee Score, Lysholm score, and Visual Analog Scale pain score, improved ( p < 0.05), but the range of motion was unchanged ( p > 0.05). The anatomical femorotibial angle (SMD 0.04, 95% CI − 0.66 to 0.74) and hip-knee-ankle angle (SMD 0.11, 95% CI − 0.11 to 0.33) data suggested that the OWHTO and CWHTO groups were similar in function of correction. Posterior tibial slope increased (SMD − 0.71, 95% CI − 1.04 to − 0.37) after OWHTO but decreased (SMD 0.72, 95% CI 0.35 to 1.08) after CWHTO. OWHTO decreased patellar height ( p < 0.05), while patellar height did not change significantly after CWHTO ( p > 0.05). Conclusion This meta-analysis indicates that compared with CWHTO, OWHTO increases the posterior slope, decreases the patellar height, and provides a similar accuracy of correction; however, CWHTO leads to a decreased posterior slope and an unchanged patellar height. Therefore, programs should be personalized and customized for the specific situation of each patient.

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Section: Discussionmentioning

confidence: 99%

“…Medial open-wedge (OW) and lateral closed wedge (CW) HTO, during which a wedge-shaped cut is made in the medial and lateral parts of the tibia [8], respectively, and internal fixation with a plate and screws is then performed at the end [2, 9], are two of the most commonly used surgical methods among young and highly active patients.…”

Section: Introductionmentioning

confidence: 99%

Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis

et al. 2019

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“…Fibular management might affect the integrity of the lateral collateral ligament and posterolateral structures of the knee [20]. The lateral wedge closing might decrease tension of the medial collateral ligament secondary to functional laxity away from the center of rotation [24]. Surgeons will be able to improve the reliability of navigation measurements for postoperative MA alignment by considering alterations in soft tissue tension after wedge closing during CAS-LCWHTO.…”

Section: Discussionmentioning

confidence: 99%

The influence of computer-assisted surgery experience on the accuracy and precision of the postoperative mechanical axis during computer-assisted lateral closing-wedge high tibial osteotomy

Lee

Song

Bae³

et al. 2019

Knee Surg & Relat Res

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Background: There is debate regarding the influence of a surgeon's experience with computer-assisted surgery (CAS) on the postoperative mechanical axis (MA) in CAS-high tibial osteotomy. The purpose of the present study was to compare radiographic results between early and late cohorts of a consecutive series of patients to assess the influence of CAS experience on accuracy and precision of the postoperative MA during CAS lateral closingwedge high tibial osteotomy (LCWHTO). Materials and methods: Results from 140 CAS-LCWHTO operations were retrospectively reviewed. The first 70 cases, performed during the learning curve period for CAS between 2005 and 2009, were considered to be the "early cohort." The subsequent 70 cases, performed with greater CAS experience after the completion of the learning curve between 2009 and 2014, were considered to be the "late cohort." The target postoperative MA angle was valgus 3°. Pre-and postoperative MA angles were evaluated by navigation and radiographs. The proportion of postoperative MA inliers (≤ target angle ±3°) was investigated radiographically. The correlation between the navigation and radiographic measurements was analyzed. Results: The average postosteotomy MA angle on navigation was 3.4°in both cohorts. The average postoperative MA angle on radiographs was 1.0°in the early cohort and 2.2°in the late cohort (P = 0.003). Radiographically, the proportion of postoperative MA inliers was greater in the late cohort than in the early cohort (early versus late, 71.4% versus 90%; P = 0.011). The pre-and postoperative correlation between navigation and radiographic measurements was also stronger in the late cohort (early versus late; preoperative r = 0.558 versus 0.663; postoperative r = 0.310 versus 0.376). Conclusions: Greater experience with CAS increased the accuracy and precision of postoperative MA alignment as well as the correlation between navigation and radiographic measurements. Caution should be taken during registration procedures to achieve accurate alignment correction in CAS-LCWHTO.

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“…The MPTA was the medial angle between 2 lines, the line of the tibial anatomical axis and the tangent line of the tibial plateau (Figure C). The PSA was defined as the angle formed by a line perpendicular to the reference line and the medial tibial plateau (Figure A). The reference line of the PSA was defined as the line connecting the centre of the medullary canal 10 and 20 cm distal to the tibial plateau.…”

Section: Methodsmentioning

confidence: 99%

“…The reference line of the PSA was defined as the line connecting the centre of the medullary canal 10 and 20 cm distal to the tibial plateau. The mJSW was measured as the shortest distance between the medial femoral condyle and the medial tibial plateau (Figure B).…”

Section: Methodsmentioning

confidence: 99%

Clinical and radiologic results after open‐wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity

et al. 2018

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Serial Changes in the Joint Space Width and Joint Line Convergence Angle After Closed-Wedge High Tibial Osteotomy

Abstract: Cartilage healing, as indicated by the JSW, and clinical improvement were maintained over the minimum 3-year follow-up after CWHTO. Cartilage pressure, as indicated by the convergence angle, remained unchanged after CWHTO.

Cited by 36 publications

References 42 publications

Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis

Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis

The influence of computer-assisted surgery experience on the accuracy and precision of the postoperative mechanical axis during computer-assisted lateral closing-wedge high tibial osteotomy

Clinical and radiologic results after open‐wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity

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