The coronal hypomochlion

Heijens, E.; Kornherr, Patrick; Meister, C.

doi:10.1302/0301-620x.98b5.33394

Cited by 31 publications

(29 citation statements)

References 13 publications

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“…As bony correction of the tibia becomes more accurate, the effect of additional alignment change due to soft tissue laxity became prominent. As other authors 23 – 27) have already remarked, soft tissue laxity could change the extent of correction additionally in MOWHTO. These results suggest that conventional techniques used to decide correction angle may be inappropriate for achieving a targeted limb alignment and preventing overcorrection.…”

Section: Discussionmentioning

confidence: 71%

“…By contrast, the incidence of overcorrection showed an increasing tendency as surgical experience increases. Several studies 23 – 27) have reported that overcorrection in MOWHTO is associated with soft tissue laxity. Kyung et al 24) have reported that bony correction in MOWHTO could be consistently achieved in their navigation study; however, the bony correction was not consistent with the change of mechanical limb alignment.…”

Section: Discussionmentioning

confidence: 99%

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The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

Lee

Kim

Ham

et al. 2018

Knee Surg Relat Res

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PurposeThe purpose of this study was to investigate whether surgical experience could improve surgical competency in medial open wedge high tibial osteotomy (MOWHTO).Materials and MethodsOne hundred consecutive cases of MOWHTO were performed with preoperative planning using the Miniaci method. Surgical errors were defined as under- or overcorrection, excessive posterior slope change, or the presence of a lateral hinge fracture. Each of these treatment failures was separately evaluated using the cumulative summation test for learning curve (LC-CUSUM).ResultsThe LC-CUSUM showed competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture after 27, 47, and 42 procedures, respectively. However, the LC-CUSUM did not signal achievement of competency in prevention of overcorrection after 100 procedures. Furthermore, the failure rate for overcorrection showed an increasing tendency as surgical experience increased.ConclusionsSurgical experience may improve the surgeon’s competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture. However, it may not help reduce the incidence of overcorrection even after performance of 100 cases of MOWHTO over a period of 6 years.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

Lee

Kim

Ham

et al. 2018

Knee Surg Relat Res

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“…Therefore, our findings showed that the postoperative WBL ratio moved more laterally than template during the preoperative planning. In addition, unintended decrease of the JLCA [ 18 , 19 ] might result in a little more laterally postoperative WBL ratio. The medial movement of hinge position from most lateral had also affected a little more WBL ratio than 62% after OWHTO.…”

Section: Discussionmentioning

confidence: 99%

Should sagittal osteotomy line be parallel to tibial posterior slope in high tibial osteotomy?

Akamatsu

Kobayashi

Tsuji

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe reason why the osteotomy line in the sagittal view should be parallel to the medial tibial posterior slope in open wedge high tibial osteotomy (OWHTO) remains unclear. In addition, previous study reported that a posterolateral hinge position led to an increase in tibial posterior slope (TPS) after OWHTO. Our aims were to examine the relationships between angles among the tibial plateau and osteotomy planes or the hinge point and the change in TPS, and the location of the hinge position after OWHTO using three-dimensional computed tomography (3DCT). We hypothesized that the sagittal angle between the tibial plateau and osteotomy planes with an anterior-widening proximal tibial fragment resulted in increased TPS, and the hinge position located posterolaterally.MethodsPreoperative planning anticipated a weight-bearing line ratio of 62% on the radiograph. The anterior gap was 67% of the posterior gap in OWHTO. We identified the tibial plateau and upper and lower osteotomy planes on 3DCT of 82 patients with symptomatic medial osteoarthritic knee after OWHTO. The osteotomy plane angles between the tibial plateau and upper osteotomy planes, and opening gap angles between both osteotomy planes in the coronal and sagittal views were measured. The anteroposterior (AP) and lateral hinge position was displayed as a percentage on the upper osteotomy plane. We assessed the relationships among them.ResultsThe TPS significantly increased after OWHTO (p = 0.002). There was no significant difference between the sagittal osteotomy plane angle and the change in TPS. The sagittal opening gap angle and the AP hinge position ratio were significantly correlated with the change in the TPS (r = 0.477 p < 0.001 and r = − 0.342, p = 0.002, respectively). The hinge position was located a mean of 16.0% from the lateral and 48.6% from the posterior tibial edge in the upper osteotomy plane.ConclusionsContrary to our expectation, the osteotomy plane did not need to be parallel to the tibial plateau plane in the sagittal view. However, the osteotomy gap should be rectangular in the sagittal view. The hinge position located nearly in the center of the sagittal view.

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“…25,37,43 The most common method for quantifying soft tissue laxity is to measure the changes in the joint-line convergence angle (JLCA). 11,25,27 Lee et al 27 indicated that changes in JLCA correlated with correction errors and that a large JLCA change correlated with overcorrection. Heijens et al 11 also reported that the bony correction in MOWPTO is accompanied by additional JLCA changes by stretching the medial soft tissue.…”

mentioning

confidence: 99%

“…11,25,27 Lee et al 27 indicated that changes in JLCA correlated with correction errors and that a large JLCA change correlated with overcorrection. Heijens et al 11 also reported that the bony correction in MOWPTO is accompanied by additional JLCA changes by stretching the medial soft tissue. Park et al 37 noted that overcorrection was more likely to occur in cases presenting a !4 JLCA and a !1.5 valgus stress angle.…”

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confidence: 99%

Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy

Ryu

Lee

Jung

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Soft tissue laxity around the knee joint has been recognized as a crucial factor affecting correction error during medial open-wedge proximal tibial osteotomy (MOWPTO). Medial laxity in particular, which represents the changes in joint-line convergence angle (JLCA), affects soft tissue correction. Purpose: The purpose of this study was to quantify medial laxity and develop a preoperative planning method that considers medial laxity. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed 139 knees in 117 patients who underwent navigation-assisted MOWPTO from January 2014 to July 2019 for symptomatic medial compartment osteoarthritis with varus alignment >5°. We compared the results of 2 preoperative planning methods: conventional Miniaci (n = 47) and latent medial laxity reduction (LMLR) (n = 92). We evaluated the incidence of undercorrection, acceptable correction, and overcorrection. The radiologic parameters were analyzed using multiple linear regression with a stepwise selection model to establish an equation for the optimal preoperative planning method. The intraclass correlation coefficients (ICCs) of intraobserver, interobserver, and intermethod reliability were calculated. Results: The Miniaci method showed a higher incidence of overcorrection (55.3%) than the LMLR method (22.8%) at postoperative 6 months ( P = .0006). Multiple linear regression with a stepwise selection model revealed a high correlation coefficient ( R 2 = 0.888) for the following equation: Adjusted planned correction angle = 0.596 + 0.891 × Target correction angle – 0.255 × Δ JLCA valgus. Upon simplification, the following equation showed the highest intermethod ICC value (0.991): Target correction angle – ⅓Δ JLCA valgus, while the Miniaci method showed a relatively low ICC value of 0.875. Conclusion: There was a risk of overcorrection after MOWPTO using the conventional Miniaci method. An equation that considers medial laxity may help during preoperative planning for optimal correction during MOWPTO.

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The coronal hypomochlion

Abstract: It is recommended to plan realignment for medial open wedge high tibial osteotomy at a maximum of 2° valgus. Cite this article: Bone Joint J 2016;98-B:628-33.

Cited by 31 publications

References 13 publications

The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

Should sagittal osteotomy line be parallel to tibial posterior slope in high tibial osteotomy?

Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy

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