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The medial open-wegde osteotomy generates progressive intrameniscal integrity changes in the lateral knee compartment: a prospective MR-assessment after valgic osteotomy in the varus gonarthritic knee

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Meniscal changes in the lateral knee compartment after medial-opening high tibial osteotomy (HTO) with valgic overcorrection have not been investigated clinically with magnetic resonance imaging (MRI). The hypothesis of this study was that HTO with valgic overcorrection affects the lateral compartment due to the change in the bearing axis and the shift in the pressure load from the medial to the lateral compartment. This should lead to an accelerated degeneration of the lateral compartment.

Methods

Twenty-four patients (mean age, 45.7 ± 7.6 years) were prospectively and longitudinally monitored with MRI after medial-opening high tibial osteotomy. The degeneration of the meniscus was assessed at the anterior horn, pars intermedia, and posterior horn using the Stoller classification. The morphological changes were also assessed at the anterior horn, pars intermedia, and posterior horn using the relative vertical and transverse diameters of the examined part of the meniscus, according to the ratio maximal meniscal diameter/maximal tibial width. These parameters were analyzed preoperatively and at follow-up (mean 5.3 ± 1.5 years after surgery).

Results

During the follow-up period, there were no significant morphological changes in either the anterior horn, pars intermedia, or posterior horn. Nor were there any correlations between the morphological parameters, bodyweight, and the follow-up period. Despite these findings, an MRI evaluation showed progressive degeneration in every part of the meniscus according to the Stoller classification, and this was significant at the anterior horn (p < 0.01), pars intermedia (p = 0.021), and posterior horn (p < 0.01).

Conclusion

High tibial osteotomy did not lead to morphological changes in the external meniscus over a follow-up period of 5.3 ± 1.5 years. However, progressive degeneration of the meniscus was observed in the imaging data. Further research is required to confirm the observed degeneration and to evaluate the consequences of the observed degeneration.

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References

  1. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584

    Article  CAS  Google Scholar 

  2. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861

    Article  Google Scholar 

  3. Ahn JH, Shim JS, Hwang CH, Oh WH (2001) Discoid lateral meniscus in children: clinical manifestations and morphology. J Pediatr Orthop 21:812–816

    CAS  PubMed  Google Scholar 

  4. Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:197–205

    Article  Google Scholar 

  5. Becker R, Hirschmann M (2017) The pertinent question in treatment of unicompartmental osteoarthritis of the knee: high tibial osteotomy or unicondylar knee arthroplasty or total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:637–638

    Article  Google Scholar 

  6. Coventry MB (2001) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. JBJS 83:1426

    Article  Google Scholar 

  7. Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M et al (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359:1108–1115

    Article  CAS  Google Scholar 

  8. Englund M, Haugen IK, Guermazi A, Roemer FW, Niu J, Neogi T et al (2016) Evidence that meniscus damage may be a component of osteoarthritis: the Framingham study. Osteoarthr Cartil 24:270–273

    Article  CAS  Google Scholar 

  9. Felson DT, Niu J, Gross KD, Englund M, Sharma L, Cooke TDV et al (2013) Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the multicenter osteoarthritis study and the osteoarthritis initiative. Arthritis Rheum 65:355–362

    Article  Google Scholar 

  10. Fine KM, Glasgow SG, Torg JS (1995) Tibial chondral fissures associated with the lateral meniscus. Arthroscopy 11:292–295

    Article  CAS  Google Scholar 

  11. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin N Am 10:585–608

    CAS  Google Scholar 

  12. Hantes ME, Natsaridis P, Koutalos AA, Ono Y, Doxariotis N, Malizos KN (2017) Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4816-z

    Article  PubMed  Google Scholar 

  13. Heller MO, Matziolis G, König C, Taylor WR, Hinterwimmer S, Graichen H et al (2007) Musculosceletal biomechanic of the knee joint, in German. Orthopade 36:628–634

    Article  CAS  Google Scholar 

  14. Lee C-R, Bin S-I, Kim J-M, Kim N-K (2016) Magnetic Resonance imaging findings in symptomatic patients after arthroscopic partial meniscectomy for torn discoid lateral meniscus. Arthroscopy 32:2366–2372

    Article  Google Scholar 

  15. Lewandrowski K-U, Müller J, Schollmeier G (1997) Concomitant meniscal and articular cartilage lesions in the femorotibial joint. Am J Sports Med 25:486–494

    Article  CAS  Google Scholar 

  16. Lobenhoffer P (2014) Importance of osteotomy around to the knee for medial gonarthritis. Indications, technique and results. Orthopade 43:425–431

    Article  CAS  Google Scholar 

  17. Madry H, Ziegler R, Pape D, Cucchiarini M (2014) Structural changes in the lateral tibiofemoral compartment after high tibial osteotomy. Orthopade 43:958–965

    Article  CAS  Google Scholar 

  18. Parker DA, Beatty KT, Giuffre B, Scholes CJ, Coolican MRJ (2011) Articular cartilage changes in patients with osteoarthritis after osteotomy. Am J Sports Med 39:1039–1045

    Article  Google Scholar 

  19. Parker DA, Viskontas DG (2007) Osteotomy for the early varus arthritic knee. Sports Med Arthrosc 15:3–14

    Article  Google Scholar 

  20. Pujol N, Panarella L, Selmi TAS, Neyret P, Fithian D, Beaufils P (2008) Meniscal healing after meniscal repair: A CT arthrography assessment. Am J Sports Med 36:1489–1495

    Article  Google Scholar 

  21. Rosenthal R (1991) Meta-analytic procedures for social research. Sage Publications, Thousand Oaks, p 155

    Book  Google Scholar 

  22. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR (2016) High tibial osteotomy: a systematic review and current concept. Arch Bone Jt Surg 4:204–212

    PubMed  PubMed Central  Google Scholar 

  23. Samoto N, Kozuma M, Tokuhisa T, Kobayashi K (2002) Diagnosis of discoid lateral meniscus of the knee on MR imaging. Magn Reson Imaging 20:59–64

    Article  Google Scholar 

  24. Schuster P, Gesslein M, Schlumberger M, Mayer P, Mayr R, Oremek D et al (2018) Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 46:1362–1370

    Article  Google Scholar 

  25. Spahn G, Klinger HM, Harth P, Hofmann GO (2012) Cartilage regeneration after high tibial osteotomy. Results of an arthroscopic study. Z Orthop Unfall 150:272–279

    Article  CAS  Google Scholar 

  26. Spahn G, Plettenberg H, Hoffmann M, Klemm H-T, Brochhausen-Delius C, Hofmann GO (2017) The frequency of cartilage lesions in non-injured knees with symptomatic meniscus tears: results from an arthroscopic and NIR- (near-infrared) spectroscopic investigation. Arch Orthop Trauma Surg 137:837–844

    Article  Google Scholar 

  27. Stoller DW, Martin C, Crues JV, Kaplan L, Mink JH (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163:731–735

    Article  CAS  Google Scholar 

  28. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  29. van Outeren MV, Waarsing JH, Brouwer RW, Verhaar JAN, Reijman M, Bierma-Zeinstra SMA (2017) Is a high tibial osteotomy (HTO) superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis (OA)? A propensity matched study using 2 randomized controlled trial (RCT) datasets. Osteoarthr Cartil 25:1988–1993

    Article  Google Scholar 

  30. W-Dahl A, Toksvig-Larsen S, Lindstrand A (2017) Ten-year results of physical activity after high tibial osteotomy in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 25:902–909

    Article  Google Scholar 

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Acknowledgements

The authors thank the assistance of Dr. Johannes Herrmann in statistical guidance. The authors appreciate the support of performing the MR imaging of all medical technical assistants of the Department for Diagnostic and Interventional Radiology of our hospital, and our Department assistant, Brigitte Mack, for assistance in collecting the data.

Funding

The Magnetic Resonance Imaging was partially financed by third-party funds.

Author information

Authors and Affiliations

  1. Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany

    F. Bick, Y. Iffland, F. Welsch & Thomas Stein

  2. Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany

    F. Bick & R. Hoffmann

  3. Department of Sports Science, University of Bielefeld, Bielefeld, Germany

    E. Zimmermann & Thomas Stein

Authors
  1. F. Bick
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  2. Y. Iffland
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  3. E. Zimmermann
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  4. F. Welsch
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  5. R. Hoffmann
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  6. Thomas Stein
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Corresponding author

Correspondence to Thomas Stein.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The local Ethics Committee approved all the procedures performed (Ethic Committee of “Landesärztekammer Hessen, Frankfurt am Main”, ID number FF 81/2014).

Informed consent

All the subjects gave their informed consent to the procedures.

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Bick, F., Iffland, Y., Zimmermann, E. et al. The medial open-wegde osteotomy generates progressive intrameniscal integrity changes in the lateral knee compartment: a prospective MR-assessment after valgic osteotomy in the varus gonarthritic knee. Knee Surg Sports Traumatol Arthrosc 27, 1339–1346 (2019). https://doi.org/10.1007/s00167-018-5073-5

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