ACL degeneration after an excessive increase in the medial proximal tibial angle with medial open wedge high tibial osteotomy

  • Hiroyasu Ogawa
  • Kazu MatsumotoEmail author
  • Haruhiko Akiyama



This study examined the influence of the mechanical medial proximal tibial angle (MPTA) on anterior cruciate ligament (ACL) degeneration following open wedge high tibial osteotomy (OWHTO). It was hypothesised that an excessive increase in MPTA would be associated with ACL degeneration following OWHTO.


Seventy-four knees treated with OWHTO were retrospectively examined. Arthroscopic ACL grading [0 (intact) to 4 (complete rupture)], anterior tibial translation (ATT) test at the time of OWHTO with the index arthroscopy and at plate removal with the second-look arthroscopy, clinical assessments using the Knee Society Score (KSS), and radiographic evaluations of MPTA were performed. The relationship between MPTA and the ACL condition was analysed using Spearman’s correlation.


The time from the index arthroscopy to the second-look arthroscopy was 15.0 ± 4.4 months; the total follow-up was 31.0 ± 6.5 months. ACL grade significantly increased from 0.6 ± 0.8 (index arthroscopy) to 1.1 ± 1.2 (second-look arthroscopy) (p < 0.0018). ATT on the operated side significantly decreased from 7.1 ± 2.6 mm preoperatively to 5.3 ± 2.3 mm at the time of plate removal (p < 0.001). No significant difference was observed in KSS for ACL grades in the steady and progression groups. Changes in MPTA from the preoperative to postoperative period were significantly higher in the progression group (p = 0.0155). Changes in ACL grades were significantly correlated with preoperative MPTA and changes in MPTA (r = − 0.365 and 0.343, respectively; p < 0.01).


Excessively increased MPTA led to ACL degeneration following OWHTO. ACL degeneration was not associated with short-term clinical outcomes. Excessive correction of MPTA should be avoided to prevent ACL degeneration following OWHTO.

Level of evidence

Therapeutic case series, Level IV.


Medial proximal tibial angle Anterior cruciate ligament High tibial osteotomy Knee Society Score Anterior tibial translation 



No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Hiroyasu Ogawa
    • 1
    • 2
  • Kazu Matsumoto
    • 1
    Email author
  • Haruhiko Akiyama
    • 1
  1. 1.Department of Orthopaedic SurgeryGifu University Graduate School of MedicineGifuJapan
  2. 2.Department of Advanced Joint Reconstructive SurgeryGifu University Graduate School of MedicineGifuJapan

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