There are two established techniques for high tibial valgisation osteotomy (HTO): medial open wedge (MOW) and lateral closed wedge (LCW). The aim was to analyze the change of the posterior tibial slope (PTS) caused by HTOs dependent on the technique.
Four hundred fourteen cases of HTOs were analyzed retrospectively. Two hundred seventy-nine osteotomies in 247 patients matched the inclusion criteria and were divided into two treatment groups (MOW/LCW). The PTS was determined on pre- and post-surgical lateral knee X-rays by measuring the proximal posterior tibial angle (PPTA).
One hundred ninety of the included 279 cases were assigned to the MOW and 89 to the LCW group. The mean PPTA in MOW HTOs was 79.9° ± 32° (68–88°) and in LCW HTOs 80.6° ± 2.6° (74–88°). There was no statistically significant change of the PPTA in the MOW group comparing the pre- and post-surgical values (delta PPTA 0.07° ±2.9° (− 12 to 11°)). In the LCW group, the surgery resulted in a statistically significant reduction (p< 0.001) of the PTS (delta PPTA − 3.09° ± 4.5° (− 12 to 5°)).
The important finding of this study is that the thesis of a slope increase in MOW osteotomies found in the literature could not be approved regarding our results as no statistically significant change of PTS in MOW HTOs was observed. The findings support the common thesis that LCW osteotomies cause a slope reduction.
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Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion ostoeotomy 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(9):575–584
Black MS, d’Entremont AG, McCormack RG, Hansen G, Carr D, Wilson DR (2018) The effect of wedge an tibial slope angles on knee contact pressure and kinematics following medial opening-wedge high tibial osteotomy. Clin Biomech 51:17–25
Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A (1996) Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot 82(3):195–200
Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg (Br) 87(9):1227–1232
Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X, Zayni R, Bonnin M, Jalil R, Amzallag J, Rosset P, Servien E, Gaudot F, Judet T, Catonné Y (2012) Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study. Orthop Traumatol Surg Res 98(1):68–74
El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope. J Bone Joint Surg (Br) 90-B:1193–1197
Ferner F, Lutter C, Dickschas J, Strecker W (2018) Medial open wedge vs. lateral closed wedge high tibial osteotomy-indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases. Int Orthop. https://doi.org/10.1007/s00264-018-4155-9
Galla M, Lobenhoffer P (2004) Die öffnende valgisierende umstellungsosteotomie der proximalen tibia mit dem tomofix-plattenfixateur. Oper Orthop Traumatol 16:397–417
Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing the tibial slope on the biomechanics of the knee. Am J Sports Med 32:378–382
Hohmann E, Bryant A, Imhoff AB (2005) The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sport Traumtol Arthrosc 14:454–459
Kaper Bp, Bourne RB, Rorabeck CH, MacDonald SJ (2001) Patellar infera after high tibial osteotomy. J Arthroplast 16:168–173
LaPrade RF, Oro FP, Ziegler CG, Wijdicks CA, Walsh MP (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38:160–170
Matsuda S, Miura H, Nagamine R, Urabe K, Ikenoue T, Okazaki K, Iwamoto Y (1999) Posterior tibial slope in the normal and varus knee. Am J Knee Surg 12(3):165–168
Nha K-W, Kim H-J, Ahn H-S, Lee D-H (2016) Change in posterior tibial slope after open-wedge and closed-wedge high tibial osteotomy-a meta-analysis. Am J Sports Med 44(11):3006–3013
Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H (2016) Effect of wedge insertion angle on posterior tibial slope in medial opening wedge high tibial osteotomy. Orthop J Sports Med 4(2):2325967116630748. https://doi.org/10.1177/2325967116630748
Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465
Portner O (2014) High tibial valgus osteotomy: closing, opening or combined? Patellar height as a determining factor. Clin Orthop Relat Res 472:3432–3440
Smith TO, Sexton D, Mitchel P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 18:361–368
Strecker W, Muller M, Urschel C (2014) High tibial closed wedge valgus osteotomy. Oper Orthop Traumatol 26:196–205
Turgut A, Kayali C, Agus H (2012) Radiological analysis of closed-wedge high tibial osteotomy. Eklem Hastalik Cerrahisi 23(2):82–87
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Schubert, I., Ferner, F. & Dickschas, J. The effect of open-wedge and closed-wedge high tibial osteotomies on the tibial posterior slope—a study of two hundred seventy-nine cases. International Orthopaedics (SICOT) (2020). https://doi.org/10.1007/s00264-020-04499-9
- Posterior tibial slope
- Medial open wedge osteotomy (MOW)
- Lateral closed wedge osteotomy (LCW)