Skip to main content
SpringerLink
Log in

Sagittal osteotomy inclination in medial open-wedge high tibial osteotomy

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

Abstract

Purpose

Unlike postoperative changes in posterior tibial slope after medial open-wedge high tibial osteotomy, sagittal osteotomy inclination has not been examined. It has been recommended that the osteotomy line in the sagittal plane be parallel to the medial posterior tibial slope. The purpose of this study was to determine the frequency of parallel osteotomy in medial open-wedge high tibial osteotomy.

Methods

To determine the sagittal osteotomy inclination, the angle between the medial joint line and the osteotomy line was measured in the lateral radiograph. A positive angle value indicates that the osteotomy is anteriorly inclined relative to the medial posterior tibial slope. Correlation between the sagittal osteotomy inclination and posterior tibial slope was also evaluated.

Results

The mean sagittal osteotomy inclination was 15.1 ± 7.5°. The majority 87.1 % of knees showed an anterior-inclined osteotomy. There was a significantly positive correlation between the postoperative posterior tibial slope and the sagittal osteotomy inclination (r, 0.33; 95 % confidence interval (CI) 0.19–0.46; P < 0.001). The postoperative change in posterior tibial slope also showed a significantly positive correlation with the sagittal osteotomy inclination (r, 0.35; 95 % CI 0.21–0.47; P < 0.001).

Conclusion

Although parallel osteotomy in the sagittal plane relative to the medial joint line was planned, only 12.9 % of cases achieved osteotomy parallel to the medial posterior tibial slope in the sagittal plane. Because of high rate of the anterior-inclined osteotomy and their correlations with posterior tibial slope, surgeons should make all efforts to perform parallel osteotomy relative to medial posterior tibial slope.

Level of evidence

IV

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90:592–596

    Article  CAS  PubMed  Google Scholar 

  2. Amendola A (2003) Unicompartmental osteoarthritis in the active patient: the role of high tibial osteotomy. Arthroscopy 19(Suppl 1):109–116

    Article  PubMed  Google Scholar 

  3. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  CAS  PubMed  Google Scholar 

  4. Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, Castoldi F, Rossi R (2014) Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med 42:690–698

    Article  PubMed  Google Scholar 

  5. Chae DJ, Shetty GM, Lee DB, Choi HW, Han SB, Nha KW (2008) Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 15:128–133

    Article  PubMed  Google Scholar 

  6. Cho SW, Kim DH, Lee GC, Lee SH, Park SH (2013) Comparison between autogenous bone graft and allogenous cancellous bone graft in medial open wedge high tibial osteotomy with 2-Year follow-up. Knee Surg Relat Res 25:117–125

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cooley VJ, Deffner KT, Rosenberg TD (2001) Quadrupled semitendinosus anterior cruciate ligament reconstruction: 5-year results in patients without meniscus loss. Arthroscopy 17:795–800

    Article  CAS  PubMed  Google Scholar 

  8. Cotic M, Vogt S, Feucht MJ, Saier T, Minzlaff P, Hinterwimmer S, Imhoff AB (2014) Prospective evaluation of a new plate fixator for valgus-producing medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3287-8

    Google Scholar 

  9. Cotic M, Vogt S, Hinterwimmer S, Feucht MJ, Slotta-Huspenina J, Schuster T, Imhoff AB (2014) A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek-carbon composite plate versus titanium plate. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2914-8

    Google Scholar 

  10. El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S (2010) Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38:323–329

    Article  PubMed  Google Scholar 

  11. 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: a retrospective radiological review of 120 cases. J Bone Joint Surg Br 90:1193–1197

    Article  CAS  PubMed  Google Scholar 

  12. Eriksson K, Hamberg P, Jansson E, Larsson H, Shalabi A, Wredmark T (2001) Semitendinosus muscle in anterior cruciate ligament surgery: morphology and function. Arthroscopy 17:808–817

    Article  CAS  PubMed  Google Scholar 

  13. Fleiss JL, Levin BA, Paik MC (2003) Statistical methods for rates and proportions, 3rd edn./Joseph L. Fleiss, Bruce Levin, Myunghee Cho Paik, edn. Wiley-Interscience, Hoboken, NJ

  14. Fu F, Christel P, Miller MD, Johnson DL (2009) Graft selection for anterior cruciate ligament reconstruction. Instr Course Lect 58:337–354

    PubMed  Google Scholar 

  15. 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 North Am 10:585–608

    CAS  PubMed  Google Scholar 

  16. Han SB, Bae JH, Lee SJ, Jung TG, Kim KH, Kwon JH, Nha KW (2014) Biomechanical properties of a new anatomical locking metal block plate for opening wedge high tibial osteotomy: uniplane osteotomy. Knee Surg Relat Res 26:155–161

    Article  PubMed  PubMed Central  Google Scholar 

  17. Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW (2013) A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 21:90–95

    Article  CAS  PubMed  Google Scholar 

  18. Hernigou P (2002) Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee 9:15–20

    Article  PubMed  Google Scholar 

  19. Jung KA, Kim SJ, Lee SC, Song MB, Yoon KH (2008) ‘Fine-tuned’ correction of tibial slope with a temporary external fixator in opening wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16:305–310

    Article  PubMed  Google Scholar 

  20. Jung KA, Lee SC, Hwang SH, Song MB (2009) ACL injury while jumping rope in a patient with an unintended increase in the tibial slope after an opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 129:1077–1080

    Article  PubMed  Google Scholar 

  21. Lee DC, Byun SJ (2012) High tibial osteotomy. Knee Surg Relat Res 24:61–69

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lee YS, Park SJ, Shin VI, Lee JH, Kim YH, Song EK (2010) Achievement of targeted posterior slope in the medial opening wedge high tibial osteotomy: a mathematical approach. Ann Biomed Eng 38:583–593

    Article  PubMed  Google Scholar 

  23. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    Article  PubMed  Google Scholar 

  24. Lobenhoffer P, Galla M, Agneskirchner JD (2008) Osteotomies around the knee: indications, planning, surgical techniques using plate fixators. Thieme, Stuttgart

    Google Scholar 

  25. Lobenhoffer P, Heerwaarden Rv, Agneskirchner J (2014) Kniegelenknahe osteotomien indikation; planung; operationstechniken mit plattenfixateuren. Thieme publisher, Teningen

  26. Longino PD, Birmingham TB, Schultz WJ, Moyer RF, Giffin JR (2013) Combined tibial tubercle osteotomy with medial opening wedge high tibial osteotomy minimizes changes in patellar height: a prospective cohort study with historical controls. Am J Sports Med 41:2849–2857

    Article  PubMed  Google Scholar 

  27. Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25:639–646

    Article  PubMed  Google Scholar 

  28. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 246:250–259

    Google Scholar 

  29. Mochizuki T, Akita K, Muneta T, Sato T (2004) Pes anserinus: layered supportive structure on the medial side of the knee. Clin Anat 17:50–54

    Article  PubMed  Google Scholar 

  30. Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387

    Article  PubMed  Google Scholar 

  31. Rodner CM, Adams DJ, Diaz-Doran V, Tate JP, Santangelo SA, Mazzocca AD, Arciero RA (2006) Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med 34:1431–1441

    Article  PubMed  Google Scholar 

  32. Rossi R, Bonasia DE, Amendola A (2011) The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 19:590–599

    Article  PubMed  Google Scholar 

  33. Saito T, Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y (2014) Five- to ten-year outcome following medial opening-wedge high tibial osteotomy with rigid plate fixation in combination with an artificial bone substitute. Bone Joint J 96:339–344

    Article  PubMed  Google Scholar 

  34. Sariali E, Catonne Y (2009) Modification of tibial slope after medial opening wedge high tibial osteotomy: clinical study and mathematical modelling. Knee Surg Sports Traumatol Arthrosc 17:1172–1177

    Article  PubMed  Google Scholar 

  35. Schaefer TK, Majewski M, Hirschmann MT, Friederich NF (2008) Comparison of sagittal and frontal plane alignment after open- and closed-wedge osteotomy: a matched-pair analysis. J Int Med Res 36:1085–1093

    Article  CAS  PubMed  Google Scholar 

  36. Song EK, Seon JK, Park SJ (2007) How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 30:S127–S131

    PubMed  Google Scholar 

  37. Song EK, Seon JK, Park SJ, Jeong MS (2010) The complications of high tibial osteotomy: closing- versus opening-wedge methods. J Bone Joint Surg Br 92:1245–1252

    Article  CAS  PubMed  Google Scholar 

  38. Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34(Suppl 2):B55–B62

    Article  PubMed  Google Scholar 

  39. Wang JH, Bae JH, Lim HC, Shon WY, Kim CW, Cho JW (2009) Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope. Am J Sports Med 37:2411–2418

    Article  PubMed  Google Scholar 

  40. Yang JH, Lee SH, Nathawat KS, Jeon SH, Oh KJ (2013) The effect of biplane medial opening wedge high tibial osteotomy on patellofemoral joint indices. Knee 20:128–132

    Article  CAS  PubMed  Google Scholar 

  41. Yoo JH, Chang CB, Shin KS, Seong SC, Kim TK (2008) Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes. J Arthroplasty 23:586–592

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, 421 Siheung-daero, Geumcheon-gu, Seoul, 08523, Republic of Korea

    Seung-Yup Lee & Hong-Chul Lim

  2. Department of Orthopaedic Surgery, College of Medicine, Guro Hospital, Korea University, 80, Guro-dong, Guro-gu, Seoul, 152-703, Republic of Korea

    Ji Hoon Bae

  3. Department of Orthopaedic Surgery, College of Medicine, Ansan Hospital, Korea University, 516, Gojan 1-dong, Danwon-gu, Ansan, 425-707, Republic of Korea

    Jae Gyoon Kim

  4. Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 6-2, Dunchon-dong, Kangdong-gu, Seoul, 134-791, Republic of Korea

    Se-Hyeok Yun, Jae-Hyuk Yang & Jung-Ro Yoon

Authors
  1. Seung-Yup Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong-Chul Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ji Hoon Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jae Gyoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Se-Hyeok Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jae-Hyuk Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jung-Ro Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jung-Ro Yoon.

Ethics declarations

Conflict of interest

The authors of this manuscript have no financial conflicts of interest to report regarding this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, SY., Lim, HC., Bae, J.H. et al. Sagittal osteotomy inclination in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25, 823–831 (2017). https://doi.org/10.1007/s00167-016-4115-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4115-0

Keywords

Search

Navigation