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The Dugdale planning method for high tibial osteotomies underestimates the correction angle compared to the Miniaci method

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the planning methods of Dugdale and Miniaci for high tibial osteotomies (HTO) and to assess how their use could influence on the degree of correction and thus the postoperative weight bearing line (WBL).

Methods

Pre- and postoperative standing hip-knee-ankle (HKA) radiographs were obtained from 70 patients that underwent HTO. The correction angles were determined using Dugdale’s and Miniaci’s methods, and for the latter, both for an opening wedge as well for a closing wedge osteotomy. In a subset of 50 patients, the calculations were performed twice by two observers to calculate inter- and intra-rater reliability. Regression analysis and Bland–Altman plots were used to compare the methods. Whereas the Dugdale method had been used in the planning of the real operations, a regression model was used to predict how the obtained correction would have been if the Miniaci method had been used instead.

Results

Intra- and inter-rater reliability was excellent for the correction angle for both Dugdale’s (0.992 and 0.991) and Miniaci’s methods (0.988 and 0.987). When planning for an opening wedge osteotomy (OW) and a closing wedge osteotomy (CW), using the Miniaci method and comparing the correction angle with the angle obtained by the Dugdale method, the Miniaci OW and CW angles were larger by a factor of 1.07 (95% CI 1.06–1.08) and 1.10 (95% CI 1.09–1.11). Postoperatively, a mean undercorrection of 2.9° (SD = 2.3) was found. Predicting the correction with use of the calculated Miniaci angles resulted in an undercorrection of 2.5°, indicating that use of the Dugdale method accounted for 14% of the undercorrection.

Conclusion

It is more likely to underestimate the correction angle when using the Dugdale method compared to the Miniaci method. This could lead to poorer correction accuracy. As the inter-rater reliability is excellent for both methods, choosing to use the Dugdale method on basis of simplicity is not justified.

Level of evidence

III, Diagnostic study.

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Abbreviations

WBL:

Weight-bearing line

HTO:

High tibial osteotomy

HKA:

Hip–knee–ankle

CI:

Confidence interval

SD:

Standard deviation

ICC:

Intra-class correlation

SRD:

Smallest real difference

CR:

Coefficient of repeatability

SRM:

Standard error of measurement

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Acknowledgements

The authors are grateful to the patients that were willing to participate in the study.

Funding

No particular funding was provided to this work.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Nydalen, Postboks 4970, 0440, Oslo, Norway

    Einar Andreas Sivertsen

  2. Department of Orthopedic Surgery, Baerum Hospital, Baerum, Norway

    Jarle Vik

  3. Department of Orthopedic Surgery, Sykehuset Innlandet Hospital Trust, Lillehammer, Norway

    Arn Ståle Vålnes Meland

  4. Department of Orthopedic Surgery, Martina Hansens Hospital, Baerum, Norway

    Tor Kjetil Nerhus

Authors
  1. Einar Andreas Sivertsen
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  2. Jarle Vik
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  3. Arn Ståle Vålnes Meland
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  4. Tor Kjetil Nerhus
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Contributions

EAS participated in design of the study, analyzed the data and drafted the manuscript. JV participated in design of the study, collected data, and reviewed the manuscript. ASVM collected data and reviewed the manuscript. TKN participated in design of the study, collected data and reviewed the manuscript.

Corresponding author

Correspondence to Einar Andreas Sivertsen.

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Conflict of interest

The authors report no conflict of interest.

Ethical approval

The regional health ethics board approved the study with reference number 53-07027a 12007.70.

Informed consent

All participants consented to participate in the study.

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Sivertsen, E.A., Vik, J., Meland, A.S.V. et al. The Dugdale planning method for high tibial osteotomies underestimates the correction angle compared to the Miniaci method. Knee Surg Sports Traumatol Arthrosc 31, 1507–1514 (2023). https://doi.org/10.1007/s00167-021-06663-z

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  • DOI: https://doi.org/10.1007/s00167-021-06663-z

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