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Transverse osteotomy closer to tibial plateau is associated with larger postoperative change in valgus laxity after open-wedge high tibial osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To identify the factors impacting changes in valgus laxity between before and after open-wedge high tibial osteotomy (OW-HTO) using quantitative valgus stress radiographs.

Methods

A total of 40 knees from 38 patients who underwent OW-HTO were assessed. The study population comprised 14 men and 24 women, with a mean age of 61.5 years. Valgus stress radiographs before and 1 year after OW-HTO were performed using a Telos device. The difference between pre- and postoperative joint line convergence angle (JLCA) was expressed as ΔJLCA (post–pre). As indicators of the proximal detachment of superficial medial collateral ligament (sMCL) on radiographs, two distances were defined: the distance from the level of the osteotomy starting point to the tangent line of the proximal tibial plateau (Distance A), or to the medial edge of the proximal tibial plateau (Distance B). Correlations between ΔJLCA and radiographic parameters or KOOS sub-scores were assessed using Spearman’s rank correlation coefficient analysis. Receiver operator curves were generated to evaluate the predictive strength of the significant factor for an increase in ΔJLCA > 1°.

Results

Pre-operative OA severity consisted of Kellgren–Lawrence grade 2 (n = 18), 3 (n = 16), and 4 (n = 6). The average ΔJLCA (post–pre) was 0.5°, and ranged from − 1.4° to + 3.0°. The maximum systemic measurement error and limits of agreement were 0.07° and 0.20°, respectively. There were significant correlations between ΔJLCA and Distance A (36.9 ± 3.9 mm, R =  − 0.46, p = 0.002), between ΔJLCA and Distance B (39.9 ± 4.0 mm, R =  − 0.49, p = 0.001). The cut-off value for Distance A was determined to be 35 mm below the tibial plateau; the AUC was 0.804, with a sensitivity of 0.75 and a specificity of 0.82. Distance B correlated strongly with Distance A (R = 0.96, p < 0.001). There was no significant correlation between ΔJLCA and KOOS sub-scores 1 year after OW-HTO.

Conclusions

Transverse osteotomy closer to tibial plateau was associated with larger valgus joint laxity postoperatively. This finding implies that sMCL proximal detachment, which was related to the level of the osteotomy starting point on the proximal tibia, potentially affected postoperative valgus laxity.

Level of evidence

IV.

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Abbreviations

OW-HTO:

Open-wedge high tibial osteotomy

OA:

Osteoarthritis

sMCL:

Superficial medial collateral ligament

TKA:

Total knee arthroplasty

JLCA:

Joint line convergence angle

HKAA:

Hip–knee–ankle angle

%MA:

Percentage of mechanical axis

MPTA:

Medial proximal tibial angle

References

  1. 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  PubMed  Google Scholar 

  2. Bagherifard A, Jabalameli M, Mirzaei A, Khodabandeh A, Abedi M, Yahyazadeh H (2020) Retaining the medial collateral ligament in high tibial medial open-wedge osteotomy mostly results in post-operative intra-articular gap reduction. Knee Surg Sports Traumatol Arthrosc 28:1388–1393

    Article  PubMed  Google Scholar 

  3. Freisinger GM, Schmitt LC, Wanamaker AB, Siston RA, Chaudhari AMW (2017) Tibiofemoral osteoarthritis and varus-valgus laxity. J Knee Surg 30:440–451

    Article  PubMed  Google Scholar 

  4. Gaudiani MA, Knapik DM, Kaufman MW, Salata MJ, Voos JE, Karns MR (2020) Percutaneous superficial medial collateral ligament release outcomes during medial meniscal arthroscopy: a systematic review. Arthrosc Sports Med Rehabil 2:e153–e159

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kappel A, Mortensen JF, Nielsen PT, Odgaard A, Laursen M (2020) Reliability of stress radiography in the assessment of coronal laxity following total knee arthroplasty. Knee 27:221–228

    Article  PubMed  Google Scholar 

  6. LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89:2000–2010

    Article  Google Scholar 

  7. Okazaki K, Miura H, Matsuda S, Takeuchi N, Mawatari T, Hashizume M et al (2006) Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 11:264–266

    Article  PubMed  Google Scholar 

  8. Pape D, Duchow J, Rupp S, Seil R, Kohn D (2006) Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy. A human cadaver study evaluating medial joint opening by stress radiography. Knee Surg Sports Traumatol Arthrosc 14:141–148

    Article  PubMed  Google Scholar 

  9. Sato D, Kondo E, Yabuuchi K, Onodera J, Onodera T, Yagi T et al (2019) Assessment of valgus laxity after release of the medial structure in medial open-wedge high tibial osteotomy: an in vivo biomechanical study using quantitative valgus stress radiography. BMC Musculoskelet Disord 20:481

    Article  PubMed  PubMed Central  Google Scholar 

  10. Seitz AM, Nelitz M, Ignatius A, Durselen L (2019) Release of the medial collateral ligament is mandatory in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:2917–2926

    Article  PubMed  Google Scholar 

  11. Seo SS, Kim CW, Seo JH, Kim DH, Lee CR (2016) Does superficial medial collateral ligament release in open-wedge high tibial osteotomy for varus osteoarthritic knees increase valgus laxity? Am J Sports Med 44:908–915

    Article  PubMed  Google Scholar 

  12. Sharma L, Lou C, Felson DT, Dunlop DD, Kirwan-Mellis G, Hayes KW et al (1999) Laxity in healthy and osteoarthritic knees. Arthritis Rheum 42:861–870

    Article  CAS  PubMed  Google Scholar 

  13. Song SJ, Bae DK, Kim KI, Lee CH (2016) Conversion total knee arthroplasty after failed high tibial osteotomy. Knee Surg Relat Res 28:89–98

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ushio T, Mizu-Uchi H, Okazaki K, Miyama K, Akasaki Y, Ma Y et al (2019) Medial soft tissue contracture does not always exist in varus osteoarthritis knees in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:1642–1650

    Article  PubMed  Google Scholar 

  15. van der Esch M, Steultjens M, Wieringa H, Dinant H, Dekker J (2005) Structural joint changes, malalignment, and laxity in osteoarthritis of the knee. Scand J Rheumatol 34:298–301

    Article  PubMed  Google Scholar 

  16. van Egmond N, Hannink G, Janssen D, Vrancken AC, Verdonschot N, van Kampen A (2017) Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time. Knee Surg Sports Traumatol Arthrosc 25:800–807

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

There was no funding in this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yu Soejima, Yukio Akasaki, Satoshi Hamai, Hidetoshi Tsushima, Shinya Kawahara & Yasuharu Nakashima

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  1. Yu Soejima
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  2. Yukio Akasaki
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  3. Satoshi Hamai
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  4. Hidetoshi Tsushima
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  5. Shinya Kawahara
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  6. Yasuharu Nakashima
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Correspondence to Yukio Akasaki.

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Ethical approval was provided in the Methods just before statistical analysis.

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Soejima, Y., Akasaki, Y., Hamai, S. et al. Transverse osteotomy closer to tibial plateau is associated with larger postoperative change in valgus laxity after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 30, 3983–3991 (2022). https://doi.org/10.1007/s00167-021-06810-6

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  • DOI: https://doi.org/10.1007/s00167-021-06810-6

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