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Additional anteromedial staple fixation prevents changes in the posterior tibial slope in retrotuberosity bi-planar open-wedge high tibial osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare the changes in posterior tibial slope (PTS) between retrotuberosity biplane open-wedge high tibial osteotomies (RT-OWHTOs) with and without additional anteromedial staple fixation.

Methods

Seventy-nine and 77 cases of RT-OWHTOs without (Group N) and with (Group S) additional staple fixation, respectively, were retrospectively reviewed. All procedures were performed using a locking spacer plate. Demographics and preoperative knee condition were similar between the groups. Clinically, the Western Ontario and McMaster Universities Arthritis Index and range of motion were evaluated preoperatively and 2 years postoperatively. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and PTS were evaluated preoperatively and within 2 years postoperatively. Hinge fractures were investigated using computed tomography at 2 weeks postoperatively. PTS loss was defined as the difference between the corresponding values at 2 weeks and 2 years postoperatively. The incidence of PTS failure (PTS loss ≥  ± 3°) was also investigated.

Results

The clinical results were not significantly different between groups N and S preoperatively and 2 years postoperatively. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively; changes in these variables did not differ significantly between the groups. The incidence of hinge fractures, all of which were categorized as Takeuchi type 1, did not differ significantly. PTS loss within 2 years postoperatively was significantly greater in group N than in group S (1.0° vs. 0.1°; p < 0.01). The incidence of the PTS failure was 16.5% (13/79) and 2.6% (2/77) in groups N and S, respectively (p < 0.01).

Conclusion

Additional anteromedial staple fixation could prevent changes in the PTS in RT-OWHTO. It is a simple method for preventing an increase in the PTS after RT-OWHTO.

Level of evidence

III.

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Data availability

Our data are available in the figashare repository (https://doi.org/10.6084/m9.figshare.22696285.v1).

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Funding

No external funding was used for this retrospective study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea

    Kyoung Ho Yoon, Sang Jun Song, Sung Hyun Hwang, Dae Hyeok Kim & Cheol Hee Park

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  1. Kyoung Ho Yoon
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  2. Sang Jun Song
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  3. Sung Hyun Hwang
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  4. Dae Hyeok Kim
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  5. Cheol Hee Park
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Contributions

The following authors have made substantial contributions to the followings: (1) the conception and design of the study (KHY, SJS, and CHP), provision of study materials or patients (KHY and CHP), acquisition of data (HSL, DHK, and CHP), analysis and interpretation of data (all authors), (2) drafting the article (all authors), and (3) final approval of the version to be submitted (all authors).

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Correspondence to Cheol Hee Park.

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Conflict of interest

All authors have received no benefits in any form from a commercial party related directly or indirectly to the subject of this article.

IRB approval

The study was approved by the institutional review boards of our institutions (KHUH 2023-04-039).

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Yoon, K.H., Song, S.J., Hwang, S.H. et al. Additional anteromedial staple fixation prevents changes in the posterior tibial slope in retrotuberosity bi-planar open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 3956–3963 (2023). https://doi.org/10.1007/s00167-023-07427-7

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