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Higher fibular head is a risk for lateral hinge fracture in medial open wedge high tibial osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To examine the association between the hinge position, fibular head position, and type III lateral hinge fracture (LHF) in patients with knee osteoarthritis (OA) who underwent medial open wedge high tibial osteotomy (MOWHTO).

Methods

This retrospective study examined patients who underwent MOWHTO. Radiographically, the Kellgren–Lawrence (K/L) classification, distance between the articular surface and the tip of the fibular head (fibular head position), hinge point (hinge position), type of LHF, and safe zone (within the proximal tibiofibular joint) outlier were evaluated. To determine the cut-off value of the hinge position and fibular head position associated with type III LHF, a receiver operating characteristic (ROC) curve analysis was performed. The odds ratio (OR) was calculated from the obtained cut-off values using logistic regression, which was adjusted by age, gender, body mass index, and opening distance.

Results

Among 132 knees in 120 patients, the radiographic severity of knee OA was 19 (14%), 73 (55%), and 40 (30%) of K/L grades 2, 3, and 4, respectively. LHF was observed in 40 knees (30%), including types I, II, and III fractures in 21 (16%), 5 (4%), and 14 (11%) knees, respectively. Hinge and fibular head positions were 16 and 10 mm, respectively, with significant correlation. Safe zone outlier was observed in 38 knees (29%). The hinge and fibular head positions with type III LHF were significantly higher (more cranial) than those with no fracture or other LHF subtypes. The ROC curve revealed that the cut-off value for the hinge and fibular head positions was 13.3 and 8.6 mm, respectively. The OR of the hinge and fibular head positions was 22.42 and 13.86, respectively.

Conclusions

A higher hinge position was a risk factor for type III LHF and was associated with a higher fibular head in patients with knee OA who underwent MOWHTO. The hinge position should be placed at a certain distance from the articular surface to avoid type III LHF, especially in participants with higher fibular head position, even if the hinge position is located in the safe zone.

Level of evidence

Retrospective cohort study, Level III.

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Data availability

The datasets that support the findings of this study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

This study was supported in part by Grant-in-Aid for Scientific Research from the Japanese Society for the Promotion of Science (JSPS) to KY (JP22K16775), HK (15K20019 and 18K09083), SH (16K20069), and MI (15K10494 and 18K09082). This study was also funded in part by a High Technology Research Center Grant and the Program for the Strategic Research Foundation at Private Universities (2014–2019) from the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT).

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Keiichi Yoshida, Mitsuaki Kubota, Haruka Kaneko, Youngji Kim, Keiji Kobayashi, Shinnosuke Hada, Yoshitomo Saita & Muneaki Ishijima

  2. Department of Medicine for Orthopedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Keiichi Yoshida, Mitsuaki Kubota, Haruka Kaneko & Muneaki Ishijima

  3. Sportology Center, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Muneaki Ishijima

Authors
  1. Keiichi Yoshida
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  2. Mitsuaki Kubota
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  3. Haruka Kaneko
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  4. Youngji Kim
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  5. Keiji Kobayashi
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  6. Shinnosuke Hada
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  7. Yoshitomo Saita
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  8. Muneaki Ishijima
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Contributions

KY conceived and designed the study, played a major role in the analysis and interpretation of the data, and contributed to drafting the report. MK and HK also conceived and designed the study, collected and registered patients, and played a role the in analysis and interpretation of the data. YK and KK played a role in analysis and contributed to drafting the report. SH played a role in the interpretation of the data and contributed to drafting the report. YS played a role in analysis and contributed to drafting the report. MI conceived and designed the study, played a major role in the analysis and interpretation of the data, and contributed to drafting the report.

Corresponding authors

Correspondence to Keiichi Yoshida or Muneaki Ishijima.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

The study protocol is complied with the principles outlined in the Declaration of Helsinki and was approved by the Ethical Review Board Committee of the University (approval number: E22-0166).

Informed consent

As the present study was categorized as a retrospective study, the Ethical Review Board Committee waived the requirement for patients’ informed consent because of the anonymous nature of the data.

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Yoshida, K., Kubota, M., Kaneko, H. et al. Higher fibular head is a risk for lateral hinge fracture in medial open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 4935–4941 (2023). https://doi.org/10.1007/s00167-023-07544-3

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  • DOI: https://doi.org/10.1007/s00167-023-07544-3

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