Skip to main content

Advertisement

SpringerLink
Log in

Analysis of the determinant factor of the medial joint space width after medial opening wedge high tibial osteotomy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The decrease in the medial joint space width (MJSW) in patients with osteoarthritis (OA) is proportional to the degree of arthritis. The purpose of this study was to evaluate the affecting factors of the MJSW by serial radiologic assessment after medial open wedge high tibial osteotomy (MOW-HTO).

Materials and methods

Between March 2014 and March 2019, 162 MOW-HTO knees that underwent serial radiologic assessment and follow-up MRI were enrolled. Changes in the MJSW were analyzed by dividing into three groups: group I, low quartile (< 25%); II, middle quartile (25–75%); and III, high quartile (> 75%), according to the magnitude of the MJSW. The correlation between the MJSW and weight-bearing line ratio (WBLR), hip knee ankle angle (HKA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (m-LDFA), joint line orientation angle (JLOA), and MRI cartilage status was analyzed. Multiple linear regression analysis was used to analyze factors affecting the amount of change in the MJSW. The clinical outcome was also correlated with the MJSW.

Results

The amount of change in the JLCA, which has the largest beta value (weight-bearing standing anteroposterior (AP) view and 45° flexion posteroanterior view (Rosenberg view) β =  − 0.699 and β = −5.221, both p < 0.001, respectively), had the greatest contribution to the change in the MJSW. The WBLR was also related (standing AP and Rosenberg β = 0.177 and β = 0.264, p = 0.015 and p = 0.004, respectively). There was no statistical difference between the amount of change in the MJSW and the change in cartilage. The clinical outcomes did not differ between the groups.

Conclusion

The JLCA was the most important contributing factor for the MJSW, followed by WBLR. This contribution was more pronounced in Rosenberg view than standing AP view. Changes in cartilage status were not related to the MJSW and JLCA. The clinical outcome was not related to the MJSW, either.

Level of evidence Cohort study; level III.

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

Similar content being viewed by others

Availability of data and material

Every data were transparency.

Code availability

Not applicable.

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(8):852–861

    Article  PubMed  Google Scholar 

  2. Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):197–205

    Article  PubMed  Google Scholar 

  3. 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(5):1388–1393

    Article  PubMed  Google Scholar 

  4. Casari FA, Germann C, Weigelt L, Wirth S, Viehofer A, Ackermann J (2021) The role of magnetic resonance imaging in autologous matrix-induced chondrogenesis for osteochondral lesions of the talus: analyzing MOCART 1 and 2.0. Cartilage 13(1 Suppl):639S-645S

    Article  CAS  PubMed  Google Scholar 

  5. Dieppe P, Cushnaghan J, Young P, Kirwan J (1993) Prediction of the progression of joint space narrowing in osteoarthritis of the knee by bone scintigraphy. Ann Rheum Dis 52(8):557–563

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Jansen MP, Besselink NJ, van Heerwaarden RJ et al (2021) Knee joint distraction compared with high tibial osteotomy and total knee arthroplasty: two-year clinical, radiographic, and biochemical marker outcomes of two randomized controlled trials. Cartilage 12(2):181–191

    Article  CAS  PubMed  Google Scholar 

  7. Jung WH, Takeuchi R, Chun CW et al (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30(1):72–79

    Article  PubMed  Google Scholar 

  8. Kim JE, Kim DH, Lee JI et al (2021) Difference of preoperative varus-valgus stress radiograph is effective for the correction accuracy in the preoperative planning during open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 29(4):1035–1044

    Article  PubMed  Google Scholar 

  9. Kim MS, Koh IJ, Choi KY, Kim BS, In Y (2021) Changes in joint space width over time and risk factors for deterioration of joint space width after medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 142:2513–2524

    Article  PubMed  Google Scholar 

  10. Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10(3):229–236

    Article  PubMed  Google Scholar 

  11. Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Koshino T, Saito T (2017) Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25(3):779–784

    Article  PubMed  Google Scholar 

  12. LaPrade RF, Bernhardson AS, Griffith CJ, Macalena JA, Wijdicks CA (2009) Correlation of valgus stress radiographs with medial knee ligament injuries. Am J Sports Med 38(2):330–338

    Article  PubMed  Google Scholar 

  13. Laprade RF, Bernhardson AS, Griffith CJ, Macalena JA, Wijdicks CA (2010) Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med 38(2):330–338

    Article  PubMed  Google Scholar 

  14. Lee DH, Park SC, Park HJ, Han SB (2016) Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 24(12):3704–3712

    Article  PubMed  Google Scholar 

  15. Lee S-J, Kim J-H, Choi W (2021) Factors related to the early outcome of medial open wedge high tibial osteotomy: coronal limb alignment affects more than cartilage degeneration state. Arch Orthop Trauma Surg 141(8):1339–1348

    Article  PubMed  Google Scholar 

  16. Lee SM, Bin SI, Kim JM, Lee BS, Suh KT, Song JH (2021) Joint space width increases medially and decreases laterally at different time points after medial open-wedge high tibial osteotomy. Arthroscopy 37(11):3316–3323

    Article  PubMed  Google Scholar 

  17. Matsumoto H, Suda Y, Otani T, Niki Y, Seedhom BB, Fujikawa K (2001) Roles of the anterior cruciate ligament and the medial collateral ligament in preventing valgus instability. J Orthop Sci 6(1):28–32

    Article  CAS  PubMed  Google Scholar 

  18. Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S (2002) Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis 61(7):617–622

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Moon HS, Choi CH, Yoo JH et al (2021) An increase in medial joint space width after medial open-wedge high tibial osteotomy is associated with an increase in the postoperative weight-bearing line ratio rather than with cartilage regeneration: comparative analysis of patients who underwent second-look arthroscopic assessment. Arthroscopy 37(2):657–668

    Article  PubMed  Google Scholar 

  20. Na YG, Lee BK, Choi JU, Lee BH, Sim JA (2021) Change of joint-line convergence angle should be considered for accurate alignment correction in high tibial osteotomy. Knee Surg Relat Res 33(1):4

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nha KW, Oh SM, Ha YW, Patel MK, Seo JH, Lee BH (2019) Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:2021–2029

    Article  PubMed  Google Scholar 

  22. Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H (2016) Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 136(10):1337–1342

    Article  PubMed  Google Scholar 

  23. 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. Knee Surg Sports Traumatol Arthrosc 14(2):141–148

    Article  PubMed  Google Scholar 

  24. Park CH, Bae DK, Kim KI, Lee JW, Song SJ (2017) Serial changes in the joint space width and joint line convergence angle after closed-wedge high tibial osteotomy. Am J Sports Med 45(14):3254–3261

    Article  PubMed  Google Scholar 

  25. Purevsuren T, Khuyagbaatar B, Kim K, Kim YH (2019) Effects of medial collateral ligament release, limb correction, and soft tissue laxity on knee joint contact force distribution after medial opening wedge high tibial osteotomy: a computational study. Comput Methods Biomech Biomed Eng 22(3):243–250

    Article  Google Scholar 

  26. Ravaud P, Giraudeau B, Auleley GR et al (1998) Variability in knee radiographing: implication for definition of radiological progression in medial knee osteoarthritis. Ann Rheum Dis 57(10):624–629

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Rosenberg T, Paulos L, Parker R, Coward D, Scott S (1988) The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. JBJS 70(10):1479–1483

    Article  CAS  Google Scholar 

  28. Sato D, Kondo E, Yabuuchi K 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(1):481

    Article  PubMed  PubMed Central  Google Scholar 

  29. Schreiner MM, Raudner M, Marlovits S et al (2021) The MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score and atlas. Cartilage 13(1 Suppl):571S-587S

    Article  PubMed  Google Scholar 

  30. Tsai YC, Tseng TH, Ho CH, Wang CC, Shih YC, Wang JH (2020) Medial joint space width and convergence angle change with time after medial opening-wedge high tibial osteotomy. Knee 27(6):1923–1930

    Article  PubMed  Google Scholar 

  31. 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(3):800–807

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT). No. 2021R1A2C1092657.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Ho Won Jeong, Seung Jae Shim, Seong Yun Park & Yong Seuk Lee

Authors
  1. Ho Won Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seung Jae Shim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seong Yun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yong Seuk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HWJ, SJS, and YSL participated in study design and drafted the manuscript, HWJ performed the statistical analysis, HWJ and SYP collected the data and contributed to performing statistical analysis, SYP conceived of the study, participated in coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yong Seuk Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The article does not contain any studies with human participants or animals performed by any of the authors. Institutional Review Board approval was obtained before performing the study (B-2110-714-106).

Consent to participate

Every author consent to participate.

Consent for publication

Every author consent for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jeong, H.W., Shim, S.J., Park, S.Y. et al. Analysis of the determinant factor of the medial joint space width after medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 143, 4879–4888 (2023). https://doi.org/10.1007/s00402-023-04818-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-04818-w

Keywords

Search

Navigation