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High tibial osteotomy to neutral alignment improves medial knee articular cartilage composition

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to: (1) test the hypothesis that HTO improves articular cartilage composition in the medial compartment without adversely affecting the lateral compartment and patella, and; (2) explore associations between knee alignment and cartilage composition after surgery.

Methods

3T MRI and standing radiographs were obtained from 34 patients before and 1-year after HTO. Articular cartilage was segmented from T2 maps. Mechanical axis angle (MAA), posterior tibial slope, and patellar height were measured from radiographs. Changes in T2 and radiographic measures were assessed using paired t tests, and associations were assessed using Pearson correlation coefficients.

Results

The mean (SD) MAA before and after HTO was − 6.5° (2.4) and 0.6° (3.0), respectively. There was statistically significant shortening [mean (95%CI)] of T2 in the medial femur [− 2.8 ms (− 4.2; − 1.3), p < 0.001] and medial tibia [− 2.2 ms (− 3.3; − 1.0), p < 0.001], without changes in the lateral femur [− 0.5 ms (− 1.6; 0.6), p = 0.3], lateral tibia [0.2 ms (− 0.8; 1.1), p = NS], or patella [0.5 ms (− 1.0; 2.1), p = NS). Associations between radiographic measures and T2 were low. 23% of the increase in lateral femur T2 was explained by postoperative posterior tibial slope (r = 0.48).

Conclusion

Performing medial opening wedge HTO without overcorrection improves articular cartilage composition in the medial compartment of the knee without compromising the lateral compartment or the patella. Although further research is required, these results suggest HTO is a disease structure-modifying treatment for knee OA.

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Availability of data and materials

Data are available upon request.

Code/software availability

This study used an in-house proprietary program to measure radiographic angles, and 3D Slicer, an open-source medical imaging processing platform.

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Funding

This study was funded in part by the Canadian Institutes of Health Research, The Arthritis Society, the Western University Bone & Joint Insitute, the Canada Research Chairs program, and the Centre for Functional and Metabolic Mapping Internal Research Fund and Brain Canada.

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Authors and Affiliations

  1. Robarts Research Institute, University of Western Ontario, London, Canada

    Hayden F. Atkinson & D. W. Holdsworth

  2. Bone and Joint Institute, University of Western Ontario, London, Canada

    Hayden F. Atkinson, Trevor B. Birmingham, Jenna M. Schulz, Codie A. Primeau, Kristyn M. Leitch & J. R. Giffin

  3. School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada

    Trevor B. Birmingham, Jenna M. Schulz & Codie A. Primeau

  4. Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada

    Stephany L. Pritchett, D. W. Holdsworth & J. R. Giffin

Authors
  1. Hayden F. Atkinson
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  2. Trevor B. Birmingham
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Contributions

All authors contributed to either the conception, design, data collection, or analysis. Each author contributed to the final version of the manuscript and has seen this document.

Corresponding author

Correspondence to Trevor B. Birmingham.

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The study was approved by the institution’s Research Ethics Board for Health Science Research Involving Human Subjects.

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Atkinson, H.F., Birmingham, T.B., Schulz, J.M. et al. High tibial osteotomy to neutral alignment improves medial knee articular cartilage composition. Knee Surg Sports Traumatol Arthrosc 30, 1065–1074 (2022). https://doi.org/10.1007/s00167-021-06516-9

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  • DOI: https://doi.org/10.1007/s00167-021-06516-9

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