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Lateral tibial intercondylar eminence is a reliable reference for alignment correction in high tibial osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the study is to determine whether the lateral tibial intercondylar eminence (LTIE) is a reliable reference for alignment correction in high tibial osteotomy (HTO).

Methods

A total of 1954 consecutive standing whole-leg radiography (WLR) examinations of 1373 adult patients with knee osteoarthritis between 2012 and 2019 were reviewed retrospectively; 145 patients were included, 53 males and 92 females, with a mean age of 63.3 years. Virtual simulation of HTO was performed to measure weight-bearing line (WBL) percentages and hip–knee–ankle (HKA) angles when the WBL passed through the Fujisawa, top, bottom, upper 1/3, and middle points of the lateral slope of the LTIE, and the positional relationship between the Fujisawa point and the lateral slope of the LTIE was determined.

Results

When the WBL passed through the top, bottom, upper 1/3, and middle points of the lateral slope of the LTIE, the mean WBL percentages were 57.7% ± 2.1%, 74.6% ± 3.3%, 63.4% ± 2.1%, and 66.2% ± 2.3%, respectively, and the mean HKA angles were 182.1° ± 0.5°, 185.9° ± 0.8°, 183.3° ± 0.5°, and 184.0° ± 0.5°, respectively. When the WBL passed through the Fujisawa point, it was passing through 28.6% ± 12.7% of the width of the lateral slope (the top and bottom points were defined as 0% and 100%, respectively). When the WBL passed through the middle and upper 1/3 points of the lateral slope of the LTIE, the majority of cases (96.1%–100%) were within the limits of acceptability, as defined by the widely accepted standard of a postoperative HKA angle ranging from 183° to 186°.

Conclusion

The upper 1/3 and middle points of the lateral slope of the LTIE are reliable references for guiding the alignment correction in HTO. In clinical application, if 62%–66% of the postoperative WBL percentage is the acceptable target range, the upper 1/3 point of the lateral slope of the LTIE may be a better alternative than the midpoint. If the postoperative HKA angle between 183° and 186° is acceptable, the midpoint of the lateral slope of the LTIE may be better than the upper 1/3 point. These findings are crucial for the accuracy of the traditional intraoperative alignment assessment techniques.

Level of evidence

IV.

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Data availability

Transparency of the data could be provided, if necessary.

Code availability

The software application is available, we can provide the software application what we used in current study, if necessary.

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Acknowledgements

We would like to thank Editage (www.editage.cn) for English language editing.

Funding

This work was supported by the Science and Technology Commission of Shanghai Municipality (21S31905500, 20ZR1432000, 16441908700); the Clinical Research Program of 9th People’s Hospital affiliated with Shanghai Jiao Tong University School of Medicine (Grant No. JYLJ025); the Project of the Shanghai Collaborative Innovation Center for Translational Medicine (Grant No. TM201814); Technology and Innovation Fund (Chuang Ke) of the Ninth People’s Hospital Shanghai Jiao Tong University School of Medicine (Grant No. CK2018011); 3D Snowball Project of Shanghai Jiao Tong University School of Medicine (Grant No. GXQ202007); National Natural Science Foundation of China (81772425); Shanghai Jiao Tong University (YG2016MS11), Science and Technology Project of Guangdong Province (201707010089).

Author information

Author notes

  1. Xu Jiang, Bo Li, and Kai Xie contributed equally to this work.

Authors and Affiliations

  1. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China

    Xu Jiang, Kai Xie, Liao Wang & Mengning Yan

  2. Department of Orthopaedic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China

    Xu Jiang, Bo Li, Xumin Hu & Liangbin Gao

  3. Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China

    Songtao Ai

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  1. Xu Jiang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XJ, KX, and SA. The first draft of the manuscript was written by XJ, BL, and KX, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xumin Hu, Liangbin Gao, Liao Wang or Mengning Yan.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Medical Ethics Committee of Shanghai Ninth People's Hospital approved the study design (SH9H-2019-T10-2).

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Due to the retrospective nature of our study, Informed consent was not required.

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Jiang, X., Li, B., Xie, K. et al. Lateral tibial intercondylar eminence is a reliable reference for alignment correction in high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 1515–1523 (2023). https://doi.org/10.1007/s00167-021-06736-z

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