Abstract
Purpose
For opening-wedge high tibial osteotomy, previous studies have shown that most osteotomies were anterior-inclined. The purpose of this study was to determine the effect of sagittal osteotomy inclination on the anteroposterior translation of osteomized fragments and discuss its possible impact on the patellofemoral joint.
Methods
We retrospectively measured the angle between the joint line and the sagittal osteotomy line. We also evaluated the anteroposterior translation of osteomized fragments by measuring the distance from the most posterior point of the tibial plateau to the tibial tuberosity and the anterior cortical line. Correlation between the sagittal osteotomy inclination and the anteroposterior translation of fragments was analyzed.
Results
The mean sagittal osteotomy inclination was 6.3 ± 8.4° anteriorly to the joint line and 82% of osteotomies were anterior-inclined. The anteroposterior translation of the osteomized fragments was moderately correlated to the sagittal inclination. Anterior-inclined osteotomy tends to result in the anterior translation of the proximal fragment.
Conclusion
High rates of anterior-inclined osteotomy have been described previously as well as in this study. Anterior-inclined osteotomy tends to result in the anterior translation of the proximal fragment. This may result in increased vertical vector force onto the patellofemoral joint, which further accelerates patellofemoral joint degeneration. Therefore, surgeons should attempt to perform parallel osteotomy or avoid anterior displacement of the proximal fragment if there is concern of anterior-inclined osteotomy.
Similar content being viewed by others
References
Bin SI, Kim HJ, Ahn HS, Rim DS, Lee DH (2016) Changes in patellar height after opening wedge and closing wedge high tibial osteotomy: a meta-analysis. Arthroscopy 32:2393–2400
Bito H, Takeuchi R, Kumagai K, Aratake M, Saito I, Hayashi R et al (2010) Opening wedge high tibial osteotomy affects both the lateral patellar tilt and patellar height. Knee Surg Sports Traumatol Arthrosc 18:955–960
Chae DJ, Shetty GM, Lee DB, Choi HW, Han SB, Nha KW (2008) Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 15:128–133
El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg Br 90:1193–1197
Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608
Gaasbeek R, Welsing R, Barink M, Verdonschot N, van Kampen A (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15:978–984
Goshima K, Sawaguchi T, Sakagoshi D, Shigemoto K, Hatsuchi Y, Akahane M (2017) Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:918–923
Han JH, Kim HJ, Song JG, Yang JH, Nakamura R, Shah D et al (2017) Locking plate versus non-locking plate in open-wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 25:808–816
Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354
Hinterwimmer S, Feucht MJ, Paul J, Kirchhoff C, Sauerschnig M, Imhoff AB et al (2016) Analysis of the effects of high tibial osteotomy on tibial rotation. Int Orthop 40:1849–1854
Ihle C, Ahrend M, Grunwald L, Ateschrang A, Stockle U, Schroter S (2017) No change in patellar height following open wedge high tibial osteotomy using a novel femur-referenced measurement method. Knee 24:1118–1128
Javidan P, Adamson GJ, Miller JR, Durand P Jr, Dawson PA, Pink MM et al (2013) The effect of medial opening wedge proximal tibial osteotomy on patellofemoral contact. Am J Sports Med 41:80–86
Jung WH, Chun CW, Lee JH, Ha JH, Kim JH, Jeong JH (2013) Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy 29:1063–1071
Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH et al (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30:72–79
Kim JH, Kim HJ, Lee DH (2017) Survival of opening versus closing wedge high tibial osteotomy: a meta-analysis. Sci Rep 7:7296
Kim KI, Kim DK, Song SJ, Lee SH, Bae DK (2017) Medial open-wedge high tibial osteotomy may adversely affect the patellofemoral joint. Arthroscopy 33:811–816
Kim KI, Seo MC, Song SJ, Bae DK, Kim DH, Lee SH (2017) Change of chondral lesions and predictive factors after medial open-wedge high tibial osteotomy with a locked plate system. Am J Sports Med 45:1615–1621
Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444
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 25:779–784
LaPrade RF, Oro FB, Ziegler CG, Wijdicks CA, Walsh MP (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38:160–170
Lee YS, Lee SB, Oh WS, Kwon YE, Lee BK (2016) Changes in patellofemoral alignment do not cause clinical impact after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 24:129–133
Lee SY, Lim HC, Bae JH, Kim JG, Yun SH, Yang JH et al (2017) Sagittal osteotomy inclination in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:823–831
Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138
Lustig S, Scholes CJ, Costa AJ, Coolican MJ, Parker DA (2013) Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:32–38
Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387
Ozalay M, Ozkoc G, Circi E, Akpinar S, Hersekli MA, Uysal M et al (2008) The correlation of correction magnitude and tibial slope changes following open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16:948–951
Ozel O, Yucel B, Mutlu S, Orman O, Mutlu H (2017) Changes in posterior tibial slope angle in patients undergoing open-wedge high tibial osteotomy for varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc 25:314–318
Smith TO, Sexton D, Mitchell P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 18:361–368
Song EK, Seon JK, Park SJ (2007) How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 30:S127–S131
Song IH, Song EK, Seo HY, Lee KB, Yim JH, Seon JK (2012) Patellofemoral alignment and anterior knee pain after closing- and opening-wedge valgus high tibial osteotomy. Arthroscopy 28:1087–1093
Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury 34(Suppl 2):B55–B62
Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK (2010) Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 38:1420–1424
Sun H, Zhou L, Li F, Duan J (2017) Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: a systematic review and meta-analysis. J Knee Surg 30:158–165
W-Dahl A, Lidgren L, Sundberg M, Robertsson O (2015) Introducing prospective national registration of knee osteotomies. A report from the first year in Sweden. Int Orthop 39:1283–1288
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Tseng, TH., Tsai, YC., Lin, KY. et al. The correlation of sagittal osteotomy inclination and the anteroposterior translation in medial open-wedge high tibial osteotomy—one of the causes affecting the patellofemoral joint?. International Orthopaedics (SICOT) 43, 605–610 (2019). https://doi.org/10.1007/s00264-018-3951-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-018-3951-6