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The use of medial joint opening rather than mechanical axis deviation to determine the clinical outcomes after high tibial osteotomy

胫骨高位截骨术 口腔正畸科 仰卧位 截骨术 医学 射线照相术 绝对偏差 外科 骨关节炎 数学 替代医学 病理 统计
作者
Sung Eun Kim,Junpyo Kwak,Du Hyun Ro,Myung C. Lee,Hyuk‐Soo Han
出处
期刊:The bone & joint journal [British Editorial Society of Bone & Joint Surgery]
卷期号:106-B (3): 240-248 被引量:2
标识
DOI:10.1302/0301-620x.106b3.bjj-2023-0337.r3
摘要

Aims The aim of this study was to evaluate whether achieving medial joint opening, as measured by the change in the joint line convergence angle (∆JLCA), is a better predictor of clinical outcomes after high tibial osteotomy (HTO) compared with the mechanical axis deviation, and to find individualized targets for the redistribution of load that reflect bony alignment, joint laxity, and surgical technique. Methods This retrospective study analyzed 121 knees in 101 patients. Patient-reported outcome measures (PROMs) were collected preoperatively and one year postoperatively, and were analyzed according to the surgical technique (opening or closing wedge), postoperative mechanical axis deviation (deviations above and below 10% from the target), and achievement of medial joint opening (∆JLCA > 1°). Radiological parameters, including JLCA, mechanical axis deviation, and the difference in JLCA between preoperative standing and supine radiographs (JLCA PD ), an indicator of medial soft-tissue laxity, were measured. Cut-off points for parameters related to achieving medial joint opening were calculated from receiver operating characteristic (ROC) curves. Results Patients in whom the medial joint opening was achieved had significantly better postoperative PROMs compared with those without medial opening (all p < 0.05). Patients who were outliers with deviation of > 10% from the target mechanical axis deviation had significantly similar PROMs compared with patients with an acceptable axis deviation (all p > 0.05). Medial joint opening was affected by postoperative mechanical axis deviation and JLCA PD . The influence of JLCA PD on postoperative axis deviation was more pronounced in a closing wedge than in an opening wedge HTO. Conclusion Medial joint opening rather than the mechanical axis deviation determined the clinical outcome in patients who underwent HTO. The JLCA PD identified the optimal postoperative axis deviation necessary to achieve medial joint opening. For patients with increased laxity, lowering the target axis deviation is recommended to achieve medial joint opening. The target axis deviation should also differ according to the technique of undergoing HTO. Cite this article: Bone Joint J 2024;106-B(3):240–248.
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