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How to achieve an optimal alignment in medial opening wedge high tibial osteotomy?

왕준호|Kang Byoung Youl|Lee Do Kyung|Kim Hyeon Soo
대한슬관절학회 (Korean Knee Society)|2022.12|Knee Surgery and Related Research|제34권 |pp. 3-3|DOI 10.1186/s43019-021-00130-2

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키워드

Medial opening wedge high tibial osteotomyMechanical axisOvercorrectionUndercorrectionHigh tibial osteotomyOptimal alignmentOperative planningCorrection errorSoft tissue laxity

초록

Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used surgical treatment option for medial compartmental osteoarthritis with varus deformity. It is important that proper lower limb alignment is achieved. However, there has been no consensus about an optimal alignment in MOWHTO. Most studies suggest that achieving valgus alignment is necessary, and recent studies support slight valgus mechanical alignment of less than 3° of mechanical femorotibial angle. Overcorrection and undercorrection is not recommended for achieving good surgical outcomes. To prevent undercorrection and overcorrection in MOWHTO, the method of placing the weight-bearing line in the target range must be precise. There are several ways to place a weight-bearing line within the target range. While the most important factor for a successful MOWHTO is achieving an ideal mechanical axis correction, there are a few other factors to consider, including joint line obliquity, posterior tibial slope, ligament balancing, and patellar height. Several factors exist that lead to undercorrection and overcorrection. Preoperative amount of varus deformity, lateral hinge fracture, and fixation failure can result in undercorrection, while medial soft tissue laxity and the amount of correction angle and target point beyond hypomochlion can result in overcorrection. This study aimed to review the literature on optimal alignment in MOWHTO and report on the factors to be considered to prevent correction errors and how to achieve an optimal alignment.

Abstract

Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used surgical treatment option for medial compartmental osteoarthritis with varus deformity. It is important that proper lower limb alignment is achieved. However, there has been no consensus about an optimal alignment in MOWHTO. Most studies suggest that achieving valgus alignment is necessary, and recent studies support slight valgus mechanical alignment of less than 3° of mechanical femorotibial angle. Overcorrection and undercorrection is not recommended for achieving good surgical outcomes. To prevent undercorrection and overcorrection in MOWHTO, the method of placing the weight-bearing line in the target range must be precise. There are several ways to place a weight-bearing line within the target range. While the most important factor for a successful MOWHTO is achieving an ideal mechanical axis correction, there are a few other factors to consider, including joint line obliquity, posterior tibial slope, ligament balancing, and patellar height. Several factors exist that lead to undercorrection and overcorrection. Preoperative amount of varus deformity, lateral hinge fracture, and fixation failure can result in undercorrection, while medial soft tissue laxity and the amount of correction angle and target point beyond hypomochlion can result in overcorrection. This study aimed to review the literature on optimal alignment in MOWHTO and report on the factors to be considered to prevent correction errors and how to achieve an optimal alignment.

참고문헌 (76)

  1. Jakob R, "Tibial osteotomy for varus gonarthrosis : indication, planning, and operative technique", Instr Course Lect, 41, pp.87~ (1992)
  2. Prodromos CC, "High tibial osteotomy : indications, techniques", Instr Course Lect, 64, pp.555~565 (2015)
  3. Gomoll AH, "High tibial osteotomy for the treatment of unicompartmental knee osteoarthritis : a review of the literature, indications, and technique", Phys Sportsmed, 39(3), pp.45~54 (2011)
  4. Bonasia DE, "High tibial osteotomy", Curr Rev Musculoskelet Med, 7(4), pp.292~301 (2014)
  5. Agneskirchner JD, "The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee : a biomechanical study", Arthroscopy, 23(8), pp.852~861 (2007)
  6. Mina C, "High tibial osteotomy for unloading osteochondral defects in the medial compartment of the knee", Am J Sports Med, 36(5), pp.949~955 (2008)
  7. Hankemeier S, "Accuracy of high tibial osteotomy : comparison between open-and closed-wedge technique", Knee Surg Sports Traumatol Arthrosc, 18(10), pp.1328~1333 (2010)
  8. Amendola A, "Opening wedge high tibial osteotomy using a novel technique-early results and complications", J Knee Surg, 17(03), pp.164~169 (2004)
  9. Lo W, "Arthroscopy-assisted computer navigation in high tibial osteotomy for varus knee deformity", J Orthop Surg, 17(1), pp.51~55 (2009)
  10. Lee D-H, "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), pp.3704~3712 (2016)
  11. Kyung BS, "Are navigation systems accurate enough to predict the correction angle during high tibial osteotomy? Comparison of navigation systems with 3-dimensional computed tomography and standing radiographs", Am J Sports Med, 41(10), pp.2368~2374 (2013)
  12. Marti CB, "Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy", Arthroscopy, 20(4), pp.366~372 (2004)
  13. Gebhard F, "Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy", Arch Orthop Trauma Surg, 131(3), pp.297~302 (2011)
  14. Wang G, "Implementation, accuracy evaluation, and preliminary clinical trial of a CT-free navigation system for high tibial opening wedge osteotomy", Comput Aided Surg, 10(2), pp.73~86 (2005)
  15. Parker DA, "Osteotomy for the early varus arthritic knee", Sports Med Arthrosc Rev, 15(1), pp.3~14 (2007)
  16. Fujisawa Y, "The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints", Orthop Clin North Am, 10(3), pp.585~608 (1979)
  17. Coventry MB, "Upper tibial osteotomy for osteoarthritis", J Bone Joint Surg Am, 67(7), pp.1136~1140 (1985)
  18. Coventry MB, "Proximal tibial osteotomy. A critical long-term study of eighty-seven cases", Bone Joint Surg Am, 75(2), pp.196~201 (1993)
  19. Hernigou P, "Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study", J Bone Joint Surg Am, 69(3), pp.332~354 (1987)
  20. Martay JLB, "A preliminary modeling investigation into the safe correction zone for high tibial osteotomy", Knee, 25(2), pp.286~295 (2018)
  21. Kuriyama S, "Large medial proximal tibial angles cause excessively medial tibiofemoral contact forces and abnormal knee kinematics following open-wedge high tibial osteotomy", Clin Biomech, 80, pp.105190~ (2020)
  22. Atkinson HF, "High tibial osteotomy to neutral alignment improves medial knee articular cartilage composition", Knee Surg Sports Traumatol Arthrosc (2021)[DOI]
  23. Jakob RP, "Closing wedge osteotomy of the tibial head in treatment of single compartment arthrosis", Orthopade, 33(2), pp.143~152 (2004)
  24. Kim MK, "The proper correction of the mechanical axis in high tibial osteotomy with concomitant cartilage procedures-a retrospective comparative study", J Orthop Surg Res, 14(1), pp.281~ (2019)
  25. Odenbring S, "Ten-year results of tibial osteotomy for medial gonarthrosis", Arch Orthop Trauma Surg, 110(2), pp.103~108 (1991)
  26. El-Azab HM, "Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome", Orthopedics, 34(10), pp.e622~e628 (2011)
  27. Sim JA, "Effect of weight-bearing on the alignment after open wedge high tibial osteotomy", Knee Surg Sports Traumatol Arthrosc, 18(7), pp.874~878 (2010)
  28. Dowd GS, "High tibial osteotomy for medial compartment osteoarthritis", Knee, 13(2), pp.87~92 (2006)
  29. Yin Y, "What is the relationship between the “Fujisawa point” and postoperative knee valgus angle? A theoretical, computer-based study", Knee, 27(1), pp.183~191 (2020)
  30. Bin S-I, "Changes in patellar height after opening wedge and closing wedge high tibial osteotomy : a meta-analysis", Arthroscopy, 32(11), pp.2393~2400 (2016)
  31. Lee S-S, "Predictive factors for patellofemoral degenerative progression after opening-wedge high tibial osteotomy", Arthroscopy, 35(6), pp.1703~1710 (2019)
  32. 송상준, "Conversion Total Knee Arthroplasty after Failed High Tibial Osteotomy", Knee Surgery and Related Research, 28(2), pp.89~98 (2016), 대한슬관절학회
  33. Miniaci A, "Proximal tibial osteotomy. A new fixation device", Clin Orthop Relat Res, 246, pp.250~259 (1989)
  34. Lee YS, "Reliability of the imaging software in the preoperative planning of the open-wedge high tibial osteotomy", Knee Surg Sports Traumatol Arthrosc, 23(3), pp.846~851 (2015)
  35. Elson D, "High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method", Knee Surg Sports Traumatol Arthrosc, 23(7), pp.2041~2048 (2015)
  36. Dugdale TW, "Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length", Clin Orthop Relat Res, 274, pp.248~264 (1992)
  37. Schröter S, "Surgical accuracy in high tibial osteotomy : coronal equivalence of computer navigation and gap measurement", Knee Surg Sports Traumatol Arthrosc, 24(11), pp.3410~3417 (2016)
  38. Blackburn J, "Reliability of two techniques and training level of the observer in measuring the correction angle when planning a high tibial osteotomy", Knee, 25(1), pp.130~134 (2018)
  39. Lee DH, "The weightbearing scanogram technique provides better coronal limb alignment than the navigation technique in open high tibial osteotomy", Knee, 21(2), pp.451~455 (2014)
  40. Yang JC-S, "Clinical experience using a 3D-printed patient-specific instrument for medial opening wedge high tibial osteotomy", BioMed Res (2018)[DOI]
  41. Tardy N, "Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy?", Orthop Traumatol Surg Res, 106(8), pp.S231~S236 (2020)
  42. Seong-Dae Yoon, "Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy", Knee Surgery and Related Research, 28(4), pp.283~288 (2016), 대한슬관절학회
  43. Moore J, "Applicability of a modified angular correction measurement method for open-wedge high tibial osteotomy", Knee Surg Sports Traumatol Arthrosc, 25(3), pp.846~852 (2017)
  44. Kim MS, "Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy", Arch Orthop Trauma Surg, 137(8), pp.1035~1045 (2017)
  45. Hyun-Jung Kim, "Imageless Navigation Versus Conventional Open Wedge High Tibial Osteotomy: A Meta-Analysis of Comparative Studies", Knee Surgery and Related Research, 28(1), pp.16~26 (2016), 대한슬관절학회
  46. Yan J, "Outcome reporting following navigated high tibial osteotomy of the knee : a systematic review", Knee Surg Sports Traumatol Arthrosc, 24(11), pp.3529~3555 (2016)
  47. Kyung Wook Nha, "Navigated versus Conventional Technique in High Tibial Osteotomy: A Meta­Analysis Focusing on Weight Bearing Effect", Knee Surgery and Related Research, 31(2), pp.81~102 (2019), 대한슬관절학회
  48. Song E-K, "Navigated open wedge high tibial osteotomy", Sports Med Arthrosc Rev, 16(2), pp.84~90 (2008)
  49. Hofmann S, "Osteotomies of the knee joint in patients with monocompartmental arthritis", Der Orthopade, 38(8), pp.755~769 (2009)
  50. Takeuchi R, "Medial opening wedge high tibial osteotomy with early full weight bearing", Arthroscopy, 25(1), pp.46~53 (2009)
  51. Nakayama H, "Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage", Knee Surg Sports Traumatol Arthrosc, 26(6), pp.1873~1878 (2018)
  52. Song J-H, "What is an acceptable limit of joint-line obliquity after medial open wedge high tibial osteotomy? Analysis based on midterm results", Am J Sports Med, 48(12), pp.3028~3035 (2020)
  53. Oh K-J, "Analysis of knee joint line obliquity after high tibial osteotomy", J Knee Surg, 29(08), pp.649~657 (2016)
  54. El-Azab H, "Patellar height and posterior tibial slope after open-and closed-wedge high tibial osteotomy : a radiological study on 100 patients", Am J Sports Med, 38(2), pp.323~329 (2010)
  55. Nha K-W, "Change in posterior tibial slope after open-wedge and closed-wedge high tibial osteotomy : a meta-analysis", Am J Sports Med, 44(11), pp.3006~3013 (2016)
  56. Giffin JR, "Effects of increasing tibial slope on the biomechanics of the knee", Am J Sports Med, 32(2), pp.376~382 (2004)
  57. Song E-K, "How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy", Orthopedics, 30(10), pp.S127~ (2007)
  58. Wang JH, "Medial open wedge high tibial osteotomy : the effect of the cortical hinge on posterior tibial slope", Am J Sports Med, 37(12), pp.2411~2418 (2009)
  59. Gaasbeek R, "The influence of open and closed high tibial osteotomy on dynamic patellar tracking : a biomechanical study", Knee Surg Sports Traumatol Arthrosc, 15(8), pp.978~984 (2007)
  60. Stoffel K, "Patellofemoral contact pressure following high tibial osteotomy : a cadaveric study", Knee Surg Sports Traumatol Arthrosc, 15(9), pp.1094~1100 (2007)
  61. Kim K-I, "Medial open-wedge high tibial osteotomy may adversely affect the patellofemoral joint", Arthroscopy, 33(4), pp.811~816 (2017)
  62. Gaasbeek R, "Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera : a new technique", Knee, 11(6), pp.457~461 (2004)
  63. Horikawa T, "Distal tuberosity osteotomy in open-wedge high tibial osteotomy does not exacerbate patellofemoral osteoarthritis on arthroscopic evaluation", Knee Surg Sports Traumatol Arthrosc, 28(6), pp.1750~1756 (2020)
  64. Kamada S, "Severe varus knees result in a high rate of undercorrection of lower limb alignment after opening wedge high tibial osteotomy", J Orthop Surg(Hong Kong), 27(2), pp.2309499019846660~ (2019)
  65. Hernigou P, "Safety of a novel high tibial osteotomy locked plate fixation for immediate full weight-bearing : a case-control study", Int Orthop, 37(12), pp.2377~2384 (2013)
  66. Miller BS, "Complications after medial opening wedge high tibial osteotomy", Arthroscopy, 25(6), pp.639~646 (2009)
  67. Kazımoğlu C, "Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study", Knee, 15(4), pp.305~308 (2008)
  68. Lee S-S, "Predictive factors for and detection of lateral hinge fractures following open wedge high tibial osteotomy : plain radiography versus computed tomography", Arthroscopy, 34(11), pp.3073~3079 (2018)
  69. Nakamura R, "Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy", Bone Joint J, 99(10), pp.1313~1318 (2017)
  70. Han SB, "A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture", Knee Surg Sports Traumatol Arthrosc, 21(1), pp.90~95 (2013)
  71. So S-Y, "Difference in joint line convergence angle between the supine and standing positions is the most important predictive factor of coronal correction error after medial opening wedge high tibial osteotomy", Knee Surg Sports Traumatol Arthrosc (2019)[DOI]
  72. Ogawa H, "Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy", Arch Orthop Trauma Surg, 136(10), pp.1337~1342 (2016)
  73. Pape D, "Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy", Knee Surg Sports Traumatol Arthrosc, 14(2), pp.141~148 (2006)
  74. Lee DK, "Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy", Knee Surg Sports Traumatol Arthrosc, 28(5), pp.1411~1418 (2020)
  75. Ryu DJ, "Reliability of preoperative planning method that considers latent medial joint laxity in medial open-wedge proximal tibial osteotomy", Orthop J Sports Med, 9(10), pp.232596712110341~ (2021)
  76. Heijens E, "The coronal hypomochlion : a tipping point of clinical relevance when planning valgus producing high tibial osteotomies", Bone Joint J. (2016)[DOI]

관련 논문AI추천

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