Advertisement

Retaining the medial collateral ligament in high tibial medial open-wedge osteotomy mostly results in post-operative intra-articular gap reduction

  • Abolfazl Bagherifard
  • Mahmoud Jabalameli
  • Alireza Mirzaei
  • Akbar Khodabandeh
  • Majid Abedi
  • Hooman YahyazadehEmail author
KNEE
  • 20 Downloads

Abstract

Purpose

The current study aimed to evaluate how open-wedge high tibial osteotomy (OWHTO) without the release of medial collateral ligament (MCL) changes in vivo intra-articular joint space after the surgery.

Methods

Patients with varus malalignment of the knee with an indication for OWHTO were included in this study. The intra-articular gap was measured before and 30 min after OWHTO without MCL release using a series of calibrated nerve hooks. The association of post-operative gap size with varus angle, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA) and joint line convergence angle (JLCA) was also assessed.

Results

A total of 42 knees from 38 patients were evaluated. The mean size of the intra-articular gap of the medial compartment was 5.2 ± 1 mm before the osteotomy and 3.1 ± 2.2 mm at 30 min post-osteotomy. The size of the intra-articular gap decreased post-operatively in 30 knees (71.5%), increased in eight knees (19%) and remained the same in the remaining four knees (9.5%). Smaller MPTA and more correction were associated with a decrease in gap size after the osteotomy (p = 0.01 and p = 0.03, respectively). A significant negative correlation was observed between the correction size and the gap size after osteotomy (r = − 0.317, p = 0.04).

Conclusion

Intra-articular pressure of the medial compartment increases in the majority of cases following OWHTO without MCL release. Until the factors affecting this increased pressure are thoroughly identified, MCL release seems to be a wiser option during OWHTO.

Level of evidence

III.

Keywords

Open-wedge high tibial osteotomy Medial collateral ligament Gap size Intra-articular pressure 

Abbreviations

MCL

Medial collateral ligament

OWHTO

Open-wedge high tibial osteotomy

MPTA

Medial proximal tibial angle

LDFA

Lateral distal femoral angle

JLCA

Joint line convergence angle

Notes

Author contributions

AB made substantial contributions to conception and design of the study. MJ supervised the study and did the surgeries and gap tests. AM analysed the data and prepared the first draft of the article. AKH was responsible for radiographic data collection and patient recruitment. MA assisted in the surgeries and critically revised the article for important intellectual content. HY was involved in drafting the manuscript and assisted in the surgeries. All authors read and approved the final draft of the manuscript.

Funding

This work was supported by Iran University of Medical Sciences (Grant no. IR.IUMS.FMD.REC.1397.243).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This research was conducted in accordance with the 1964 Helsinki Declaration.

Informed consent

Informed consent was obtained from the patients before their participation in the study.

References

  1. 1.
    Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861CrossRefGoogle Scholar
  2. 2.
    Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160CrossRefGoogle Scholar
  3. 3.
    Bagherifard A, Jabalameli M, Rezazadeh J, Askari A, Yoosefzadeh A, Mohammadpour M et al (2018) The effect of opening-wedge high tibial osteotomy on the posterior tibial slope assessed by three different evaluation methods. Shafa Orthop J 5:e68424Google Scholar
  4. 4.
    Beighton P, Solomon L, Soskolne C (1973) Articular mobility in an African population. Ann Rheum Dis 32:413CrossRefGoogle Scholar
  5. 5.
    Bellemans J, Vandenneucker H, Vanlauwe J, Victor J (2010) The influence of coronal plane deformity on mediolateral ligament status: an observational study in varus knees. Knee Surg Sports Traumatol Arthrosc 18:152–156CrossRefGoogle Scholar
  6. 6.
    Egmond·NV, Hannink G, Janssen D, Vrancken AC, Verdonschot N, Kampen AV (2017) Relaxation of the MCL after an open-wedge high tibial osteotomy results in decreasing contact pressures of the knee over time. Knee Surg Sports Traumatol Arthrosc 25:800–807CrossRefGoogle Scholar
  7. 7.
    Gaasbeek RD, Nicolaas L, Rijnberg WJ, van Loon CJ, van Kampen A (2010) Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one-year randomised controlled study. Int Orthop 34:201–207CrossRefGoogle Scholar
  8. 8.
    Kohn L, Sauerschnig M, Iskansar S, Lorenz S, Meidinger G, Imhoff A et al (2013) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:146–151CrossRefGoogle Scholar
  9. 9.
    Laprade RF, Bernhardson AS, Griffith CJ, Macalena JA, Wijdicks CA (2010) Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med 38:330–338CrossRefGoogle Scholar
  10. 10.
    Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138CrossRefGoogle Scholar
  11. 11.
    Madry H, Goebel L, Hoffmann A, Dück K, Gerich T, Seil R et al (2017) Surgical anatomy of medial open-wedge high tibial osteotomy: crucial steps and pitfalls. Knee Surg Sports Traumatol Arthrosc 25:3661–3669CrossRefGoogle Scholar
  12. 12.
    Matsumoto H, Suda Y, Otani T, Niki Y, Seedhom BB, Fujikawa K (2001) Roles of the anterior cruciate ligament and the medial collateral ligament in preventing valgus instability. J Orthop Sci 6:28–32CrossRefGoogle Scholar
  13. 13.
    Noyes FR, Barber-Westin SD, Hewett TE (2000) High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med 28:282–296CrossRefGoogle Scholar
  14. 14.
    Pape D, Duchow J, Rupp S, Seil R, Kohn D (2006) Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy. A human cadaver study evaluating medial joint opening by stress radiography. Knee Surg Sports Traumatol Arthrosc 14:141–148CrossRefGoogle Scholar
  15. 15.
    Pornrattanamaneewong C, Narkbunnam R, Chareancholvanich K (2012) Medial proximal tibial angle after medial opening wedge HTO: a retrospective diagnostic test study. Indian J Orthop 46:525CrossRefGoogle Scholar
  16. 16.
    Robinson JR, Bull AM, Thomas RR, Amis AA (2006) The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity. Am J Sports Med 34:1815–1823CrossRefGoogle Scholar
  17. 17.
    Seitz AM, Nelitz M, Ignatius A, Dürselen L (2018) Release of the medial collateral ligament is mandatory in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-018-5167-0 Google Scholar
  18. 18.
    Seo S-S, Kim C-W, Seo J-H, Kim D-H, Lee C-R (2016) Does superficial medial collateral ligament release in open-wedge high tibial osteotomy for varus osteoarthritic knees increase valgus laxity? Am J Sports Med 44:908–915CrossRefGoogle Scholar
  19. 19.
    Smith AD (1994) Orthopaedic sports medicine: principles and practice. JAMA 272:1301–1302CrossRefGoogle Scholar
  20. 20.
    Suero EM, Sabbagh Y, Westphal R, Hawi N, Citak M, Wahl FM et al (2015) Effect of medial opening wedge high tibial osteotomy on intraarticular knee and ankle contact pressures. J Orthop Res 33:598–604CrossRefGoogle Scholar
  21. 21.
    van Egmond N, Hannink G, Janssen D, Vrancken AC, Verdonschot N, van Kampen A (2017) Relaxation of the MCL after an open-wedge high tibial osteotomy results in decreasing contact pressures of the knee over time. Knee Surg Sports Traumatol Arthrosc 25:800–807CrossRefGoogle Scholar
  22. 22.
    van Egmond N, van Grinsven S, van Loon CJ, Gaasbeek RD, van Kampen A (2016) Better clinical results after closed- compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment. Knee Surg Sports Traumatol Arthrosc 24:34–41CrossRefGoogle Scholar
  23. 23.
    Yan J, Musahl V, Kay J, Khan M, Simunovic N, Ayeni OR (2016) Outcome reporting following navigated high tibial osteotomy of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:3529–3555CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Abolfazl Bagherifard
    • 1
  • Mahmoud Jabalameli
    • 1
  • Alireza Mirzaei
    • 1
  • Akbar Khodabandeh
    • 1
  • Majid Abedi
    • 1
  • Hooman Yahyazadeh
    • 1
    Email author
  1. 1.Bone and Joint Reconstruction Research Center, Shafa Orthopedic HospitalIran University of Medical SciencesTehranIran

Personalised recommendations