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Increased preoperative medial and lateral laxity is a predictor of overcorrection in open wedge high tibial osteotomy

  • Jun-Gu Park
  • Jong-Min Kim
  • Bum-Sik Lee
  • Sang-Min Lee
  • Oh-Jin Kwon
  • Seong-Il BinEmail author
KNEE
  • 24 Downloads

Abstract

Purpose

This study aimed at determining whether overcorrection after open wedge high tibial osteotomy (OWHTO) would be predicted by the magnitude of preoperative medial and lateral coronal soft tissue laxity around the knee joint.

Methods

Overall, 68 knees of 62 patients who underwent OWHTO for primary medial osteoarthritis were retrospectively reviewed. The mechanical hip–knee–ankle (HKA) axis, weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), joint line obliquity, coronal subluxation, and joint line convergence angle (JLCA) were measured on full-weight-bearing long-standing HKA radiographs preoperatively and at 1 year postoperatively. The varus valgus stress angle was measured on preoperative radiographs. The correction amount due to soft tissue factors was calculated as the difference between the WBL ratio on postoperative 1-year radiographs and that on virtually corrected preoperative radiographs with the same amount of MPTA at 1 year postoperatively. The patients were grouped according to the presence or absence of a ≥ 10% overcorrection of WBL ratio (overcorrection or expected correction). Multiple logistic regression analysis was performed to identify the preoperative risk factors of overcorrection.

Results

The average WBL ratio was corrected from 19.0 ± 13.5% preoperatively to 61.6 ± 9.1% postoperatively (P < 0.001). The average MPTA changed from 85.1 ± 1.7° preoperatively to 93.6 ± 2.6° postoperatively, resulting in an average tibia correction angle of 8.6 ± 3.1°. The average estimated correction from soft tissue factors was 5.8 ± 7.4% of the WBL ratio. Soft tissue correction of the WBL ratio > 10% was confirmed in 17 patients (28%). The preoperative JLCA and valgus stress angle were significantly greater in the overcorrection group than in the expected correction group: 5.0 ± 1.7° vs. 3.4 ± 1.9° (P = 0.003) and 2.4 ± 1.0° vs. 1.3 ± 1.2° (P = 0.002), respectively. Among the radiologic parameters, the presence of both ≥ 4° JLCA and ≥ 1.5° valgus stress angle was the only significant risk factor for overcorrection from soft tissue factors (P = 0.006; odds ratio, 30.2).

Conclusions

The magnitude of both medial and lateral coronal soft tissue laxity was a predictor of overcorrection from soft tissue factors after OWHTO. Overcorrection was more likely to occur in cases with both ≥ 4° JLCA and ≥ 1.5° valgus stress angle.

Level of evidence

III.

Keywords

Knee High tibial osteotomy Overcorrection Joint line convergence angle Soft tissue laxity 

Notes

Compliance with ethical standards

Conflict of interest

Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

Funding

No funding for this study was required.

Ethical approval

This study was approved by the institutional review board of Asan Medical Center (AMC IRB No. 2018-1225).

Supplementary material

167_2019_5805_MOESM1_ESM.docx (18 kb)
Supplementary file1 (DOCX 17 kb)

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Copyright information

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

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan HospitalPusan National University School of MedicineYangsanRepublic of Korea

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