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

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.

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References

  1. 1.

    Akamatsu Y, Ohno S, Kobayashi H, Kusayama Y, Kumagai K, Saito T (2017) Coronal subluxation of the proximal tibia relative to the distal femur after opening wedge high tibial osteotomy. Knee 24(1):70–75

    Article  Google Scholar 

  2. 2.

    Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a 10- to 20-year follow-up. J Bone Jt Surg Br 90(5):592–596

    CAS  Article  Google Scholar 

  3. 3.

    Andriacchi TP (1994) Dynamics of knee malalignment. Orthop Clin N Am 25(3):395–403

    CAS  Google Scholar 

  4. 4.

    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(2):152–156

    Article  Google Scholar 

  5. 5.

    Briem K, Ramsey DK, Newcomb W, Rudolph KS, Snyder-Mackler L (2007) Effects of the amount of valgus correction for medial compartment knee osteoarthritis on clinical outcome, knee kinetics and muscle co-contraction after opening wedge high tibial osteotomy. J Orthop Res 25(3):311–318

    Article  Google Scholar 

  6. 6.

    El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG (2011) Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics 34(10):e622–628

    PubMed  Google Scholar 

  7. 7.

    Elson DW, Petheram TG, Dawson MJ (2015) High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci's method. Knee Surg Sports Traumatol Arthrosc 23(7):2041–2048

    CAS  Article  Google Scholar 

  8. 8.

    Feucht MJ, Minzlaff P, Saier T, Cotic M, Sudkamp NP, Niemeyer P, Imhoff AB, Hinterwimmer S (2014) Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. Int Orthop 38(11):2273–2280

    Article  Google Scholar 

  9. 9.

    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 N Am 10(3):585–608

    CAS  Google Scholar 

  10. 10.

    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(2):201–207

    Article  Google Scholar 

  11. 11.

    Gebhard F, Krettek C, Hufner T, Grutzner PA, Stockle U, Imhoff AB, Lorenz S, Ljungqvist J, Keppler P, Ao C (2011) Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy. Arch Orthop Trauma Surg 131(3):297–302

    Article  Google Scholar 

  12. 12.

    Heijens E, Kornherr P, Meister C (2016) The coronal hypomochlion: a tipping point of clinical relevance when planning valgus producing high tibial osteotomies. Bone Jt J 98(5):628–633

    Article  Google Scholar 

  13. 13.

    Hinman RS, May RL, Crossley KM (2006) Is there an alternative to the full-leg radiograph for determining knee joint alignment in osteoarthritis? Arthritis Rheum 55(2):306–313

    Article  Google Scholar 

  14. 14.

    Kim YT, Choi JY, Lee JK, Lee YM, Kim JI (2019) Coronal tibiofemoral subluxation is a risk factor for postoperative overcorrection in high tibial osteotomy. Knee 26(4):832–837

    Article  Google Scholar 

  15. 15.

    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(6):439–444

    Article  Google Scholar 

  16. 16.

    Lee DH, Park SC, Park HJ, Han SB (2016) 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):3704–3712

    Article  Google Scholar 

  17. 17.

    Lee DK, Wang JH, Won Y, Min YK, Jaiswal S, Lee BH, Kim JY (2019) Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05502-6

    Article  PubMed  Google Scholar 

  18. 18.

    Madry H, Goebel L, Hoffmann A, Duck K, Gerich T, Seil R, Tschernig T, Pape D (2017) Surgical anatomy of medial open-wedge high tibial osteotomy: crucial steps and pitfalls. Knee Surg Sports Traumatol Arthrosc 25(12):3661–3669

    Article  Google Scholar 

  19. 19.

    Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646

    Article  Google Scholar 

  20. 20.

    Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 246:250–259

    Google Scholar 

  21. 21.

    Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H (2016) Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 136(10):1337–1342

    Article  Google Scholar 

  22. 22.

    Seitz AM, Nelitz M, Ignatius A, Durselen L (2019) Release of the medial collateral ligament is mandatory in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27(9):2917–2926

    Article  Google Scholar 

  23. 23.

    So SY, Lee SS, Jung EY, Kim JH, Wang JH (2019) 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. https://doi.org/10.1007/s00167-019-05555-7

    Article  PubMed  Google Scholar 

  24. 24.

    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):B55–62

    Article  Google Scholar 

  25. 25.

    Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GH (2009) Complications after tomofix medial opening wedge high tibial osteotomy. J Knee Surg 22(3):218–225

    Article  Google Scholar 

  26. 26.

    Van den Bempt M, Van Genechten W, Claes T, Claes S (2016) How accurately does high tibial osteotomy correct the mechanical axis of an arthritic varus knee? A systematic review. Knee 23(6):925–935

    Article  Google Scholar 

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Correspondence to Seong-Il Bin.

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

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Park, JG., Kim, JM., Lee, BS. et al. Increased preoperative medial and lateral laxity is a predictor of overcorrection in open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28, 3164–3172 (2020). https://doi.org/10.1007/s00167-019-05805-8

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Keywords

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