Effect of knee suspension on posterior tibial slope after medial opening-wedge high tibial osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jun , LIANG Shuai , YAO Yunfeng , LÜ Hao ,  JING Juehua

Department of Orthopedics, the Second Hospital of Anhui Medical University, Hefei Anhui, 230601, P. R. China;

Corresponding author：

JING Juehua, Email: 278353834@qq.com

Keywords：

Knee osteoarthritis; high tibial osteotomy; posterior tibial slope; suspended knee joint

DOI：

10.7507/1002-1892.202202056

Video：

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Objective To investigate the effect of knee suspension during titanium plate fixation on postoperative posterior tibial slope (PTS) in knee osteoarthritis (KOA) with medial opening-wedge high tibial osteotomy (OWHTO). Methods The clinical data of 47 patients with KOA treated by OWHTO between January 2019 and December 2020 was retrospectively analyzed. In 24 cases, the knee joint was suspended when titanium plate was fixed (research group), and in 23 cases, the knee joint was naturally straightened when titanium plate was fixed (control group). There was no significant difference in gender, age, side, body mass index, disease duration, preoperative visual analogue scale (VAS) score, American Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Lysholm score, and preoperative PTS between the two groups (P>0.05). PTS were measured at 1 day after operation and last follow-up, and were compared with that before operation. Before operation and at last follow-up, VAS score was used to evaluate the knee pain, HSS score, WOMAC score, and Lysholm score were used to evaluate the knee function. Results The patients in both groups were followed up 13-24 months, with an average of 19.9 months. There was no complication such as incision infection, screw fracture, and deep venous thrombosis of lower limbs in two groups. At last follow-up, the VAS score, HSS score, WOMAC score, and Lysholm score in two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference between the two groups in the each score difference of before and after operation (P>0.05). There was no significant difference in PTS at each time point before and after operation in the research group (P>0.05), but PTS in the control group significantly increased at 1 day after operation and last follow-up (P<0.05). PTS of the research group at 1 day after operation and last follow-up were significantly lower than those of the control group (P<0.05). Conclusion OWHTO can effectively relieve knee pain and improve knee function in KOA, and the increase of postoperative PTS can be effectively avoided by suspending knee joint.

Citation： LI Jun, LIANG Shuai, YAO Yunfeng, LÜ Hao, JING Juehua. Effect of knee suspension on posterior tibial slope after medial opening-wedge high tibial osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 703-707. doi: 10.7507/1002-1892.202202056 Copy

1.	王飞, 陈百成, 高石军, 等. 内侧撑开和外侧闭合胫骨高位截骨术治疗膝内翻骨关节炎. 中华骨科杂志, 2010, 30(6): 558-562.
2.	中华医学会骨科分会关节外科学组, 吴阶平医学基金会骨科学专家委员会. 膝骨关节炎阶梯治疗专家共识 (2018年版). 中华关节外科杂志 (电子版), 2019, 13(1): 124-130.
3.	Papachristou G. Photoelastic study of the internal and contact stresses on the knee joint before and after osteotomy. Arch Orthop Trauma Surg, 2004, 124(5): 288-297.
4.	Lau LCM, Chui ECS, Fan JCH, et al. Patient-specific instrumentation (PSI) Referencing High Tibial Osteotomy Technological Transfer and Education: protocol for a double-blind, randomised controlled trial (PROTECTED HTO Trial). BMJ Open, 2021, 11(2): e041129. doi: 10.1136/bmjopen-2020-041129.
5.	张艺, 亓建洪. 胫骨平台后倾角与半月板损伤的相关性研究进展. 中国矫形外科杂志, 2020, 28(8): 721-724.
6.	白皓宇, 王逍遥, 宋晓晖, 等. 胫骨平台后倾角在前交叉韧带损伤中的研究进展. 现代医学, 2018, 46(5): 598-601.
7.	Wang JH, Bae JH, Lim HC, et al. Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope. Am J Sports Med, 2009, 37(12): 2411-2418.
8.	Ma W, Han Z, Sun S, et al. Use of a suspended and straightened knee joint position when fixing steel plates can prevent the increase in postoperative posterior tibial slope after open-wedge high tibial osteotomy. J Orthop Surg Res, 2021, 16(1): 684. doi: 10.1186/s13018-021-02834-3.
9.	Lee YS, Park SJ, Shin VI, et al. Achievement of targeted posterior slope in the medial opening wedge high tibial osteotomy: a mathematical approach. Ann Biomed Eng, 2010, 38(3): 583-593.
10.	Noyes FR, Mayfield W, Barber-Westin SD, et al. Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med, 2006, 34(8): 1262-1273.
11.	Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med, 2005, 33(3): 378-387.
12.	Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 2000, 28(3): 282-296.
13.	赵允, 胡文晋, 黄竞敏, 等. 内侧撑开高位胫骨截骨术联合调整胫骨平台后倾角治疗屈曲受限型膝内翻骨关节炎的早期疗效. 中国修复重建外科杂志, 2018, 32(2): 157-161.
14.	Lobenhoffer P, Agneskirchner J, Zoch W. Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade, 2004, 33(2): 153-160.
15.	Jiang J, Liu Z, Wang X, et al. Increased posterior tibial slope and meniscal slope could be risk factors for meniscal injuries: A systematic review. Arthroscopy, 2022. doi: 10.1016/j.arthro.2022.01.013.
16.	Dæhlin L, Inderhaug E, Strand T, et al. The effect of posterior tibial slope on the risk of revision surgery after anterior cruciate ligament reconstruction. Am J Sports Med, 2022, 50(1): 103-110.
17.	Shelburne KB, Kim HJ, Sterett WI, et al. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res, 2011, 29(2): 223-231.
18.	El-Azab H, Halawa A, Anetzberger H, et al. The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg (Br), 2008, 90(9): 1193-1197.
19.	Marti CB, Gautier E, Wachtl SW, et al. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy, 2004, 20(4): 366-372.
20.	Kim GB, Kim KI, Song SJ, et al. Increased posterior tibial slope after medial open-wedge high tibial osteotomy may result in degenerative changes in anterior cruciate ligament. J Arthroplasty, 2019, 34(9): 1922-1928.
21.	LaPrade RF, Oro FB, Ziegler CG, et al. Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med, 2010, 38(1): 160-170.

1. 王飞, 陈百成, 高石军, 等. 内侧撑开和外侧闭合胫骨高位截骨术治疗膝内翻骨关节炎. 中华骨科杂志, 2010, 30(6): 558-562.
2. 中华医学会骨科分会关节外科学组, 吴阶平医学基金会骨科学专家委员会. 膝骨关节炎阶梯治疗专家共识 (2018年版). 中华关节外科杂志 (电子版), 2019, 13(1): 124-130.
3. Papachristou G. Photoelastic study of the internal and contact stresses on the knee joint before and after osteotomy. Arch Orthop Trauma Surg, 2004, 124(5): 288-297.
4. Lau LCM, Chui ECS, Fan JCH, et al. Patient-specific instrumentation (PSI) Referencing High Tibial Osteotomy Technological Transfer and Education: protocol for a double-blind, randomised controlled trial (PROTECTED HTO Trial). BMJ Open, 2021, 11(2): e041129. doi: 10.1136/bmjopen-2020-041129.
5. 张艺, 亓建洪. 胫骨平台后倾角与半月板损伤的相关性研究进展. 中国矫形外科杂志, 2020, 28(8): 721-724.
6. 白皓宇, 王逍遥, 宋晓晖, 等. 胫骨平台后倾角在前交叉韧带损伤中的研究进展. 现代医学, 2018, 46(5): 598-601.
7. Wang JH, Bae JH, Lim HC, et al. Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope. Am J Sports Med, 2009, 37(12): 2411-2418.
8. Ma W, Han Z, Sun S, et al. Use of a suspended and straightened knee joint position when fixing steel plates can prevent the increase in postoperative posterior tibial slope after open-wedge high tibial osteotomy. J Orthop Surg Res, 2021, 16(1): 684. doi: 10.1186/s13018-021-02834-3.
9. Lee YS, Park SJ, Shin VI, et al. Achievement of targeted posterior slope in the medial opening wedge high tibial osteotomy: a mathematical approach. Ann Biomed Eng, 2010, 38(3): 583-593.
10. Noyes FR, Mayfield W, Barber-Westin SD, et al. Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med, 2006, 34(8): 1262-1273.
11. Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med, 2005, 33(3): 378-387.
12. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 2000, 28(3): 282-296.
13. 赵允, 胡文晋, 黄竞敏, 等. 内侧撑开高位胫骨截骨术联合调整胫骨平台后倾角治疗屈曲受限型膝内翻骨关节炎的早期疗效. 中国修复重建外科杂志, 2018, 32(2): 157-161.
14. Lobenhoffer P, Agneskirchner J, Zoch W. Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade, 2004, 33(2): 153-160.
15. Jiang J, Liu Z, Wang X, et al. Increased posterior tibial slope and meniscal slope could be risk factors for meniscal injuries: A systematic review. Arthroscopy, 2022. doi: 10.1016/j.arthro.2022.01.013.
16. Dæhlin L, Inderhaug E, Strand T, et al. The effect of posterior tibial slope on the risk of revision surgery after anterior cruciate ligament reconstruction. Am J Sports Med, 2022, 50(1): 103-110.
17. Shelburne KB, Kim HJ, Sterett WI, et al. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res, 2011, 29(2): 223-231.
18. El-Azab H, Halawa A, Anetzberger H, et al. The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg (Br), 2008, 90(9): 1193-1197.
19. Marti CB, Gautier E, Wachtl SW, et al. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy, 2004, 20(4): 366-372.
20. Kim GB, Kim KI, Song SJ, et al. Increased posterior tibial slope after medial open-wedge high tibial osteotomy may result in degenerative changes in anterior cruciate ligament. J Arthroplasty, 2019, 34(9): 1922-1928.
21. LaPrade RF, Oro FB, Ziegler CG, et al. Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med, 2010, 38(1): 160-170.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of knee suspension on posterior tibial slope after medial opening-wedge high tibial osteotomy

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