Purpose
The primary aim of this study was to evaluate the 3-dimensional morphology of the
proximal tibia around the osteotomy plane in open-wedge high tibial osteotomy, focusing
on the posterolateral (PL) and posteromedial (PM) tibial condyles, and to clarify
the changes in morphologic parameters due to differences in patient characteristics
and hinge position. The secondary aim was to examine whether morphologic features
were associated with insufficient osteotomy, which increases the risk of lateral hinge
fracture (LHF).
Methods
The PL and PM anteroposterior distance, asymmetry ratio, and discrepancy between PL
and PM distances along the tibial osteotomy plane were measured. We investigated changes
in the parameters due to differences in patient characteristics and hinge position.
Osteotomy configurations and LHFs were evaluated using postoperative computed tomography
scans.
Results
The 3-dimensional preoperative plans of 117 knees (male, 41 knees; female, 76 knees)
were evaluated. PL distances were larger than PM distances in almost all cases. The
average asymmetry ratio was 1.35, and the standard deviation was 0.22. Higher hinge
position was associated with a larger asymmetry ratio and discrepancy (P < .001). The asymmetry ratio and discrepancy were independently positively correlated
with male sex (P = .002 and P = .001, respectively) and gentle posterior tibial slope (P < .001 and P < .001, respectively). Osteotomies with type III LHFs showed lower osteotomy sufficiency
than osteotomies without LHFs (P < .001).
Conclusions
PL tibial condyle protrusion was more pronounced in male patients and those with a
high hinge position, and may result in insufficient PL osteotomy, which is a risk
factor for type III LHF during open-wedge high tibial osteotomy. The optimal hinge
position was located approximately 15 mm and 20 mm distal to the lateral tibial plateau
in female and male patients, respectively.
Level of Evidence
IV: retrospective case series.
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Article info
Publication history
Published online: August 09, 2022
Accepted:
July 13,
2022
Received:
February 4,
2022
Footnotes
See commentary on page 335
The authors report the following potential conflicts of interest or sources of funding: S.K. reports grants from Olympus Terumo Biomaterials Corp., Tokyo, Japan, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
