Abstract
PurposeThis study evaluated the medial joint stability after high tibial osteotomy (HTO) releasing the superficial medial collateral ligament (sMCL) without cutting and repairing.MethodsTwenty-one patients who performed HTO were enrolled. After an L-shaped incision was made in the pes anserinus, the sMCL was released from the distal portion during surgery. After plate fixation, the sMCL was reattached and the pes anserinus was repaired underneath the plate. Plate removal was performed after 31.1 ± 14.2 months. Before HTO, a valgus force of 40 N was exerted at extension for reference values. Before and after plate removal, a valgus force of 40 N was exerted at extension and at a flexion position of 20°. Medial stability was evaluated by measuring the joint line convergence angle (JLCA).ResultsThe JLCAs in the extension state before HTO and plate removal were 1.64° ± 1.15° and 1.83° ± 1.36°, respectively; there was no significant difference (p = 0.198). There was also no significant difference in JLCA before HTO and after plate removal (p = 0.835). There was also no significant difference in JLCA before and after plate removal both at a knee extension and flexion position of 20° (p = 0.348 and p = 0.456, respectively).ConclusionsReleasing the sMCL without cutting and repairing the pes anserinus underneath the plate during medial open wedge HTO could facilitate the maintenance of medial joint stability.
Highlights
High tibial osteotomy (HTO) is a useful surgical option for medial osteoarthritis combined with varus deformity in young active patients [1, 2]
Medial open wedge HTO with locking plates has become favored to avoid co-morbidity associated with fibular osteotomy, which is required for closed wedge osteotomy [5]
The mean mechanical femorotibial angle was changed from preoperative varus at 7.3° ± 1.7° to postoperative valgus at 3.4° ± 1.5°
Summary
High tibial osteotomy (HTO) is a useful surgical option for medial osteoarthritis combined with varus deformity in young active patients [1, 2]. Several surgical options for HTO exist, including the lateral closed wedge and medial open wedge osteotomy [3, 4]. Medial open wedge HTO with locking plates has become favored to avoid co-morbidity associated with fibular osteotomy, which is required for closed wedge osteotomy [5]. It is assumed that medial stability could be maintained when the sMCL is released and reattached at the tibial attachment without cutting and the pes anserinus repaired underneath the plate. The aim of the present study was to evaluate medial joint stability before and after plate removal among patients who have undergone HTO with sMCL reattachment and pes anserinus repair under the plate
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