Abstract
IntroductionMedial closing wedge high tibial osteotomy (CWHTO) for valgus deformity correction was first described by Coventry whom performed an additional reefing of the medial collateral ligament (MCL) to prevent instability postoperative. In our clinic the additional reefing procedure has never been performed and instability has not been reported routinely by patients. Using instrumented laxity testing, pre- and postoperative valgus and varus knee laxity can be measured objectively. We hypothesize that absence of changes in laxity testing and subjective knee stability scores support that no additional reefing procedure is necessary.Materials and methodsIn a prospective cohort study 11 consecutive patients indicated for medial CWHTO were subjected to pre- and postoperative stress X-rays in 30° and 70° of flexion and opening of the joint line was measured in degrees on the radiographs. Patient reported outcome scores were documented with the KOOS, Lysholm, SF36, Oxford Knee Score and a VAS instability scoring tool.ResultsAll patients (7 females) completed the study, mean age was 46 years. Mean preoperative Hip Knee Ankle angle 6.4° valgus was corrected to mean postoperative alignment 0.1° valgus. A significant difference was measured between mean pre- and postoperative 30° valgus laxity (2.8° vs 5.3°, P = 0.005), 30° varus laxity (6.7° vs 3.2°, P = 0.005) and 70° valgus laxity (2.0° vs 4.8°, P = 0.008). Postoperative patient-reported knee instability as measured with the Lysholm questionnaire was significantly improved compared to preoperative instability (P = 0.006). VAS instability improved, but didn’t reach significance (8.0 preoperative and 5.5 postoperative (P = 0.127). Other outcome measures showed improvement as well. No correlations between radiological findings and outcome scores were found.ConclusionA significant increase in postoperative valgus laxity in 30° and 70° of flexion deems reconsidering addition of MCL reefingplasty to the medial CWHTO although patient reported outcome on subjective stability scores fails to report increase of instability in this study population. Instrumented laxity measurements of medial CWHTO patients treated with additional medial reefingplasty should be performed to prove the value of this procedure.
Highlights
Medial closing wedge high tibial osteotomy (CWHTO) for valgus deformity correction was first described by Coventry whom performed an additional reefing of the medial collateral ligament (MCL) to prevent instability postoperative
Instrumented laxity measurements of medial CWHTO patients treated with additional medial reefingplasty should be performed to prove the value of this procedure
Inclusion criteria were symptomatic valgus malalignment located in the proximal tibia, indication for a medial CWHTO, based on the severity of the complaints and the observed deformity according to Paley (Paley 2002), age 18–65 years and no history of knee ligament injuries
Summary
Medial closing wedge high tibial osteotomy (CWHTO) for valgus deformity correction was first described by Coventry whom performed an additional reefing of the medial collateral ligament (MCL) to prevent instability postoperative. Coventry (1985, 1987) described the varus producing medial closing wedge high tibial osteotomy (CWHTO) to treat valgus malalignment of the knee (Coventry 1985; Coventry 1987). He stated that, by removing a bony wedge on the medial side of the proximal tibia, a laxity of the superficial medial collateral ligament (MCL) is introduced. Till date no study has evaluated the MCL-laxity before and after a varus producing medial CWHTO for valgus malalignment of the knee
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