Abstract
Although rotation of the distal portion of the tibia below the osteotomy site is considered an inevitable change in the axial plane in open wedge high tibial osteotomy (HTO), several studies on this issue have shown contradictory results. The purpose of this study was, therefore, to determine the direction and amount of distal tibial rotation following open wedge HTO using a three-dimensional reconstructed model. This study involved 41 patients (42 knees) undergoing open wedge HTO for primary medial osteoarthritis. Distal tibial rotation was measured on the overlaid tibial plateau of a preoperative and postoperative 3-dimensional reconstructed model based on computed tomography. The mean distal tibial external rotation was 2.7° ± 2.3° (range, -0.9° to 9.9°), and the opening gap was larger in the group with > 3° distal tibial rotation than in the group with ≤ 3° distal tibial rotation (11.4 mm vs. 9.6 mm, P = 0.027). Multiple regression analysis showed that the opening gap was the only predictor of distal tibial rotation. On receiver operating characteristics analysis, an opening gap of 10 mm was found to be the optimal cutoff value for achieving greater than 3° of distal tibial rotation. Following medial opening wedge HTO, the distal tibial portion below the osteotomy site rotated approximately 3° externally. The magnitude of the external rotation of the distal tibia was affected by the opening gap width.
Highlights
Open wedge high tibial osteotomy (HTO) is an established procedure that provides pain relief and functional improvement in patients with medial knee osteoarthritis and varus deformities. [1,2,3,4,5,6] The biomechanical rationale of this procedure is to shift joint loading from the medial compartment, which has osteoarthritic cartilage, to the lateral compartment with relatively intact cartilage in the coronal plane.[2]
The mean distal tibial external rotation was 2.7 ̊ ± 2.3 ̊, and the opening gap was larger in the group with > 3 ̊ distal tibial rotation than in the group with 3 ̊ distal tibial rotation (11.4 mm vs. 9.6 mm, P = 0.027)
Multiple regression analysis showed that the opening gap was the only predictor of distal tibial rotation
Summary
Open wedge high tibial osteotomy (HTO) is an established procedure that provides pain relief and functional improvement in patients with medial knee osteoarthritis and varus deformities. [1,2,3,4,5,6] The biomechanical rationale of this procedure is to shift joint loading from the medial compartment, which has osteoarthritic cartilage, to the lateral compartment with relatively intact cartilage in the coronal plane.[2]. Previous studies[12,13,14] dealt with distal tibial fragment rotation and used various unreliable measurement methods, such as intraoperative visualization of landmarks, Kirschner wire, or the axial plane of two-dimensional computed tomography (CT), and contradictory results were obtained regarding the direction and the amount of distal tibial rotation It is unclear whether the distal part under the osteotomy site rotates internally or externally, and if it does rotate, what the degree of rotation is remains unclear
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