Abstract

Purpose: Excessive joint line obliquity (JLO) after open-wedge high tibial osteotomy (OWHTO) induces detrimental stress on the articular cartilage. The purpose of this article is to assess the correlation between JLO and the clinical results after OWHTO.Methods: 68 patients were followed up for more than 1 year. JLO was assessed using a long-leg standing anteroposterior radiograph. The knee osteoarthritis outcome score (KOOS) and KSS (Knee Society score) objective knee score were assessed as clinical scores. The Weight-bearing line ratio (WBLR), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint line convergence angle (JLCA) were assessed as radiological parameters. The timed up-and-go (TUG) test and single-leg standing (SLS) test were performed, and the isometric muscle strength of the quadriceps and hamstrings was assessed to evaluate the knee function. The primary outcomes were the correlations between the JLO and the clinical score, radiological parameters and knee function after OWHTO. The secondary objective of this study was to detect the factor with the greatest influence on JLO.Results: There were significant correlations between the postoperative JLO and the KOOS in the subcategories of pain, activities of daily living (ADL), and sports and recreation (r = −0.311, −0.302, −0.282, p = 0.011, 0.014, 0.022, respectively). However, the postoperative JLO was not significantly correlated with the KSS, knee function, or muscle strength. The preoperative LDFA and postoperative MPTA were factors influencing increased JLO after OWHTO.Discussion: There was no significant correlation between the JLO and the actual knee function. The preoperative LDFA and postoperative MPTA were factors that influenced the increase in JLO after OWHTO.

Highlights

  • Knee joint line obliquity (JLO) after open-wedge high tibial osteotomy (OWHTO) corresponds to an excessive valgus of the tibial mechanical axis [1]

  • Significant correlations were noted between the JLO and knee osteoarthritis outcome score (KOOS) subcategories of pain, activities of daily living (ADL), and sports and recreation in the clinical results after OWHTO (r = À0.311, À0.302, À0.278, p = 0.011, 0.014, 0.022, respectively)

  • No significant correlations were observed between JLO and the KSS, timed up-and-go (TUG), single-leg standing (SLS), or muscle strength

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Summary

Introduction

Knee joint line obliquity (JLO) after open-wedge high tibial osteotomy (OWHTO) corresponds to an excessive valgus of the tibial mechanical axis [1]. To resolve these problems for severe varus alignment, the proximal tibia should be overcorrected through OWHTO, which can increase the JLO in the coronal plane. Excessive JLO increases the shear stress at the joint surface [1,2,3,4,5]. Over 5° of JLO may induce detrimental stress on the articular cartilage [3]. JLO should be parallel to the floor in the coronal plane to prevent further progression of osteoarthritis.

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