AI Article Synopsis
- The study assessed how medial opening-wedge high tibial osteotomy (MOWHTO) affects knee joint line obliquity (KJLO) and other related joint parameters in 109 patients over the course of a year.
- It found significant relationships between changes in the medial proximal tibial angle (MPTA), ankle joint line obliquity (AJLO), and hip abduction angle (HAA) and the postoperative KJLO, identifying MPTA as the most predictive factor.
- The results suggest that while MOWHTO increases KJLO through tibial valgization, changes in hip and ankle positioning can offset this increase, highlighting the importance of considering these joints for optimal outcomes.
Article Abstract
Purpose: This study aimed to measure the change in knee joint line obliquity (KJLO) and the changes in radiologic parameters of the ankle and hip joints after medial opening-wedge high tibial osteotomy (MOWHTO), and to evaluate the correlation and causal relationship between these parameters.
Methods: This study evaluated 109 patients who underwent MOWHTO between April 2015 and December 2021. Radiologic parameters, including KJLO, medial proximal tibial angle (MPTA), ankle joint line obliquity (AJLO), and hip abduction angle (HAA), were analysed before and 1 year after MOWHTO. Multiple linear regression analysis was used to identify independent variables that significantly affected the change in KJLO after MOWHTO. Receiver operating characteristic (ROC) analysis was used to evaluate the cutoff value for a change in KJLO that exceeded 5° postoperatively, and the predicting values of radiologic parameters.
Results: Multiple linear regression analysis showed that changes in MPTA, AJLO, and HAA (β = 0.440, P < 0.001; β = - 0.310, P < 0.001; β = 0.164, P = 0.035, respectively) were predictors of the change in KJLO after MOWHTO. ROC analysis showed that the threshold value for a change in KJLO which exceeded 5° postoperatively was 4.6° (66.7% sensitivity, 63.8% specificity, P = 0.025). Moreover, ROC curves for predicting a change in KJLO of > 4.6° showed that the AUC was significantly higher for the change in MPTA than that of the other two parameters (P = 0.011 for AJLO and P < 0.001 for HAA).
Conclusion: MOWHTO increases the KJLO by valgization of the proximal tibia and causes hip adduction and ankle valgization. The postoperative ankle valgization after MOWHTO could reduce the increase in KJLO, counteracting the effects of proximal tibial valgization and hip adduction. Therefore, the effects of the hip and ankle joints should be considered to achieve an optimal KJLO and satisfactory clinical outcomes after MOWHTO.
Level Of Study: Cohort study, IV.
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