Ziegler Raphaela, Goebel Lars, Seidel Roland, Cucchiarini Magali, Pape Dietrich, Madry Henning
Center of Experimental Orthopaedics, Saarland University, Kirrbergerstr. 1, Building 37, 66421, Homburg, Saarland, Germany.
Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2704-14. doi: 10.1007/s00167-014-3134-y. Epub 2014 Jun 14.
First, to evaluate whether medial open wedge high tibial osteotomy (HTO) induces alterations of the microstructure of the lateral tibial subchondral bone plate of sheep. Second, to test the hypothesis that specific correlations exist between topographical structural alterations of the subchondral bone, the cartilage and the lateral meniscus.
Three experimental groups received biplanar osteotomies of the right proximal tibiae: (a) closing wedge HTO (4.5° of tibial varus), (b) opening wedge HTO (4.5° tibial valgus; standard correction) and (c) opening wedge HTO (9.5° of valgus; overcorrection), each of which was compared to the non-osteotomised contralateral proximal tibiae. After 6 months, subchondral bone structure indices were measured by computed tomography. Correlations between the subchondral bone, the articular cartilage and the lateral meniscus were determined.
Increased loading by valgus overcorrection led to an enlarged specific bone surface (BS/BV) in the subarticular spongiosa compared with unloading by varisation. The subchondral bone plate was 3.9-fold thicker in the central region of the lateral tibial plateau than in the submeniscal periphery. Its thickness in the central region significantly correlated with the thickness of the articular cartilage. In the submeniscal region, such correlation did not exist. In general, a higher degree of osteoarthritis (OA) correlated with alterations of the subchondral bone plate microstructure. OA of the submeniscal articular cartilage also correlated with worse matrix staining of the lateral meniscus.
Osteoarthritis changes are associated with alterations of the subchondral bone plate microstructure. Specific topographical relationships exist in the central region between the articular cartilage and subchondral bone plate thickness, and in the submeniscal periphery between and the articular cartilage and lateral meniscus. From a clinical perspective, the combined follow-up data from this and the previous two investigations suggest that open wedge valgus HTO is a safe procedure for the lateral compartment to manage medial osteoarthritis of the knee with varus malalignment in the short term.
第一，评估内侧开放楔形高位胫骨截骨术（HTO）是否会引起绵羊胫骨外侧软骨下骨板微观结构的改变。第二，验证以下假设：软骨下骨、软骨和外侧半月板的地形结构改变之间存在特定的相关性。
三个实验组接受了右胫骨近端的双平面截骨术：（a）闭合楔形HTO（4.5°胫骨内翻），（b）开放楔形HTO（4.5°胫骨外翻；标准矫正）和（c）开放楔形HTO（9.5°外翻；过度矫正），每组均与未进行截骨术的对侧胫骨近端进行比较。6个月后，通过计算机断层扫描测量软骨下骨结构指数。确定软骨下骨、关节软骨和外侧半月板之间的相关性。
与内翻导致的负荷减轻相比，外翻过度矫正导致的负荷增加使关节下松质骨的比骨表面积（BS/BV）增大。胫骨外侧平台中央区域的软骨下骨板比半月板下周边厚3.9倍。其在中央区域的厚度与关节软骨的厚度显著相关。在半月板下区域，不存在这种相关性。一般来说，骨关节炎（OA）程度越高，与软骨下骨板微观结构的改变相关。半月板下关节软骨的OA也与外侧半月板的基质染色较差相关。
骨关节炎改变与软骨下骨板微观结构的改变有关。关节软骨和软骨下骨板厚度在中央区域存在特定的地形关系，在半月板下周边，关节软骨和外侧半月板之间也存在特定的地形关系。从临床角度来看，本研究以及前两项研究的综合随访数据表明，开放楔形外翻HTO在短期内是治疗膝关节内侧骨关节炎伴内翻畸形的外侧间室的安全手术。
