Lee O-Sung, Ahn Soyeon, Lee Yong Seuk
Division of Orthopaedics, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Gyeonggi-do, Seoul, Republic of Korea.
Division of Statistics, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Knee Surg. 2018 Aug;31(7):625-634. doi: 10.1055/s-0037-1605561. Epub 2017 Aug 14.
The present systematic review and meta-analysis were aimed to verify the effect of open-wedge (OW) and closed-wedge (CW) high-tibial osteotomy (HTO) on sagittal and axial alignments of the patella. A vigorous search was performed for studies that compared the changes of sagittal and axial alignments of patella after OW and CW HTO. After evaluating publication bias and heterogeneity, we aggregated variables by using the random-effects model. The weighted mean differences in sagittal and axial alignment of patella were estimated with 95% confidence intervals. Also, we analyzed the changes in sagittal alignment of various OW HTO techniques, such as uniplanar, biplanar, and retrotubercle osteotomy. Overall, 20 studies that included 831 OW HTOs and 206 CW HTOs were included in this study. Patellar height decreased after OW HTO based on the Blackburne-Peel index (BPI, mean: -0.10), and Caton-Deschamps index (CDI, mean: -0.08). However, the patellar height after CW HTO showed no change after surgery (BPI [mean: -0.02], and CDI [mean: 0.02]). Among OW HTO techniques, the retrotubercle osteotomy showed the least change in patellar height after surgery. The lateral patellar tilt decreased by 1.74 degrees, and lateral patellar shift showed no change after OW HTO. However, there was a lack of evidence to conclude the change of axial alignment of patella after CW HTO. Our results supported that the sagittal alignment of patella lowered after OW HTO. However, CW HTO maintained the constant sagittal position of the patella. Among OW HTO techniques, the retrotubercle osteotomy had the least effect on the sagittal alignment of the patella. Regarding the axial alignment of the patella, OW HTO resulted in a little change of lateral patellar tilt; however, there was little evidence to confirm the change of the axial alignment of patella after CW HTO.
本系统评价和荟萃分析旨在验证开放性楔形（OW）和闭合性楔形（CW）高位胫骨截骨术（HTO）对髌骨矢状面和轴面排列的影响。对比较OW和CW HTO术后髌骨矢状面和轴面排列变化的研究进行了全面检索。在评估发表偏倚和异质性后，我们使用随机效应模型汇总变量。用95%置信区间估计髌骨矢状面和轴面排列的加权平均差异。此外，我们分析了各种OW HTO技术（如单平面、双平面和结节后截骨术）矢状面排列的变化。本研究共纳入20项研究，包括831例OW HTO和206例CW HTO。基于Blackburne-Peel指数（BPI，平均值：-0.10）和Caton-Deschamps指数（CDI，平均值：-0.08），OW HTO术后髌骨高度降低。然而，CW HTO术后髌骨高度术后无变化（BPI[平均值：-0.02]，CDI[平均值：0.02]）。在OW HTO技术中，结节后截骨术术后髌骨高度变化最小。OW HTO术后髌骨外侧倾斜度降低1.74度，髌骨外侧移位无变化。然而，缺乏证据来推断CW HTO术后髌骨轴面排列的变化。我们的结果支持OW HTO术后髌骨矢状面排列降低。然而，CW HTO维持了髌骨矢状面位置不变。在OW HTO技术中，结节后截骨术对髌骨矢状面排列影响最小。关于髌骨轴面排列，OW HTO导致髌骨外侧倾斜度略有变化；然而，几乎没有证据证实CW HTO术后髌骨轴面排列的变化。
