Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan.
Department of Advanced Joint Reconstructive Surgery, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan.
Knee Surg Sports Traumatol Arthrosc. 2019 Oct;27(10):3374-3380. doi: 10.1007/s00167-019-05354-0. Epub 2019 Jan 17.
This study examined the influence of the mechanical medial proximal tibial angle (MPTA) on anterior cruciate ligament (ACL) degeneration following open wedge high tibial osteotomy (OWHTO). It was hypothesised that an excessive increase in MPTA would be associated with ACL degeneration following OWHTO.
Seventy-four knees treated with OWHTO were retrospectively examined. Arthroscopic ACL grading [0 (intact) to 4 (complete rupture)], anterior tibial translation (ATT) test at the time of OWHTO with the index arthroscopy and at plate removal with the second-look arthroscopy, clinical assessments using the Knee Society Score (KSS), and radiographic evaluations of MPTA were performed. The relationship between MPTA and the ACL condition was analysed using Spearman's correlation.
The time from the index arthroscopy to the second-look arthroscopy was 15.0 ± 4.4 months; the total follow-up was 31.0 ± 6.5 months. ACL grade significantly increased from 0.6 ± 0.8 (index arthroscopy) to 1.1 ± 1.2 (second-look arthroscopy) (p < 0.0018). ATT on the operated side significantly decreased from 7.1 ± 2.6 mm preoperatively to 5.3 ± 2.3 mm at the time of plate removal (p < 0.001). No significant difference was observed in KSS for ACL grades in the steady and progression groups. Changes in MPTA from the preoperative to postoperative period were significantly higher in the progression group (p = 0.0155). Changes in ACL grades were significantly correlated with preoperative MPTA and changes in MPTA (r = - 0.365 and 0.343, respectively; p < 0.01).
Excessively increased MPTA led to ACL degeneration following OWHTO. ACL degeneration was not associated with short-term clinical outcomes. Excessive correction of MPTA should be avoided to prevent ACL degeneration following OWHTO.
Therapeutic case series, Level IV.
本研究探讨了机械性胫骨近端内侧角（MPTA）对开放式楔形胫骨高位截骨术（OWHTO）后前交叉韧带（ACL）退变的影响。研究假设，MPTA 的过度增加与 OWHTO 后 ACL 退变有关。
回顾性分析了 74 例接受 OWHTO 治疗的膝关节。行关节镜 ACL 分级[0（完整）至 4（完全断裂）]、OWHTO 时的前胫骨平移（ATT）试验（首次关节镜检查）和钢板取出时的二次关节镜检查、膝关节学会评分（KSS）的临床评估以及 MPTA 的放射学评估。使用 Spearman 相关分析来分析 MPTA 与 ACL 状况之间的关系。
首次关节镜检查至二次关节镜检查的时间为 15.0±4.4 个月；总随访时间为 31.0±6.5 个月。ACL 分级从 0.6±0.8（首次关节镜检查）显著增加至 1.1±1.2（二次关节镜检查）（p<0.0018）。患侧 ATT 从术前的 7.1±2.6mm 显著减少至钢板取出时的 5.3±2.3mm（p<0.001）。在稳定组和进展组中，ACL 分级的 KSS 没有显著差异。进展组从术前到术后 MPTA 的变化明显更高（p=0.0155）。ACL 分级的变化与术前 MPTA 和 MPTA 的变化显著相关（r=-0.365 和 0.343，p<0.01）。
OWHTO 后 MPTA 的过度增加导致 ACL 退变。ACL 退变与短期临床结果无关。为了防止 OWHTO 后 ACL 退变，应避免过度矫正 MPTA。
治疗性病例系列，IV 级。
