Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Knee Surg Sports Traumatol Arthrosc. 2020 Sep;28(9):3022-3030. doi: 10.1007/s00167-019-05762-2. Epub 2019 Nov 8.
This study aimed to assess the effect of soft tissue correction due to knee joint laxity, which induces alignment error after hybrid closed-wedge high tibial osteotomy (CWHTO). In addition, to verify whether postoperative soft tissue correction can be predicted from preoperative radiographic parameters.
A retrospective evaluation of data from patients treated by CWHTO in 2016-2019 was performed. Standing full-length anteroposterior radiograph measurement was performed pre- and post-surgery, and short anteroposterior radiographs of the knee under maximal manual varus and valgus stress were taken preoperatively. The weight-bearing line, hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured, in addition to JLCA under varus or valgus conditions. Soft tissue correction was defined as ΔHKA minus ΔMPTA. Multiple regression analysis was performed to evaluate preoperative factors that could influence soft tissue correction.
Data from 49 knees were included in the analysis. The mean soft tissue correction was 3.2°, which indicates an over-correction. Multiple regression analysis revealed that JLCA (β = 0.642; p < 0.001) and valgus JLCA (β = - 0.422; p = 0.001) were significantly associated with postoperative soft tissue correction. The final model of the regression formula was described by the following equation: postoperative soft tissue correction = 0.691 × JLCA - 0.411 × valgus JLCA - 0.399.
Preoperative values for JLCA and JLCA under valgus stress are associated with soft tissue correction. Surgeons should, therefore, consider these measurements to achieve postoperative limb alignment.
本研究旨在评估因膝关节松弛导致的软组织矫正效果，这种松弛会在混合闭合楔形胫骨高位截骨术（CWHTO）后引起对线不良。此外，验证术后软组织矫正是否可以从术前影像学参数中预测。
对 2016-2019 年接受 CWHTO 治疗的患者数据进行回顾性评估。术前和术后均行站立全长前后位 X 线测量，并在最大手动内翻和外翻应力下拍摄膝关节短前后位 X 线片。测量了负重线、髋膝踝角（HKA）、内侧胫骨近端角（MPTA）和关节线会聚角（JLCA），以及内翻和外翻条件下的 JLCA。软组织矫正定义为ΔHKA 减去ΔMPTA。进行多元回归分析，以评估可能影响软组织矫正的术前因素。
分析纳入了 49 膝的数据。平均软组织矫正为 3.2°，提示过度矫正。多元回归分析显示，JLCA（β=0.642；p<0.001）和外翻 JLCA（β=-0.422；p=0.001）与术后软组织矫正显著相关。回归公式的最终模型可由以下方程描述：术后软组织矫正=0.691×JLCA-0.411×外翻 JLCA-0.399。
JLCA 和外翻应力下的 JLCA 术前值与软组织矫正相关。因此，外科医生应考虑这些测量值以实现术后肢体对线。
