Kim Ji Eui, Won Samuel, Jaffar Mohd Shahrul Azuan, Lee Jae Ik, Kim Tae Woo, Lee Yong Seuk
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
Department of Orthopaedic Surgery and Traumatology, Sarawak General Hospital, Sarawak, Malaysia.
Knee. 2020 Jun;27(3):940-948. doi: 10.1016/j.knee.2020.04.008. Epub 2020 Apr 22.
Open-wedge high tibial osteotomy (OWHTO) produces three- dimensional (3D) geometric changes. Among them, increased posterior tibial slope (PTS), and altered coronal inclination that induces unintended tibial translation may affect anterior cruciate ligament (ACL) status. The purpose of current study was to evaluate the geometric changes following OWHTO, such as increasing PTS and decreasing tibial subluxation, which may affect the status of ACL.
From April 2014 to December 2015, a total of 72 knees in 64 patients that underwent OWHTO, second-look arthroscopy, and magnetic resonance imaging (MRI) assessment, were enrolled. Preoperative and postoperative coronal and sagittal translation, joint line orientation angle, the distance between medial femoral notch marginal line and medial tibial spine, and PTS were evaluated. ACL status was arthroscopically graded from grade 1 (best) to 4 (worst). The MRI signal of the graft in three portions (proximal, middle, and distal) was graded from grade 1 (best) to 4 (worst).
High grade (3: partial, and 4: complete rupture) was noted in 28 cases (38.9%) at the second-look arthroscopy compared with 10 cases (13.9%) at index arthroscopy. The MRI signal grade significantly increased at follow up MRI compared with preoperative MRI (P<0.01). An increased signal was commonly noted in the middle and distal portions of the graft.
Geometric changes after OWHTO were related to ACL deterioration. The ACL was commonly affected at the middle and distal portions and rarely at the proximal portion. There is a possibility of impingement because of the geometric changes.
Level IV.
开放楔形高位胫骨截骨术（OWHTO）会产生三维（3D）几何变化。其中，胫骨后倾坡度（PTS）增加以及冠状面倾斜度改变导致意外的胫骨平移，可能会影响前交叉韧带（ACL）的状态。本研究的目的是评估OWHTO术后的几何变化，如PTS增加和胫骨半脱位减少，这些变化可能会影响ACL的状态。
2014年4月至2015年12月，共纳入64例患者的72个膝关节，这些患者均接受了OWHTO、二次关节镜检查和磁共振成像（MRI）评估。评估术前和术后的冠状面和矢状面平移、关节线方向角、股骨内侧髁间嵴边缘线与胫骨内侧棘之间的距离以及PTS。通过关节镜将ACL状态从1级（最佳）分级至4级（最差）。对移植物三个部分（近端、中间和远端）的MRI信号从1级（最佳）分级至4级（最差）。
二次关节镜检查时发现28例（38.9%）为高级别（3级：部分断裂，4级：完全断裂），而初次关节镜检查时为10例（13.9%）。与术前MRI相比，随访MRI时的MRI信号分级显著增加（P<0.01）。移植物的中间和远端部分通常出现信号增加。
OWHTO术后的几何变化与ACL退变有关。ACL通常在中间和远端部分受到影响，而在近端部分很少受到影响。由于几何变化，存在撞击的可能性。
IV级。
