Kim Hee-June, Shin Ji-Yeon, Lee Hyun-Joo, Park Kyeong-Hyeon, Jung Chul-Hee, Kyung Hee-Soo
Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
Knee Surg Relat Res. 2020 Oct 1;32(1):51. doi: 10.1186/s43019-020-00071-2.
This study evaluated the medial joint stability after high tibial osteotomy (HTO) releasing the superficial medial collateral ligament (sMCL) without cutting and repairing.
Twenty-one patients who performed HTO were enrolled. After an L-shaped incision was made in the pes anserinus, the sMCL was released from the distal portion during surgery. After plate fixation, the sMCL was reattached and the pes anserinus was repaired underneath the plate. Plate removal was performed after 31.1 ± 14.2 months. Before HTO, a valgus force of 40 N was exerted at extension for reference values. Before and after plate removal, a valgus force of 40 N was exerted at extension and at a flexion position of 20°. Medial stability was evaluated by measuring the joint line convergence angle (JLCA).
The JLCAs in the extension state before HTO and plate removal were 1.64° ± 1.15° and 1.83° ± 1.36°, respectively; there was no significant difference (p = 0.198). There was also no significant difference in JLCA before HTO and after plate removal (p = 0.835). There was also no significant difference in JLCA before and after plate removal both at a knee extension and flexion position of 20° (p = 0.348 and p = 0.456, respectively).
Releasing the sMCL without cutting and repairing the pes anserinus underneath the plate during medial open wedge HTO could facilitate the maintenance of medial joint stability.
本研究评估了在不切断和修复浅层内侧副韧带（sMCL）的情况下，高位胫骨截骨术（HTO）后的内侧关节稳定性。
纳入21例行HTO的患者。在鹅足处做L形切口后，术中从远端部分松解sMCL。钢板固定后，将sMCL重新附着，并在钢板下方修复鹅足。31.1±14.2个月后取出钢板。在HTO前，在伸直位施加40N的外翻力作为参考值。在取出钢板前后，分别在伸直位和20°屈曲位施加40N的外翻力。通过测量关节线汇聚角（JLCA）评估内侧稳定性。
HTO前和取出钢板前伸直状态下的JLCA分别为1.64°±1.15°和1.83°±1.36°；差异无统计学意义（p = 0.198）。HTO前和取出钢板后的JLCA也无显著差异（p = 0.835）。在膝关节伸直位和20°屈曲位时，取出钢板前后的JLCA也无显著差异（分别为p = 0.348和p = 0.456）。
在内侧开放楔形HTO过程中，不切断和修复钢板下方的鹅足而松解sMCL，有助于维持内侧关节稳定性。
