Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan.
Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan.
Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):688-697. doi: 10.1007/s00167-020-06430-6. Epub 2021 Jan 12.
To compare the radiographic, clinical, and arthroscopic outcomes of varus osteoarthritic knees treated with an open-wedge high tibial osteotomy (OWHTO) alone or with a double-level osteotomy (DLO). It was hypothesized that treatment with DLO would maintain the joint line obliquity (JLO) and acquire better arthroscopic and clinical outcomes after surgery than OWHTO alone.
Knees with predicted medial proximal tibial angle (MPTA) > 95° were treated with OWHTO alone or with DLO. Preoperatively, age, body mass index, and hip-knee-ankle angle (HKA) differed between the two groups. Therefore, after adjustment for those factors, 34 knees with OWHTO alone and 34 knees with DLO were compared. On whole-leg radiographs for a single leg, HKA, weightbearing line (WBL) ratio, lateral distal femoral angle (LDFA), MPTA, and JLO were measured before and 2 years after surgery. Clinical outcomes were evaluated by the Knee Society Score (KSS) knee, KSS function, Lysholm, and Knee injury and Osteoarthritis Outcome Score (KOOS) scores before and 2 years after surgery. Arthroscopic findings were obtained before and 1 year after surgery. Various factors were compared between the two groups.
JLO increased significantly from 1.4° to 6.3° in the OWHTO group (p < 0.001) and changed from 1.0° to 1.3° in the DLO group (n.s.). Postoperative MPTA and JLO in the OWHTO group were significantly higher than those in the DLO group (both p < 0.001). There were no significant differences in the KSS knee, KSS function, and KOOS scores between the two groups. Postoperative Lysholm score in the DLO group was higher than that in the OWHTO group (p < 0.025). Femoral and tibial cartilage regeneration in the medial condyles and deterioration in the lateral condyles did not differ between the two groups on second-look arthroscopy.
JLO was not significantly changed after surgery in the DLO group. DLO enabled the acquisition of physiological JLO compared with OWHTO alone.
Retrospective comparative study, Level III.
比较单纯开放式楔形胫骨高位截骨术（OWHTO）和双平面截骨术（DLO）治疗内翻性骨关节炎膝的影像学、临床和关节镜结果。假设与单独行 OWHTO 相比，DLO 治疗能保持关节线倾斜角（JLO），并在术后获得更好的关节镜和临床结果。
对预测内侧近端胫骨角（MPTA）>95°的膝关节行 OWHTO 或 DLO 治疗。两组患者术前年龄、体重指数和髋膝踝角（HKA）存在差异。因此，在调整这些因素后，对 34 例单纯行 OWHTO 和 34 例行 DLO 的膝关节进行比较。在单腿全长 X 线片上，测量术前和术后 2 年时的 HKA、负重线（WBL）比值、外侧远端股骨角（LDFA）、MPTA 和 JLO。采用膝关节学会评分（KSS）膝关节评分、KSS 功能评分、Lysholm 评分和膝关节损伤与骨关节炎结果评分（KOOS）评分评估临床结果，分别于术前和术后 2 年进行评估。于术前和术后 1 年行关节镜检查。比较两组间各项指标。
OWHTO 组 JLO 从术前的 1.4°显著增加到术后的 6.3°（p<0.001），DLO 组从术前的 1.0°变为 1.3°（n.s.）。OWHTO 组术后 MPTA 和 JLO 明显高于 DLO 组（均 p<0.001）。两组间 KSS 膝关节评分、KSS 功能评分和 KOOS 评分均无显著差异。DLO 组术后 Lysholm 评分高于 OWHTO 组（p<0.025）。内侧髁股骨和胫骨软骨再生以及外侧髁软骨退变在两组的二次关节镜检查中无差异。
DLO 组术后 JLO 无明显变化。与单纯行 OWHTO 相比，DLO 可获得生理性 JLO。
回顾性比较研究，III 级。
