Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France.
Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):715-720. doi: 10.1007/s00167-021-06446-6. Epub 2021 Jan 24.
Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity.
This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA).
From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R = 0.46; p = 0.01).
Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA.
III, retrospective comparative study.
胫骨截骨术的术前规划矫正通常基于负重位的长腿 X 射线，而手术则在仰卧非负重位进行。本研究的目的是评估三种不同负重状态下下肢对线的差异：术前行内侧开放楔形胫骨高位截骨术（MOWHTO）治疗内翻畸形时，仰卧位、双腿（DL）站立位和单腿（SL）站立位。本研究的假设是，逐渐增加肢体负荷会导致术前内翻畸形增加。
本回顾性研究纳入了 89 例（96 膝）孤立性内侧膝关节骨关节炎（Ahlbäck Ⅰ或Ⅱ级）和明显的干骺端胫骨内翻（>6°）患者。分析了仰卧位、DL 站位和 SL 站位的髋膝踝角（HKA）、外侧远端股骨角（LDFA）、内侧近端胫骨角（MPTA）、负重线比值（WBL）和关节线会聚角（JLCA）的差异。
从仰卧位到 DL 站位，HKA 角从 175.5°±1.1°略微增加到 176.3°±1.1°，JLCA 从 2.0°±0.3°变为 1.8°±0.3°，无统计学差异。从 DL 站位到 SL 站位，HKA 角从 176.3°±1.1°下降到 174.4°±1.1°（p<0.05），JLCA 从 1.8°±0.3°增加到 2.6°±0.3°（p<0.05）。DL 站位和 SL 站位之间的ΔHKA 和ΔJLCA 之间存在显著相关性（R=0.46；p=0.01）。
从双腿到单腿负重时，内翻畸形增加，同时 JLCA 增加。因此，单腿站立位 X 线片可能有助于根据 JLCA 的患者特异性变化进行术前规划校正。
III 级，回顾性比较研究。
