Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
PLoS One. 2021 Sep 14;16(9):e0257315. doi: 10.1371/journal.pone.0257315. eCollection 2021.
The present study evaluated changes in bone tracer uptake (BTU) after medial open-wedge high tibial osteotomy (MOWHTO) and determined whether postoperative BTU correlates with clinical symptoms, radiologic parameters, or cartilage regeneration following MOWHTO.
A total of 210 knees underwent MOWHTO for medial compartmental osteoarthritis (OA) were enrolled in this study. Mean follow-up period was 42.7 months. We assessed BTU for the medial compartment of the knee before MOWHTO and at the time of plate removal. Radiologic parameters included Kellgren-Lawrence (K-L) grade and Hip-Knee-Ankle angle (HKAA). Clinical evaluation included American Knee Society (AKS) score and cartilage status was graded at the time of MOWHTO and second-look arthroscopy according to the International Cartilage Repair Society (ICRS) grading system and articular cartilage regeneration stage. Statistical analysis performed to assess the relationships among postoperative BTU of the medial compartment, radiologic parameters, arthroscopic changes and clinical outcomes.
BTU of medial femoral condyle and tibial plateau were significantly decreased at 2 years after MOWHTO (p<0.001). AKS scores and arthroscopic cartilage status were also significantly improved following MOWHTO. BMI and postoperative HKAA showed significant correlations with postoperative changes of BTU in uni- and multi-variable analysis. Meanwhile, postoperative changes of BTU did not show significant correlation with clinical outcomes or cartilage regeneration following MOWHTO.
Lower BMI and postoperative valgus alignment were significant predictor for postoperative BTU decrease of the medial compartment following MOWHTO. However, postoperative changes of BTU did not reflect cartilage regeneration or clinical outcomes until the midterm follow-up.
本研究评估内侧开放楔形胫骨高位截骨术（MOWHTO）后骨示踪剂摄取（BTU）的变化，并确定术后 BTU 是否与 MOWHTO 后临床症状、影像学参数或软骨再生相关。
本研究共纳入 210 例因内侧间室骨关节炎（OA）行 MOWHTO 的膝关节。平均随访时间为 42.7 个月。我们在 MOWHTO 前和钢板取出时评估了膝关节内侧间隙的 BTU。影像学参数包括 Kellgren-Lawrence（K-L）分级和髋膝踝角（HKAA）。临床评估包括美国膝关节协会（AKS）评分，软骨状态在 MOWHTO 时和第二次关节镜检查时根据国际软骨修复协会（ICRS）分级系统和关节软骨再生阶段进行分级。进行统计学分析以评估内侧间隙术后 BTU、影像学参数、关节镜变化和临床结果之间的关系。
MOWHTO 后 2 年，内侧股骨髁和胫骨平台的 BTU 明显降低（p<0.001）。AKS 评分和关节镜下软骨状态也在 MOWHTO 后明显改善。BMI 和术后 HKAA 在单变量和多变量分析中与术后 BTU 变化均具有显著相关性。同时，术后 BTU 的变化与 MOWHTO 后临床结果或软骨再生无显著相关性。
较低的 BMI 和术后外翻对线是 MOWHTO 后内侧间隙术后 BTU 减少的显著预测因素。然而，直到中期随访，术后 BTU 的变化都不能反映软骨再生或临床结果。
