Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea. Department of Orthopedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea.
Am J Sports Med. 2022 Jan;50(1):142-151. doi: 10.1177/03635465211059162. Epub 2021 Dec 1.
During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon's preference. However, it is still unclear whether transection of sMCL increases valgus laxity.
We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability.
Case series; Level of evidence, 4.
Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs.
All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, -3.5°± 2.0°; 6 months, -3.2°± 2.3°; 1 year, -3.1°± 2.3°; 2 years, -2.9°± 2.5°; < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, -0.1°± 2.1°; 3 months, -0.2°± 2.4°; 6 months, -0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm).
Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.
在胫骨高位截骨术（HTO）中，根据外科医生的偏好，可切断或松解浅层内侧副韧带（sMCL）以暴露截骨部位并实现目标对线矫正。然而，切断 sMCL 是否会增加外翻松弛度仍不清楚。
我们旨在评估 sMCL 切断术的结果和安全性，特别是关注医源性外翻不稳定。
病例系列；证据水平，4 级。
回顾性分析 2013 年 10 月至 2018 年 9 月间接受内侧开放楔形 HT0（MOWHTO）并同时切断 sMCL 的 72 例患者（89 膝）。临床评估包括国际膝关节文献委员会（IKDC）评分、膝关节损伤和骨关节炎结果评分（KOOS）、Tegner 和 Lysholm 评分，术前和术后 2 年进行。术前和术后 3 个月、6 个月、1 年和 2 年评估影像学参数髋膝踝（HKA）角、站立位关节线会聚角（站立位 JLCA）和负重线（WBL）比值。为了评估外翻松弛度，我们在上述时间点使用外翻应力位片评估外翻位 JLCA 和内侧关节间隙张开（MJO）。
所有临床结果在术后 2 年随访时均明显优于术前评估（<.001）。术后 HKA 角与术前明显不同，且随访期间未观察到明显的外翻进展（术前，8.5°±2.7°；术后 3 个月，-3.5°±2.0°；术后 6 个月，-3.2°±2.3°；术后 1 年，-3.1°±2.3°；术后 2 年，-2.9°±2.5°；<.001）。术后 2 年 WBL 比值平均为 62.5%±9.0%。所有随访点的术后外翻位 JLCA 与术前相比均无明显变化（术前，-0.1°±2.1°；术后 3 个月，-0.2°±2.4°；术后 6 个月，-0.1°±2.5°；术后 1 年，0.1°±2.5°；术后 2 年，0.2°±2.2°）。所有随访点的术后 MJO 与术前相比均无明显变化（术前，7.1 ± 1.7 mm；术后 3 个月，7.0 ± 1.7 mm；术后 6 个月，6.9 ± 1.9 mm；术后 1 年，6.7 ± 1.8 mm；术后 2 年，6.8 ± 1.8 mm）。
在 MOWHTO 中切断 sMCL 不会增加外翻松弛度，并可获得理想的临床和影像学结果。
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