Department of Orthopaedic Surgery, National Taiwan University Hospital, 7 Chungsan South Road, Taipei City, 10002, Taiwan.
J Orthop Surg Res. 2022 Feb 5;17(1):79. doi: 10.1186/s13018-022-02976-y.
Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study aimed to investigate the capacity of the compensation by analyzing the correlation of the knee-ankle joint line angle (KAJA) and the knee joint line obliquity (KJLO).
Ninety-six patients undergoing MOWHTO were included. We measured potential predictors including preoperative or postoperative body mass index (BMI), weight-bearing line (WBL) ratio/correction amount, knee-ankle joint line angle(KAJA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), ankle joint line obliquity (AJLO), mechanical hip-knee-ankle angle (mHKA) and joint line convergence angle (JLCA). The correlations of these predictors and postoperative KJLO were determined using Pearson correlation coefficient. The contribution of significant predictors was further analyzed using multiple linear regression. Finally, the cutoff value of the most contributing factor resulting in decompensated KJLO was derived with receiver operating characteristic (ROC) curve analysis.
Preoperative AJLO, JLCA, MPTA, mHKA and KJLO and postoperative KAJA and MPTA correlated with postoperative KJLO. After multiple linear regression, only preoperative AJLO and JLCA and postoperative KAJA still showed significant contribution to postoperative KJLO. Postoperative KAJA made the greatest contribution. The cutoff value of postoperative KAJA was at 9.6° after ROC analysis. The incidence rate of high-grade KJLO was 69.6% when postoperative KAJA exceeded 9.6°.
Postoperative KAJA is a significant contributor to high-grade KJLO after MOWHTO. The incidence was increased at angles greater than 9.6°. The results suggest that KAJA should be carefully assessed during preoperative planning or intraoperative evaluation. Postoperative KAJA < 9.6° can lower the rate of early high-degree KJLO.
内侧开放楔形胫骨高位截骨术（MOWHTO）改变了冠状面上的膝关节倾斜度，这种改变可以通过踝关节来代偿。一旦出现膝关节倾斜的代偿失调，就会在关节软骨上产生过大的剪切力。本研究旨在通过分析膝关节-踝关节线角（KAJA）与膝关节线倾斜角（KJLO）的相关性，来研究这种代偿的能力。
共纳入 96 例行 MOWHTO 的患者。我们测量了潜在的预测指标，包括术前或术后的体重指数（BMI）、负重线（WBL）比值/矫正量、膝关节-踝关节线角（KAJA）、机械外侧远端股骨角（mLDFA）、内侧胫骨近端角（MPTA）、踝关节线倾斜角（AJLO）、机械髋-膝-踝关节角（mHKA）和关节线会聚角（JLCA）。使用 Pearson 相关系数确定这些预测指标与术后 KJLO 的相关性。使用多元线性回归分析显著预测指标的贡献。最后，通过接收者操作特征（ROC）曲线分析，得出导致术后 KJLO 代偿失调的最主要因素的截断值。
术前 AJLO、JLCA、MPTA、mHKA 和 KJLO 以及术后 KAJA 和 MPTA 与术后 KJLO 相关。多元线性回归后，只有术前 AJLO、JLCA 和术后 KAJA 仍对术后 KJLO 有显著贡献。术后 KAJA 的贡献最大。通过 ROC 分析，术后 KAJA 的截断值为 9.6°。当术后 KAJA 超过 9.6°时，高度 KJLO 的发生率为 69.6%。
术后 KAJA 是 MOWHTO 后高度 KJLO 的重要因素。当角度大于 9.6°时，发生率增加。结果表明，在术前规划或术中评估时应仔细评估 KAJA。术后 KAJA<9.6°可降低早期高度 KJLO 的发生率。
Zotero 插件
