Pragadeeshwaran J, Paul S, Moge N M, Goyal T
Department of Othopaedics, All India Institute of Medical Sciences, Rishikesh, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
Musculoskelet Surg. 2023 Mar;107(1):115-121. doi: 10.1007/s12306-022-00736-z. Epub 2022 Feb 24.
Deformity correction during high tibial osteotomy is generally based on coronal plane alignment. The aim of this study was to measure changes in sagittal and axial plane alignment following medial opening wedge high tibial osteotomy [mHTO], using pre- and postoperative computed tomography [CT] scans, and correlate them with changes in coronal plane. The secondary objective was to correlate changes in functional outcomes with changes in alignment in each plane. The null hypothesis was that sagittal and axial plane alignment does not change significantly following mHTO.
This was a prospective, observational study including 30 patients of isolated medial compartment osteoarthritis of the knee joint, between 30 and 60 years of age. Preoperative and postoperative computed tomography scan of bilateral lower limbs from hip to ankle was performed. Varus angle, mechanical axis deviation [MAD] of the lower limb, medial proximal tibial angle [MPTA], tibial torsion and posterior proximal tibial angle [PPTA] were measured. Visual Analogue Scale [VAS 0-10 cm scale] was used for assessment of pain. Functional outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 12 Item Short Form Survey [SF 12] and Tegner Lysholm knee scoring scale.
Mean age of patients was 44.59 ± 8.157 years. Mean preoperative varus deformity was 11.13 ± 1.5 degrees, which got corrected to a mean valgus alignment of 3.8 ± 0.93 degrees postoperatively. The mechanical axis deviation was 4.32 ± 1.76 mm lateral to the knee joint center postoperatively. Preoperatively, all knees had external tibial torsion [27.08 ± 2.18 degrees] which was corrected to a mean external tibial torsion of 19.80 ± 3.72 degree after the surgery [P < 0.001]. The overall decrease in sagittal alignment in the present study was 3.70 ± 3.14 degree, 3.97 ± 3.06 degree, 3.92 ± 2.33 degree, for medial, middle and lateral cuts, respectively. There was a significant correlation between change in varus/valgus angle and change in TT and PPTA. Significant positive correlation was seen between change in coronal alignment and functional outcome scores.
This study has shown that mHTO significantly changes torsional and sagittal alignment. This is the first study to establish relation between correction in coronal plane and associated changes in sagittal and torsional alignments.
高位胫骨截骨术中的畸形矫正通常基于冠状面的对线情况。本研究的目的是利用术前和术后的计算机断层扫描（CT）测量内侧开口楔形高位胫骨截骨术（mHTO）后矢状面和轴位面的对线变化，并将其与冠状面的变化相关联。次要目的是将功能结果的变化与每个平面的对线变化相关联。无效假设是mHTO后矢状面和轴位面的对线不会发生显著变化。
这是一项前瞻性观察性研究，纳入了30例年龄在30至60岁之间的单纯膝关节内侧间室骨关节炎患者。对双侧下肢从髋部到脚踝进行术前和术后的计算机断层扫描。测量内翻角、下肢机械轴偏移（MAD）、胫骨近端内侧角（MPTA）、胫骨扭转和胫骨近端后角（PPTA）。使用视觉模拟评分法（VAS 0 - 10厘米量表）评估疼痛。使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、12项简短调查问卷（SF 12）和Tegner Lysholm膝关节评分量表评估功能结果。
患者的平均年龄为44.59±8.157岁。术前平均内翻畸形为11.13±1.5度，术后矫正为平均外翻对线3.8±0.93度。术后机械轴偏移在膝关节中心外侧4.32±1.76毫米。术前，所有膝关节均有胫骨外旋（27.08±2.18度），术后矫正为平均胫骨外旋19.80±3.72度（P < 0.001）。在本研究中，内侧、中间和外侧截骨的矢状面对线总体下降分别为3.70±3.14度、3.97±3.06度、3.92±2.33度。内翻/外翻角的变化与TT和PPTA的变化之间存在显著相关性。冠状面对线的变化与功能结果评分之间存在显著正相关。
本研究表明mHTO显著改变了扭转和矢状面对线。这是第一项建立冠状面矫正与矢状面和扭转对线相关变化之间关系的研究。
