Katagiri Hiroki, Shioda Mikio, Nakagawa Yusuke, Ohara Toshiyuki, Ozeki Nobutake, Nakamura Tomomasa, Sekiya Ichiro, Koga Hideyuki
Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan.
Orthop J Sports Med. 2022 Sep 30;10(9):23259671221118836. doi: 10.1177/23259671221118836. eCollection 2022 Sep.
Although opening-wedge high tibial osteotomy (OWHTO) is favored for active patients who expect to return to sports, there is still a lack of robust evidence for factors affecting their recovery.
To identify (1) risk factors leading to a decreased level of return to preoperative sports after OWHTO and (2) patient characteristics and intraoperative factors influencing patient-reported outcomes after return to sports.
Case-control study; Level of evidence, 3.
Included were 69 patients who underwent OWHTO and who expected to return to their preoperative level of sports, measured as a Tegner activity level ≥2. All included patients had a minimum of 1 year of follow-up data. Logistic regression analyses were performed to assess the effect of independent variables on the level of return to preoperative sports after surgery; the independent variables were age, sex, body mass index, preoperative Tegner score, preoperative Kellgren-Lawrence grade, preoperative percentage of mechanical axis (%MA), opening gap width, concomitant meniscal treatment, postoperative %MA, postoperative medial proximal tibial angle (MPTA), and postoperative posterior tibial slope. Univariate and multiple regression analyses were performed to assess for influencing factors on postoperative International Knee Documentation Committee (IKDC) subjective scores in patients who were able to return to sports.
Of the 69 patients, 51 (73.9%) returned to sports after OWHTO. High preoperative Tegner scores were statistically associated with a decrease in return to sports (odds ratio, 1.494; = .033). Multiple regression analysis (n = 46 patients) identified that a higher postoperative MPTA was associated with a decreased IKDC subjective score after return to sports ( = -0.345; = .019).
Higher postoperative MPTA was associated with the worsening of patient-reported outcomes among those patients who did return to their preoperative sports after OWHTO. Also, participation in high-activity sports was confirmed to be a significant risk factor for a decreased rate of return to preoperative sports. These findings can support preoperative planning and intraoperative decision making, particularly for active patients.
尽管对于期望恢复运动的活跃患者而言，开放性楔形高位胫骨截骨术（OWHTO）是首选，但目前仍缺乏有关影响其恢复因素的确凿证据。
确定（1）导致OWHTO术后恢复到术前运动水平下降的危险因素，以及（2）影响恢复运动后患者报告结局的患者特征和术中因素。
病例对照研究；证据等级，3级。
纳入69例行OWHTO且期望恢复到术前运动水平（以Tegner活动水平≥2衡量）的患者。所有纳入患者均有至少1年的随访数据。进行逻辑回归分析以评估自变量对术后恢复到术前运动水平的影响；自变量包括年龄、性别、体重指数、术前Tegner评分、术前Kellgren-Lawrence分级、术前机械轴百分比（%MA）、开口间隙宽度、半月板同期治疗、术后%MA、术后胫骨近端内侧角（MPTA）以及术后胫骨后倾。对能够恢复运动的患者进行单因素和多因素回归分析，以评估影响术后国际膝关节文献委员会（IKDC）主观评分的因素。
69例患者中，51例（73.9%）在OWHTO术后恢复了运动。术前Tegner评分高与运动恢复下降在统计学上相关（比值比，1.494；P = 0.033）。多因素回归分析（n = 46例患者）确定，较高的术后MPTA与恢复运动后IKDC主观评分降低相关（β = -0.345；P = 0.019）。
较高的术后MPTA与OWHTO术后恢复到术前运动水平的患者报告结局恶化相关。此外，参与高活动量运动被证实是术前运动恢复率降低的一个重要危险因素。这些发现可为术前规划和术中决策提供支持，尤其是对于活跃患者。
