Kim Man Soo, Kim Jae Jung, Kang Ki Ho, Ihm Joon Soo, In Yong
Department of Orthopaedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Am J Sports Med. 2023 Feb;51(2):494-502. doi: 10.1177/03635465221143999. Epub 2023 Jan 19.
Medial opening-wedge high tibial osteotomy (MOWHTO) in patients with varus knee osteoarthritis (OA) causes changes to ankle and hindfoot alignment. However, the compensatory ability of the ankle and hindfoot varies according to the severity of ankle OA.
To investigate whether the changes in ankle symptoms and ankle and hindfoot alignments differ after MOWHTO according to the severity of preoperative ankle OA.
Case-control study; Level of evidence, 3.
The data of 130 patients who were followed for ≥4 years were reviewed. Patients were classified into 2 groups according to their severity of ankle OA: group 1, modified Kellgren-Lawrence grade 0 and 1; group 2, grade ≥2. Four radiographic parameters were examined to evaluate ankle alignment: tibial plafond inclination, talar tilt, talar inclination, and tibial surface angle. The hindfoot alignment was evaluated using the varus-valgus angle (VVA) of the calcaneus. A visual analog scale (VAS) was used to evaluate ankle pain. The patient-reported outcome measure of the knee joint was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score.
There were 110 patients in group 1 and 20 patients in group 2. In group 2, the change in talar inclination after MOWHTO was significantly greater and the changes in tibial plafond inclination, talar tilt, and VVA were significantly smaller compared with in group 1 (all < .05). Ankle pain VAS scores were more severe in group 2 than in group 1 pre- and postoperatively (all < .05), and group 2 reported that ankle pain worsened postoperatively ( < .05). In both groups, knee WOMAC scores improved, and there were no differences between groups pre- or postoperatively (all > .05). A multivariate regression analysis demonstrated that a small VVA change (odds ratio, 0.775; = .027) and severe OA grade of the ankle joint preoperatively (Kellgren-Lawrence grades 2-4 vs 0 and 1; odds ratio, 4.241 [ = .046]) predicted increased ankle pain VAS scores after MOWHTO.
Although the patient-reported outcome measures for the knee joint improved irrespective of the presence of ankle OA, ankle pain worsened after MOWHTO in patients with ankle OA. Inadequate compensatory change in hindfoot alignment increased ankle pain in these patients.
内翻膝骨关节炎（OA）患者行内侧开口楔形高位胫骨截骨术（MOWHTO）会引起踝关节和后足对线的改变。然而，踝关节和后足的代偿能力因踝关节OA的严重程度而异。
探讨根据术前踝关节OA的严重程度，MOWHTO术后踝关节症状、踝关节和后足对线的变化是否存在差异。
病例对照研究；证据等级，3级。
回顾了130例随访时间≥4年患者的数据。根据踝关节OA的严重程度将患者分为2组：第1组，改良Kellgren-Lawrence分级为0级和1级；第2组，分级≥2级。检查4项影像学参数以评估踝关节对线：胫骨平台倾斜度、距骨倾斜度、距骨倾斜角和胫骨表面角。使用跟骨的内翻-外翻角（VVA）评估后足对线。采用视觉模拟量表（VAS）评估踝关节疼痛。膝关节的患者报告结局指标是西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分。
第1组有110例患者，第2组有20例患者。与第1组相比，第2组MOWHTO术后距骨倾斜角的变化显著更大，而胫骨平台倾斜度、距骨倾斜度和VVA的变化显著更小（均P<0.05）。第2组术前和术后的踝关节疼痛VAS评分均比第1组更严重（均P<0.05），且第2组报告术后踝关节疼痛加重（P<0.05）。两组的膝关节WOMAC评分均有所改善，术前和术后两组之间均无差异（均P>0.05）。多因素回归分析表明，VVA变化小（比值比，0.775；P = 0.02）和术前踝关节OA严重分级（Kellgren-Lawrence分级2-4级与0级和1级相比；比值比，4.241 [P = 0.046]）可预测MOWHTO术后踝关节疼痛VAS评分增加。
尽管无论是否存在踝关节OA，膝关节的患者报告结局指标均有所改善，但踝关节OA患者MOWHTO术后踝关节疼痛加重。后足对线的代偿变化不足增加了这些患者的踝关节疼痛。
