Yoshida Keiichi, Kubota Mitsuaki, Kaneko Haruka, Kim Youngji, Kobayashi Keiji, Hada Shinnosuke, Saita Yoshitomo, Ishijima Muneaki
Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Medicine for Orthopedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4935-4941. doi: 10.1007/s00167-023-07544-3. Epub 2023 Aug 19.
To examine the association between the hinge position, fibular head position, and type III lateral hinge fracture (LHF) in patients with knee osteoarthritis (OA) who underwent medial open wedge high tibial osteotomy (MOWHTO).
This retrospective study examined patients who underwent MOWHTO. Radiographically, the Kellgren-Lawrence (K/L) classification, distance between the articular surface and the tip of the fibular head (fibular head position), hinge point (hinge position), type of LHF, and safe zone (within the proximal tibiofibular joint) outlier were evaluated. To determine the cut-off value of the hinge position and fibular head position associated with type III LHF, a receiver operating characteristic (ROC) curve analysis was performed. The odds ratio (OR) was calculated from the obtained cut-off values using logistic regression, which was adjusted by age, gender, body mass index, and opening distance.
Among 132 knees in 120 patients, the radiographic severity of knee OA was 19 (14%), 73 (55%), and 40 (30%) of K/L grades 2, 3, and 4, respectively. LHF was observed in 40 knees (30%), including types I, II, and III fractures in 21 (16%), 5 (4%), and 14 (11%) knees, respectively. Hinge and fibular head positions were 16 and 10 mm, respectively, with significant correlation. Safe zone outlier was observed in 38 knees (29%). The hinge and fibular head positions with type III LHF were significantly higher (more cranial) than those with no fracture or other LHF subtypes. The ROC curve revealed that the cut-off value for the hinge and fibular head positions was 13.3 and 8.6 mm, respectively. The OR of the hinge and fibular head positions was 22.42 and 13.86, respectively.
A higher hinge position was a risk factor for type III LHF and was associated with a higher fibular head in patients with knee OA who underwent MOWHTO. The hinge position should be placed at a certain distance from the articular surface to avoid type III LHF, especially in participants with higher fibular head position, even if the hinge position is located in the safe zone.
Retrospective cohort study, Level III.
探讨接受内侧开放楔形高位胫骨截骨术（MOWHTO）的膝关节骨关节炎（OA）患者的铰链位置、腓骨头位置与III型外侧铰链骨折（LHF）之间的关联。
这项回顾性研究对接受MOWHTO的患者进行了检查。通过影像学评估Kellgren-Lawrence（K/L）分级、关节面与腓骨头尖端之间的距离（腓骨头位置）、铰链点（铰链位置）、LHF类型以及安全区（胫腓近端关节内）异常情况。为确定与III型LHF相关的铰链位置和腓骨头位置的临界值，进行了受试者工作特征（ROC）曲线分析。使用逻辑回归从获得的临界值计算优势比（OR），并根据年龄、性别、体重指数和开口距离进行调整。
在120例患者的132个膝关节中，膝关节OA的影像学严重程度分别为K/L 2级、3级和4级，各有19个（14%）、73个（55%）和40个（30%）。40个膝关节（30%）观察到LHF，其中I型、II型和III型骨折分别在21个（16%）、5个（4%）和14个（11%）膝关节中。铰链和腓骨头位置分别为16 mm和10 mm，具有显著相关性。38个膝关节（29%）观察到安全区异常情况。III型LHF患者的铰链和腓骨头位置显著高于无骨折或其他LHF亚型的患者。ROC曲线显示，铰链和腓骨头位置的临界值分别为13.3 mm和8.6 mm。铰链和腓骨头位置的OR分别为22.42和13.86。
较高的铰链位置是III型LHF的危险因素，并且与接受MOWHTO的膝关节OA患者较高的腓骨头相关。铰链位置应与关节面保持一定距离，以避免III型LHF，尤其是在腓骨头位置较高的参与者中，即使铰链位置位于安全区内。
回顾性队列研究，III级。
