Ishii Yosuke, Ishikawa Masakazu, Kamei Goki, Nakashima Yuko, Iwamoto Yoshitaka, Takahashi Makoto, Adachi Nobuo
Dept. of Biomechanics, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Dept. of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2023 Sep 7;34:1-8. doi: 10.1016/j.asmart.2023.08.010. eCollection 2023 Oct.
This study aimed to investigate the effect of high tibial osteotomy (HTO) on medial meniscus extrusion (MME) and the association between the changes in limb alignment and MME under weight-bearing (WB) conditions after HTO.
We included 17 patients with knee osteoarthritis (OA) who underwent HTO. MME was evaluated using ultrasonography in supine and unipedal standing positions. Knee alignment was evaluated radiographically using WB, whole-leg radiographs with the hip-knee-ankle angle (HKAA), percentage of the mechanical axis (%MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). All measurements were performed serially at four time points: preoperative and 3, 6, and 12 months postoperative. Clinical outcomes were assessed by knee injury and osteoarthrosis outcome score (KOOS) and visual analogue scale (VAS) value for pain.
Mean MME in the WB position was significantly greater than that in the supine position in the preoperative condition; however, MME in both supine and WB positions was significantly lowered postoperatively. The ΔMME, difference of MME between supine and WB positions, was significantly lowered postoperatively and maintained for up to 1 year. MME change in the WB position between preop and postoperative conditions was significantly correlated with change in HKAA and %MA at 1 year postoperative. KOOS and VAS score were significantly improved after HTO.
HTO correcting varus alignment can decrease MME in WB position and minimise the change in MME between supine and WB positions. The changes in MME after HTO were correlated with changes in the mechanical alignments.
本研究旨在探讨高位胫骨截骨术（HTO）对内侧半月板挤出（MME）的影响，以及HTO术后负重（WB）条件下肢体对线变化与MME之间的关联。
我们纳入了17例行HTO的膝关节骨关节炎（OA）患者。在仰卧位和单腿站立位使用超声评估MME。使用WB全腿X线片，通过髋-膝-踝角（HKAA）、机械轴百分比（%MA）、胫骨近端内侧角（MPTA）和关节线汇聚角（JLCA）进行X线评估膝关节对线。所有测量在四个时间点进行：术前以及术后3、6和12个月。通过膝关节损伤和骨关节炎疗效评分（KOOS）以及疼痛视觉模拟量表（VAS）值评估临床结果。
术前WB位的平均MME显著大于仰卧位；然而，仰卧位和WB位的MME在术后均显著降低。ΔMME，即仰卧位和WB位MME的差值，术后显著降低并维持长达1年。术前和术后WB位MME的变化与术后1年HKAA和%MA的变化显著相关。HTO术后KOOS和VAS评分显著改善。
HTO矫正内翻对线可降低WB位的MME，并使仰卧位和WB位之间的MME变化最小化。HTO术后MME的变化与机械对线的变化相关。
