Tollefson Luke V, Lee Dustin, Keel Taidhgin, LaPrade Christopher M, LaPrade Robert F
Twin Cities Orthopedics, Edina, Minnesota, U.S.A.
Twin Cities Orthopedics, Edina, Minnesota, U.S.A..
Arthroscopy. 2025 Aug;41(8):3200-3213.e2. doi: 10.1016/j.arthro.2024.11.002. Epub 2024 Nov 10.
To compare the clinical and radiographic outcomes and complications between medial opening wedge (MOW) and lateral closing wedge (LCW) high tibial osteotomies (HTOs) in the setting of medial compartment osteoarthritis with genu varus alignment.
This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Studies that reported on MOW or LCW HTOs in the setting of medial compartment osteoarthritis were included. Analysis was performed based on radiographic and patient-reported outcomes (PROs) and complications.
A total of 40 studies were included. Hip-knee-ankle angles and PROs, including Lysholm and visual analog scale, showed significant improvements postoperatively for both MOW and LCW HTO for all included studies. For the studies that reported on it, posterior tibial slope (PTS) was significantly increased in 4 of the 9 MOW studies and significantly decreased in 8 of the 9 LCW studies. Patellar height was significantly decreased in 4 of the 5 MOW studies, while none of the 4 LCW studies reported any changes. Three comparison studies reported a higher conversion to total knee arthroplasty in the LCW cohort; otherwise, survivorship at 10 years was comparable between studies. The MOW cohort had higher rates of tibial fractures, while the LCW cohort had higher rates of nerve injuries.
This systematic review found comparable hip-knee-ankle angle correction and PROs between patients undergoing MOW or LCW HTOs to treat medial compartment osteoarthritis. Survivorship at 10 years was comparable between MOW and LCW HTOs; however, some MOW and LCW HTO comparison studies reported higher conversion to total knee arthroplasty for LCW HTO. Medial opening wedge HTO typically results in an increased PTS, decreased patellar height, and tibial fractures, while LCW HTO typically results in decreased PTS, no change in patellar height, and common peroneal nerve injuries.
Level IV, systematic review of Level I to IV studies.
比较内侧开口楔形（MOW）和外侧闭合楔形（LCW）高位胫骨截骨术（HTO）治疗伴有膝内翻畸形的内侧间室骨关节炎的临床、影像学结果及并发症。
本研究采用系统评价和Meta分析的首选报告项目。纳入报告内侧间室骨关节炎患者接受MOW或LCW HTO治疗的研究。基于影像学和患者报告结局（PROs）及并发症进行分析。
共纳入40项研究。髋-膝-踝角及PROs，包括Lysholm评分和视觉模拟量表，在所有纳入研究中，MOW和LCW HTO术后均有显著改善。在报告了该指标的研究中，9项MOW研究中有4项胫骨后倾（PTS）显著增加，9项LCW研究中有8项PTS显著降低。5项MOW研究中有4项髌腱长度显著降低，而4项LCW研究均未报告有任何变化。3项比较研究报告LCW队列中全膝关节置换术的转化率更高；除此之外，各研究间10年生存率相当。MOW队列胫骨骨折发生率较高，而LCW队列神经损伤发生率较高。
本系统评价发现，接受MOW或LCW HTO治疗内侧间室骨关节炎的患者，其髋-膝-踝角矫正效果和PROs相当。MOW和LCW HTO的10年生存率相当；然而，一些MOW与LCW HTO的比较研究报告LCW HTO全膝关节置换术的转化率更高。内侧开口楔形HTO通常会导致PTS增加、髌腱长度降低和胫骨骨折，而LCW HTO通常会导致PTS降低、髌腱长度无变化和腓总神经损伤。
IV级，对I至IV级研究的系统评价。
