Maione Alessio, Minoli Carlo, Parmigiani Matteo Davide, Travi Martino, Calanna Filippo, Marcolli Daniele, Compagnoni Riccardo, Ferrua Paolo, Berruto Massimo, Randelli Pietro Simone
U.O.C. 1st Orthopedic Clinic, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO Milan Italy.
U.O.C. Week Surgery, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO Milan Italy.
J Exp Orthop. 2025 May 5;12(2):e70252. doi: 10.1002/jeo2.70252. eCollection 2025 Apr.
This study aimed to evaluate the effect of lateral closing-wedge high tibial osteotomy (LCW-HTO) and medial closing-wedge distal femoral osteotomy (MCW-DFO) on tibio-talar inclination (TTI) and Mikulicz lateral distal tibial angle (M-LDTA). We hypothesized that knee osteotomies significantly alter ankle coronal alignment by modifying TTI and distal tibial alignment in relation to the mechanical axis.
A retrospective radiographic analysis was conducted on 60 knees from 52 patients (37 LCW-HTO and 23 MCW-DFO) treated between 2006 and 2020. Inclusion criteria included full-length weight-bearing radiographs pre- and post-operatively, no prior ipsilateral lower limb surgery, absence of shaft deformities or advanced ankle osteoarthritis (Takakura grade >1), and age ≥16 years with ≥2 years of follow-up. Radiographic parameters measured included LDTA, hip-knee-ankle angle, M-LDTA and TTI, with ankle realignment quantified through differences between LDTA and M-LDTA and between pre- and post-operative TTI.
In the MCW-DFO group, the difference between LDTA and M-LDTA decreased from 3.5 ± 2.3° to 1.3 ± 1.1° ( < 0.0001), indicating improved alignment. The LCW-HTO group showed a smaller but significant reduction from 4.5 ± 1.8° to 2.2 ± 1.7° ( < 0.0001). TTI improved significantly in both groups, with a greater adjustment in MCW-DFO (ΔTTI = 7.0 ± 4.3°, < 0.01) compared to LCW-HTO (ΔTTI = 4.2 ± 2.7°, < 0.01). The difference between LDTA and TTI decreased in both groups, reflecting post-operative convergence of the mechanical and anatomical axes.
Knee osteotomies significantly influence ankle coronal alignment, particularly modifying TTI and M-LDTA. Higher-level osteotomies (MCW-DFO) exert a greater effect on ankle alignment than LCW-HTO. Preoperative valgus or varus knee deformities must be carefully evaluated to anticipate post-operative ankle imbalance. Surgeons should assess full-length radiographs to prevent unintended malalignment.
Level III.
本研究旨在评估外侧闭合楔形高位胫骨截骨术（LCW-HTO）和内侧闭合楔形股骨远端截骨术（MCW-DFO）对胫距倾斜度（TTI）和米库利奇外侧胫骨远端角（M-LDTA）的影响。我们假设膝关节截骨术通过改变TTI和胫骨远端相对于机械轴的对线，显著改变踝关节的冠状面排列。
对2006年至2020年期间治疗的52例患者的60个膝关节进行回顾性影像学分析（37例行LCW-HTO，23例行MCW-DFO）。纳入标准包括术前和术后的全长负重X线片、同侧下肢既往无手术史、无骨干畸形或晚期踝关节骨关节炎（高仓分级>1级），以及年龄≥16岁且随访≥2年。测量的影像学参数包括LDTA、髋-膝-踝角、M-LDTA和TTI，通过LDTA与M-LDTA之间以及术前和术后TTI之间的差异对踝关节对线进行量化。
在MCW-DFO组中，LDTA与M-LDTA之间的差异从3.5±2.3°降至1.3±1.1°（<0.0001），表明对线得到改善。LCW-HTO组从4.5±1.8°降至2.2±1.7°，虽降幅较小但差异有统计学意义（<0.0001）。两组的TTI均有显著改善，与LCW-HTO组（ΔTTI = 4.2±2.7°，<0.01）相比，MCW-DFO组的调整幅度更大（ΔTTI = 7.0±4.3°，<0.01）。两组中LDTA与TTI之间的差异均减小，反映了术后机械轴和解剖轴的汇聚。
膝关节截骨术显著影响踝关节冠状面排列，尤其是改变TTI和M-LDTA。高位截骨术（MCW-DFO）对踝关节对线的影响比LCW-HTO更大。术前必须仔细评估膝关节的外翻或内翻畸形，以预测术后踝关节失衡。外科医生应评估全长X线片，以防止意外的对线不良。
III级。
