Delaigue Fanny, Wardani Hassan, Descamps Jules, Ollivier Matthieu, Nizard Rémy, Bouché Pierre-Alban
Orthopedic and Traumatology Surgery Department, Unité de Chirurgie Orthopédique et Traumatologique, Lariboisière Hospital, Aile jaune 2eétage, 2 Rue Ambroise Paré, 75010, Paris, France.
Institute for Locomotion, Aix-Marseille University, Marseille, France.
Knee Surg Relat Res. 2025 Jun 18;37(1):28. doi: 10.1186/s43019-025-00278-1.
A total of three techniques are used to guide tibial cuts in high tibial osteotomy (HTO): the conventional method, navigation systems, and patient-specific instrumentation (PSI). This network meta-analysis sought to assess whether any of these methods achieve better radiological outcomes, greater functional gains, or a reduced rate of complications.
We included all controlled and noncontrolled trials comparing at least two of the surgical techniques. Primary outcomes were rates of medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) outliers. Secondary outcomes included the rate of hip-knee-ankle (HKA) angle outliers, joint range of motion, postoperative clinical scores, and complication rates.
The analysis included 24 studies with 1817 patients and 1951 operated knees. PSI did not reduce the rate of MPTA outliers compared with conventional techniques (95% credible intervals, CI [0.09-56.84]) or navigation (95% CI [0.03-25.62]), and navigation did not reduce the rate compared with conventional methods (95% CI [0.84-9.17]). Navigation reduced the rate of PTS outliers compared with conventional techniques (95% CI [1.93-1.56.10]). No study investigating PTS outliers with PSI was identified or included. Both navigation and PSI reduced the rate of HKA angle outliers (95% CI [1.33-3.16] and [1.15-42.61], respectively). Aside from the rate of HKA angle outliers and the Lysholm score between 1 and 2 years postoperatively, no differences were observed for other outcomes.
Navigation and PSI allow for more precise achievement of the PTS and HKA angle values set by the surgeons but do not affect long-term knee function or complication rates. However, the cost and limited availability of these techniques should be considered, especially in the absence of additional functional benefits.
在高位胫骨截骨术（HTO）中，共有三种技术用于指导胫骨截骨：传统方法、导航系统和患者特异性器械（PSI）。这项网状荟萃分析旨在评估这些方法中是否有任何一种能取得更好的放射学结果、更大的功能改善或更低的并发症发生率。
我们纳入了所有比较至少两种手术技术的对照和非对照试验。主要结局是胫骨近端内侧角（MPTA）和胫骨后倾（PTS）异常值的发生率。次要结局包括髋-膝-踝（HKA）角异常值的发生率、关节活动范围、术后临床评分和并发症发生率。
该分析纳入了24项研究，涉及1817例患者和1951个手术膝关节。与传统技术相比，PSI并未降低MPTA异常值的发生率（95%可信区间，CI [0.09 - 56.84]）或导航技术（95% CI [0.03 - 25.62]），与传统方法相比，导航技术也未降低发生率（95% CI [0.84 - 9.17]）。与传统技术相比，导航技术降低了PTS异常值的发生率（95% CI [1.93 - 156.10]）。未识别或纳入任何使用PSI研究PTS异常值的研究。导航技术和PSI均降低了HKA角异常值的发生率（分别为95% CI [1.33 - 3.16]和[1.15 - 42.61]）。除了HKA角异常值的发生率和术后1至2年的Lysholm评分外，其他结局未观察到差异。
导航技术和PSI能够更精确地实现外科医生设定的PTS和HKA角值，但不影响膝关节的长期功能或并发症发生率。然而，应考虑这些技术的成本和可用性有限的问题，尤其是在没有额外功能益处的情况下。
