Abstract
Purpose
In contrast to radiographic measurements, MRI provides multiple slices of the knee joint in the sagittal plane, making it possible to assess the medial and lateral tibial slope separately. The purpose of this study is to investigate the effect of medial open-wedge high tibial osteotomy (MOWHTO) on bony and meniscal slope in the medial and lateral tibiofemoral compartments. It was hypothesised that greater changes on the medial tibial plateau would be observed compared with the lateral one.
Methods
A retrospective analysis of prospectively collected data was performed on pre- and post-operative MRIs from 21 patients (17 men and 4 women; age 52 ± 9 years). Inclusion criteria were varus alignment, medial compartment osteoarthritis and election for a primary MOWHTO. Each patient had a preoperative and a post-operative high-resolution MRI (3Tesla, Magnetom Trio, Siemens AG) at an average follow-up of 2.1 years. A previously published method was used to measure bony and meniscal slope for each compartment. The difference between pre- and post-operative tibial slope for both compartments was calculated and associated with the amount of frontal correction.
Results
There was a significant increase in bony tibial slope in both compartments following MOWHTO. When a change in bony tibial slope was detected in an individual patient, the change was larger in the medial compartment, with the average change also significantly greater (p < 0.01) in the medial compartment (2.4° ± 1.3°) compared with the lateral compartment (0.9° ± 1.1°). There was also a significant increase (p < 0.01) in the lateral tibial meniscal slope of 0.9° ± 1.4°, which was equivalent to the change in the bony lateral slope. The amount of frontal correction was not significantly associated with the amount of change in slope.
Conclusions
The results suggest that the modification of the bony slope is larger in the medial compartment after MOWHTO, which is likely related to the location of the hinge on the lateral tibial cortex. These findings suggest that consideration of the medial and lateral tibial slope intra-operatively could be important to identify the optimal location of the hinge. However, further studies are required before recommending any modification to the surgical technique, as the potential clinical consequences of tibial slope alterations remain unknown.
Level of evidence
IV.
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References
Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124(9):575–584
Ahlback S, Rydberg J (1980) X-ray classification and examination technics in gonarthrosis. Lakartidningen 77(22):2091–2093, 2096
Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20(3):586–593
Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 87(9):1227–1232
Chae DJ, Shetty GM, Lee DB, Choi HW, Han SB, Nha KW (2008) Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 15(2):128–133
Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br 76(5):745–749
Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X, Zayni R, Bonnin M, Jalil R, Amzallag J, Rosset P, Servien E, Gaudot F, Judet T, Catonne Y (2012) Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study. Orthop Traumatol Surg Res 98(1):68–74
El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S (2010) Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38(2):323–329
El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg Br 90(9):1193–1197
Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191
Feucht MJ, Mauro CS, Brucker PU, Imhoff AB, Hinterwimmer S (2012) The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-1941-6
Getgood A, Collins B, Slynarski K, Kurowska E, Parker D, Engebretsen L, Macdonald PB, Litchfield R (2011) Short-term safety and efficacy of a novel high tibial osteotomy system: a case controlled study. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1709-4
Giffin JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD (2007) Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 35(9):1443–1449
Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382
Haddad FS, Bentley G (2000) Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 15(5):597–603
Hashemi J, Chandrashekar N, Gill B, Beynnon BD, Slauterbeck JR, Schutt RC Jr, Mansouri H, Dabezies E (2008) The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Joint Surg Am 90(12):2724–2734
Hashemi J, Chandrashekar N, Mansouri H, Gill B, Slauterbeck JR, Schutt RC Jr, Dabezies E, Beynnon BD (2010) Shallow medial tibial plateau and steep medial and lateral tibial slopes: new risk factors for anterior cruciate ligament injuries. Am J Sports Med 38(1):54–62
Hinterwimmer S, Beitzel K, Paul J, Kirchhoff C, Sauerschnig M, von Eisenhart-Rothe R, Imhoff AB (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39(4):851–856
Hoell S, Suttmoeller J, Stoll V, Fuchs S, Gosheger G (2005) The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients. Arch Orthop Trauma Surg 125(9):638–643
Hohmann E, Bryant A, Reaburn P, Tetsworth K (2010) Does posterior tibial slope influence knee functionality in the anterior cruciate ligament-deficient and anterior cruciate ligament-reconstructed knee? Arthroscopy 26(11):1496–1502
Hudek R, Fuchs B, Regenfelder F, Koch PP (2011) Is noncontact ACL injury associated with the posterior tibial and meniscal slope? Clin Orthop Relat Res 469:2377–2384
Jacobi M, Wahl P, Jakob RP (2010) Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc 18(2):200–203
Jenny JY, Rapp E, Kehr P (1997) Proximal tibial meniscal slope: a comparison with the bone slope. Rev Chir Orthop Reparatrice Appar Mot 84(5):435–438
Jung KA, Kim SJ, Lee SC, Song MB, Yoon KH (2008) ‘Fine-tuned’ correction of tibial slope with a temporary external fixator in opening wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16(3):305–310
Katz MM, Hungerford DS, Krackow KA, Lennox DW (1987) Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 69(2):225–233
LaPrade RF, Oro FB, Ziegler CG, Wijdicks CA, Walsh MP (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38(1):160–170
Liu W, Maitland ME (2003) Influence of anthropometric and mechanical variations on functional instability in the ACL-deficient knee. Ann Biomed Eng 31(10):1153–1161
Lustig S, Scholes CJ, Leo SP, Coolican M, Parker DA (2012) Influence of soft tissues on the proximal bony tibial slope measured with two-dimensional MRI. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-1990-x
Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20(4):366–372
Matar WY, Boscariol R, Dervin GF (2009) Open wedge high tibial osteotomy: a roentgenographic comparison of a horizontal and an oblique osteotomy on patellar height and sagittal tibial slope. Am J Sports Med 37(4):735–742
McLean SG, Oh YK, Palmer ML, Lucey SM, Lucarelli DG, Ashton-Miller JA, Wojtys EM (2011) The relationship between anterior tibial acceleration, tibial slope, and ACL strain during a simulated jump landing task. J Bone Joint Surg Am 93(14):1310–1317
Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33(3):378–387
Ozalay M, Ozkoc G, Circi E, Akpinar S, Hersekli MA, Uysal M, Cesur N (2008) The correlation of correction magnitude and tibial slope changes following open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16(10):948–951
Petrigliano FA, Suero EM, Voos JE, Pearle AD, Allen AA (2012) The effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament- and posterolateral corner-deficient knee. Am J Sports Med 40(6):1322–1328
Rodner CM, Adams DJ, Diaz-Doran V, Tate JP, Santangelo SA, Mazzocca AD, Arciero RA (2006) Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med 34(9):1431–1441
Rubino LJ, Schoderbek RJ, Golish SR, Baumfeld J, Miller MD (2008) The effect of plate position and size on tibial slope in high tibial osteotomy: a cadaveric study. J Knee Surg 21(1):75–79
Sariali E, Catonne Y (2009) Modification of tibial slope after medial opening wedge high tibial osteotomy: clinical study and mathematical modelling. Knee Surg Sports Traumatol Arthrosc 17(10):1172–1177
Schaefer TK, Majewski M, Hirschmann MT, Friederich NF (2008) Comparison of sagittal and frontal plane alignment after open- and closed-wedge osteotomy: a matched-pair analysis. J Int Med Res 36(5):1085–1093
Smith TO, Sexton D, Mitchell P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 18(6):361–368
Sterett WI, Miller BS, Joseph TA, Rich VJ, Bain EM (2009) Posterior tibial slope after medial opening wedge high tibial osteotomy of the varus degenerative knee. J Knee Surg 22(1):13–16
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Lustig, S., Scholes, C.J., Costa, A.J. et al. Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21, 32–38 (2013). https://doi.org/10.1007/s00167-012-2229-6
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DOI: https://doi.org/10.1007/s00167-012-2229-6