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Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap in the medial biplanar open-wedge HTO

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to investigate the causes of retro-tubercular gap widening and to confirm whether this widened gap causes instability of the osteotomy configuration during open-wedge high tibial osteotomy (OWHTO).

Methods

Operative records and radiologic findings of patients who underwent biplanar medial OWHTO between 2014 and 2016 were retrospectively evaluated. To identify the osteotomy configuration including lateral hinge fracture, postoperative simple radiographs and CT images were analyzed. Postoperative CT scan was used to evaluate the widening of the retro-tubercular gap, thickness, and axial angle of retro-tubercular osteotomy, as well as the ratios of anterior and posterior osteotomy, and hinge length. The correlation of each factor was evaluated and analyzed in accordance with the lateral hinge fracture (LHF).

Results

Widening of the retro-tubercular gap showed a significant correlation with the axial angle of retro-tubercular osteotomy, anterior osteotomy ratio, and opening gap distance, but not with the thickness of retro-tubercular osteotomy, posterior osteotomy ratio, and hinge length ratio. The LHF group showed significantly larger value than the non-LHF group with respect to the thickness of retro-tubercular osteotomy (P = 0.003), axial angle of retro-tubercular osteotomy (P = 0.033), retro-planar gap distance (P = 0.001), anterior osteotomy ratio (P = 0.000), and opening gap distance (P = 0.003). The hinge length ratio was smaller in the LHF group than in the non-LHF group (P = 0.001). However, the posterior osteotomy ratio was not different between the two groups (n.s.).

Conclusion

Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap distance, which can be related to LHF. Therefore, anterior cortical osteotomy may also be an important factor for preventing instability of the proximal fragment in biplanar OWHTO.

Level of Evidence

Case–control study, Level III.

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References

  1. Baumgarten KM, Meyers KN, Fealy S, Wright TM, Wickiewicz TL (2007) The coronal plane high tibial osteotomy. Part II: a comparison of axial rotation with the opening wedge high tibial osteotomy. HSS J 3(2):155–158

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hinterwimmer S, Feucht MJ, Paul J, Kirchhoff C, Sauerschnig M, Imhoff AB, Beitzel K (2016) Analysis of the effects of high tibial osteotomy on tibial rotation. Int Orthop 40(9):1849–1854

    Article  PubMed  Google Scholar 

  3. Hohmann E, Bryant A, Imhoff AB (2006) The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc 14(5):454–459

    Article  PubMed  Google Scholar 

  4. Jacobi M, Villa V, Reischl N, Demey G, Goy D, Neyret P, Gautier E, Magnussen RA (2015) Factors influencing posterior tibial slope and tibial rotation in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23(9):2762–2768

    Article  PubMed  Google Scholar 

  5. Jang KM, Lee JH, Park HJ, Kim JL, Han SB (2016) Unintended rotational changes of the distal tibia after biplane medial open-wedge high tibial osteotomy. J Arthroplasty 31(1):59–63

    Article  PubMed  Google Scholar 

  6. Kendoff D, Lo D, Goleski P, Warkentine B, O’Loughlin PF, Pearle AD (2008) Open wedge tibial osteotomies influence on axial rotation and tibial slope. Knee Surg Sports Traumatol Arthrosc 16(10):904–910

    Article  CAS  PubMed  Google Scholar 

  7. Lee BH, Ha CW, Moon SW, Chang M, Kim HY, Park SH, Wang JH (2017) Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy. Knee 24(2):362–371

    Article  PubMed  Google Scholar 

  8. Lee OS, Lee YS (2017) Diagnostic value of computed tomography and risk factors for lateral hinge fracture in the open wedge high tibial osteotomy. Arthroscopy 34:1032–1043

    Google Scholar 

  9. Lee YS, Kang JY, Lee MC, Elazab A, Choi UH, Kang SG, Lee KJ, Lee S (2017) Osteotomy configuration of the proximal wedge and analysis of the affecting factors in the medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25(3):793–799

    Article  PubMed  Google Scholar 

  10. Lee YS, Kang JY, Lee MC, Oh WS, Elazab A, Song MK (2016) Effect of the osteotomy length on the change of the posterior tibial slope with a simple distraction of the posterior gap in the uni- and biplanar open-wedge high tibial osteotomy. Arthroscopy 32(2):263–271

    Article  PubMed  Google Scholar 

  11. Lee YS, Moon GH (2015) Comparative analysis of osteotomy accuracy between the conventional and devised technique using a protective cutting system in medial open-wedge high tibial osteotomy. J Orthop Sci 20(1):129–136

    Article  CAS  PubMed  Google Scholar 

  12. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. Pape D, Lorbach O, Schmitz C, Busch LC, Van Giffen N, Seil R, Kohn DM (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18(2):204–211

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. Song EK, Seon JK, Park SJ (2007) How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 30(10 Suppl):S127-131

    Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Suero EM, Hawi N, Westphal R, Sabbagh Y, Citak M, Wahl FM, Krettek C, Liodakis E (2017) The effect of distal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints. Knee Surg Sports Traumatol Arthrosc 25(1):299–305

    Article  PubMed  Google Scholar 

  19. Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94

    Article  PubMed  Google Scholar 

  20. Teeter MG, Leitch KM, Pape D, Yuan X, Birmingham TB, Giffin JR (2015) Radiostereometric analysis of early anatomical changes following medial opening wedge high tibial osteotomy. Knee 22(1):41–46

    Article  PubMed  Google Scholar 

  21. Turkmen F, Kacira BK, Ozkaya M, Erkocak OF, Acar MA, Ozer M, Toker S, Demir T (2016) Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 25(9):2914–2920

    Article  PubMed  Google Scholar 

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Funding

This study has been supported by Basic Science Research Program through the Ministry of Education of the Republic of Korea and National Research Foundation of Korea (NRF) (NRF-2017R1D1A1A09000509).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    In Ho Jo, O-Sung Lee, Seung Hoon Lee, Kyung Wook Kim & Yong Seuk Lee

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  1. In Ho Jo
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  2. O-Sung Lee
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  3. Seung Hoon Lee
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  4. Kyung Wook Kim
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  5. Yong Seuk Lee
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Corresponding author

Correspondence to Yong Seuk Lee.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the institutional review board of our hospital (SNUBH, B-1409/266-104).

Informed consent

For this type of study, formal informed consent was not required.

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Jo, I.H., Lee, OS., Lee, S.H. et al. Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap in the medial biplanar open-wedge HTO. Knee Surg Sports Traumatol Arthrosc 27, 2910–2916 (2019). https://doi.org/10.1007/s00167-018-4991-6

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  • DOI: https://doi.org/10.1007/s00167-018-4991-6

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