Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2016 Mar 16

PMID 26977420

Citations 12

Authors

Hiroyasu Ogawa

Kazu Matsumoto

Takahiro Ogawa

Kentaro Takeuchi

Haruhiko Akiyama

Affiliations

Soon will be listed here.

Abstract

Background: Medial opening wedge high tibial osteotomy (HTO) is a well-established surgery for medial compartment knee osteoarthritis (OA) wherein the lower extremity is realigned to shift the load distribution from the medial compartment of the knee to the lateral compartment. However, this surgery is known to affect the posterior tibial slope angle (PTSA), which could lead to abnormal knee kinematics and instability, and eventually to knee OA. Although PTSA control is as important as coronal realignment, few appropriate measurements for this parameter have been reported. The placement of a wedge spacer might have an effect on PTSA.

Purpose: To elucidate the relationship between the PTSA and the direction of insertion of a wedge spacer.

Study Design: Case series; Level of evidence, 4.

Methods: This study assessed 43 knees from 34 patients who underwent medial opening wedge HTO for knee OA. Pre- and postoperative lateral radiographs of the knee as well as postoperative computed tomography scans were performed to evaluate the relationship among PTSA, wedge insertion angle (WIA), and opening gap ratio (distance of the anterior opening gap/distance of the posterior opening gap at the osteotomy site).

Results: The PTSA significantly increased from 9.0° ± 2.8° preoperatively to 13.2° ± 4.1° postoperatively (P < .001), resulting in a mean ΔPTSA of 4.7° ± 4.5°. The mean opening gap ratio was 0.86 ± 0.11, and the mean WIA was 25.9° ± 8.4°. The WIA and opening gap ratio were both highly correlated with ΔPTSA (r = 0.71 and 0.72, respectively), implying that a smaller WIA or smaller gap ratio leads to less increase in posterior slope.

Conclusion: The direction of wedge insertion is highly correlated with PTSA increase, which suggests that the PTSA can be controlled for by adjusting the direction of wedge insertion during surgery.

Clinical Relevance: Study results suggest that it is possible to adjust the PTSA by controlling the WIA during surgery. Proper attention to WIA can avoid an iatrogenic increase in posterior tibial slope.

Citing Articles

Increased medial tibial slope is a possible risk factor for patellar cartilage lesions.

Hoffeld K, Hockmann J, Wahlers C, Eysel P, Oppermann J J Exp Orthop. 2024; 11(4):e70058.

PMID: 39610714 PMC: 11602579. DOI: 10.1002/jeo2.70058.

Postoperative onset lateral hinge fracture is a risk factor for delayed union of the tibial tuberosity in medial opening wedge distal tibial tuberosity osteotomy.

Ogawa H, Nakamura Y, Sengoku M, Shimokawa T, Ohnishi K, Akiyama H Asia Pac J Sports Med Arthrosc Rehabil Technol. 2024; 37:21-26.

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High tibial lateral closing wedge and opening wedge valgus osteotomy produce different effects on posterior tibial slope and patellar height.

Ji S, Gao Y, Zhang J, Pan F, Zhu K, Jiang X Front Surg. 2023; 10:1219614.

PMID: 37780911 PMC: 10536261. DOI: 10.3389/fsurg.2023.1219614.

Significant slope reduction in ACL deficiency can be achieved both by anterior closing-wedge and medial open-wedge high tibial osteotomies: early experiences in 76 cases.

Weiler A, Gwinner C, Wagner M, Ferner F, Strobel M, Dickschas J Knee Surg Sports Traumatol Arthrosc. 2022; 30(6):1967-1975.

PMID: 35286402 DOI: 10.1007/s00167-022-06861-3.

Incidence and Factors Affecting the Occurrence of Lateral Hinge Fracture After Medial Opening-Wedge High Tibial Osteotomy.

Lee S, Kim J, Baek E, Ryu H, Han D, Choi W Orthop J Sports Med. 2021; 9(10):23259671211035372.

PMID: 34646897 PMC: 8504237. DOI: 10.1177/23259671211035372.

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