High Rate of Radiographic Union at the Fibular Osteotomy Site With No Complications After an Acute Oblique Osteotomy and Ligation Procedure to Shorten the Fibula in High Tibial Osteotomy

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2022 Aug 22

PMID 35990872

Authors

Daisuke Ueda

Kazunori Yasuda

Takuma Kaibara

Koji Yabuuchi

Jun Yamaguchi

Jun Onodera

Norimasa Iwasaki

Tomonori Yagi

Eiji Kondo

Affiliations

Soon will be listed here.

Abstract

Background: A fibular shortening osteotomy is needed to perform lateral closing-wedge high tibial osteotomy (LCW-HTO). To achieve this shortening, we have recently developed an acute oblique osteotomy and ligation (AO/L) procedure for the center of the fibular shaft, based on the AO procedure.

Purpose: To compare the 2-year follow-up outcomes between the AO/L procedure and the AO procedure.

Study Design: Cohort study; Level of evidence, 2.

Methods: A prospective comparative cohort study was conducted involving 83 patients (83 knees) who underwent shortening osteotomy of the fibula in LCW-HTO between April 2017 and March 2019. The first consecutive 41 knees (AO group) underwent fibular osteotomy with the AO procedure. The remaining 42 knees (AO/L group) underwent fibular osteotomy with the AO/L procedure. All of the patients were evaluated for at least 2 years postoperatively via clinical and radiological assessments. To determine the time needed for complete union at the osteotomy site, we evaluated the radiographs using a radiographic union score for tibial fractures, which was modified for fibular osteotomy. Comparison of outcomes between the 2 groups was performed using the Student test for continuous variables and the Mann-Whitney test or Fisher exact test for discrete variables.

Results: Around the fibular osteotomy site, no perioperative complications were found in either group. The radiographic union score was significantly higher in the AO/L group than in the AO group ( < .0001 at 2, 3, and 6 months; = .0290 at 12 and 24 months). The union rate at the fibular osteotomy site was significantly higher in the AO/L group (97.6%) than in the AO group (82.9%) at 12 months ( = .0290).

Conclusion: The AO/L procedure significantly accelerated the formation of bridging callus at the fibular osteotomy site and provided a significantly higher union rate compared with the AO procedure. Both AO/L and AO procedures were free from perioperative complications. These results suggest that the AO/L procedure is clinically useful as an osteotomy procedure to shorten the fibula in LCW-HTO.

Citing Articles

Quantitative Technique to Precisely Fix the Tibia With a Locking Compression Plate at the Preoperatively Planned Correction Angle While Applying High Compression to the Osteotomy Site in Inverted V-Shaped High Tibial Osteotomy.

Kaibara T, Yasuda K, Kondo E, Yabuuchi K, Onodera J, Iwasaki N Arthrosc Tech. 2025; 14(2):103229.

PMID: 40041368 PMC: 11873556. DOI: 10.1016/j.eats.2024.103229.

Hybrid closing-wedge DTO using PSI was selected for a patient wit severe deformity post-fracture malunion, which enable good alignment correction and patient satisfaction.

Miyasaka T, Kayama T, Omori T, Shimokata R, Saito M J Orthop Surg Res. 2024; 19(1):687.

PMID: 39456038 PMC: 11515240. DOI: 10.1186/s13018-024-05187-9.

References

Bauer T, Hardy P, Lemoine J, Finlayson D, Tranier S, Lortat-Jacob A . Drop foot after high tibial osteotomy: a prospective study of aetiological factors. Knee Surg Sports Traumatol Arthrosc. 2004; 13(1):23-33. DOI: 10.1007/s00167-003-0481-5. View

Whelan D, Bhandari M, Stephen D, Kreder H, McKee M, Zdero R . Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma. 2009; 68(3):629-32. DOI: 10.1097/TA.0b013e3181a7c16d. View

Yasuda K, Kondo E, Ueda D, Onodera J, Yabuuchi K, Tanabe Y . An Acute Oblique Osteotomy and Suture Ligation Procedure to Shorten the Fibula in Lateral Closing-Wedge High Tibial Osteotomy. Arthrosc Tech. 2020; 9(9):e1299-e1308. PMC: 7528434. DOI: 10.1016/j.eats.2020.05.008. View

Yasuda K, Majima T, Tsuchida T, Kaneda K . A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res. 1992; (282):186-95. View

Ozcan O, Eroglu M, Boya H, Kaya Y . Proximal tibiofibular joint pain versus peroneal nerve dysfunction: clinical results of closed-wedge high tibial osteotomy performed with proximal tibiofibular joint disruption. Knee Surg Sports Traumatol Arthrosc. 2016; 25(9):2936-2941. DOI: 10.1007/s00167-016-4066-5. View

Aoki Y, Yasuda K, Mikami S, Ohmoto H, Majima T, Minami A . Inverted V-shaped high tibial osteotomy compared with closing-wedge high tibial osteotomy for osteoarthritis of the knee. Ten-year follow-up result. J Bone Joint Surg Br. 2006; 88(10):1336-40. DOI: 10.1302/0301-620X.88B10.17532. View

Kellgren J, Lawrence J . Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957; 16(4):494-502. PMC: 1006995. DOI: 10.1136/ard.16.4.494. View

Ramanoudjame M, Vandenbussche E, Baring T, Solignac N, Augereau B, Gregory T . Fibular nonunion after closed-wedge high tibial osteotomy. Orthop Traumatol Surg Res. 2012; 98(8):863-7. DOI: 10.1016/j.otsr.2012.09.010. View

Simpson A, Robiati L, Jalal M, Tsang S . Non-union: Indications for external fixation. Injury. 2019; 50 Suppl 1:S73-S78. DOI: 10.1016/j.injury.2019.03.053. View

10.

Gil-Melgosa L, Valenti A, Suarez A, Montiel V . Proximal tibiofibular joint changes after closed-wedge high tibial osteotomy. Are they relevant?. Knee. 2020; 27(5):1585-1592. DOI: 10.1016/j.knee.2020.08.015. View

11.

Kurosaka M, Tsumura N, Yoshiya S, Matsui N, Mizuno K . A new fibular osteotomy in association with high tibial osteotomy (a comparative study with conventional mid-third fibular osteotomy). Int Orthop. 2000; 24(4):227-30. PMC: 3619889. DOI: 10.1007/s002640000151. View

12.

Kirgis A, Albrecht S . Palsy of the deep peroneal nerve after proximal tibial osteotomy. An anatomical study. J Bone Joint Surg Am. 1992; 74(8):1180-5. View

13.

Torres-Claramunt R, Sanchez-Soler J, Hinarejos P, Sala-Pujals A, Leal-Blanquet J, Monllau J . Proximal Tibiofibular Dislocation in a Closing-Wedge High Tibial Osteotomy Causes Lateral Radiological Gapping of the Knee: A Prospective Randomized Study. J Clin Med. 2020; 9(6). PMC: 7355442. DOI: 10.3390/jcm9061622. View

14.

COVENTRY M . Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results. Orthop Clin North Am. 1979; 10(1):191-210. View

15.

Wildner M, Peters A, Hellich J, Reichelt A . Complications of high tibial osteotomy and internal fixation with staples. Arch Orthop Trauma Surg. 1992; 111(4):210-2. DOI: 10.1007/BF00571479. View

16.

Leow J, Clement N, Tawonsawatruk T, Simpson C, Simpson A . The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res. 2016; 5(4):116-21. PMC: 5009237. DOI: 10.1302/2046-3758.54.2000628. View

17.

Cameron H, Welsh R, Jung Y, Noftall F . Repair of nonunion of tibial osteotomy. Clin Orthop Relat Res. 1993; (287):167-9. View

18.

Kondo E, Yasuda K, Yabuuchi K, Aoki Y, Inoue M, Iwasaki N . Inverted V-Shaped High Tibial Osteotomy for Medial Osteoarthritic Knees With Severe Varus Deformity. Arthrosc Tech. 2018; 7(10):e999-e1012. PMC: 6203232. DOI: 10.1016/j.eats.2018.06.005. View

19.

Insall J, Joseph D, Msika C . High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am. 1984; 66(7):1040-8. View

20.

Sanchez-Soler J, Coelho A, Torres-Claramunt R, Gasol B, Fontanellas A, Perelli S . Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement. J Clin Med. 2021; 10(13). PMC: 8267674. DOI: 10.3390/jcm10132743. View