Clinical Relevance of Joint Line Obliquity After High Tibial Osteotomy for Medial Knee Osteoarthritis Remains Controversial: a Systematic Review

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2023 Jun 20

PMID 37340220

Authors

Tianshun Xie

Reinoud W Brouwer

Inge van den Akker-Scheek

Hugo C van der Veen

Affiliations

Soon will be listed here.

Abstract

Purpose: To systematically review the literature on the association between knee joint line obliquity (KJLO) and clinical outcome after high tibial osteotomy (HTO) for medial knee osteoarthritis and summarize the KJLO cut-off value used when studying this association.

Methods: A systematic search was conducted in three databases (PubMed, Embase, and Web of Science) on September 2022, updated on February 2023. Eligible studies describing postoperative KJLO in relation to clinical outcome after HTO for medial knee osteoarthritis were included. Nonpatient studies and conference abstracts without full-text were excluded. Two independent reviewers assessed title, abstract and full-text based on the inclusion and exclusion criteria. The modified Downs and Black checklist was used to assess the methodological quality of each included study.

Results: Of the seventeen studies included, three had good methodological quality, thirteen fair quality, and one had poor quality. Conflicting findings were shown on the associations between postoperative KJLO and patient-reported outcome, medial knee cartilage regeneration, and 10-year surgical survival in sixteen studies. Three good-quality studies found no significant differences in lateral knee cartilage degeneration between postoperative medial proximal tibial angle > 95° and < 95°. Joint line orientation angles by the tibial plateau of 4° and 6°, joint line orientation angle by the middle knee joint space of 5°, medial proximal tibial angles of 95° and 98°, and Mikulicz joint line angle of 94° were KJLO cut-off values used in the included studies.

Conclusion: Based on current evidence, the actual association between postoperative KJLO and clinical consequences after HTO for medial knee osteoarthritis cannot be ascertained. The clinical relevance of KJLO after HTO remains controversial.

Level Of Evidence: IV.

Citing Articles

Comparative impact of high tibial osteotomy and supramalleolar osteotomy on limb alignment and ankle function: a retrospective study.

Li J, Li R, Li Y, Zhao Z J Orthop Surg Res. 2025; 20(1):234.

PMID: 40038785 PMC: 11881441. DOI: 10.1186/s13018-025-05511-x.

Assessing joint line obliquity in valgus-producing high tibial osteotomy: A scoping review of the literature.

Xie T, Brouwer R, van den Akker-Scheek I, van der Veen H J Orthop. 2025; 67:94-100.

PMID: 39906180 PMC: 11788681. DOI: 10.1016/j.jor.2025.01.021.

An increased medial proximal tibial angle of greater than 95 degrees after opening wedge high tibial osteotomy is not associated with deterioration of minimum 10-year clinical outcomes.

Yamada S, Kumagai K, Nejima S, Choe H, Ike H, Kobayashi N Arch Orthop Trauma Surg. 2024; 145(1):4.

PMID: 39666051 DOI: 10.1007/s00402-024-05696-6.

Adjusted planning based on the joint line convergence angle improves correction accuracy in the standing position after opening wedge high tibial osteotomy.

Kumagai K, Yamada S, Nejima S, Choe H, Ike H, Kobayashi N J Orthop Surg Res. 2024; 19(1):598.

PMID: 39342372 PMC: 11437682. DOI: 10.1186/s13018-024-05096-x.

Influence of Increased Joint Line Obliquity on Survivorship After Lateral Closing-Wedge High Tibial Osteotomy.

Xie T, de Vries A, van der Veen H, Brouwer R Am J Sports Med. 2024; 52(11):2792-2798.

PMID: 39165165 PMC: 11408944. DOI: 10.1177/03635465241270292.

References

Akamatsu Y, Kumagai K, Kobayashi H, Tsuji M, Saito T . Effect of Increased Coronal Inclination of the Tibial Plateau After Opening-Wedge High Tibial Osteotomy. Arthroscopy. 2018; 34(7):2158-2169.e2. DOI: 10.1016/j.arthro.2018.01.055. View

Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S . Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2021; 30(2):688-697. DOI: 10.1007/s00167-020-06430-6. 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

Babis G, An K, Chao E, Larson D, Rand J, Sim F . Upper tibia osteotomy: long term results - realignment analysis using OASIS computer software. J Orthop Sci. 2008; 13(4):328-34. DOI: 10.1007/s00776-008-1234-6. View

Bellamy N, BUCHANAN W, Goldsmith C, Campbell J, Stitt L . Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15(12):1833-40. View

Cheng H, Hsu W, Chen C, Li C . Activation of NOTCH1 by Shear Force Elicits Immediate Cytokine Expression in Human Chondrocytes. Int J Mol Sci. 2020; 21(14). PMC: 7404062. DOI: 10.3390/ijms21144958. View

Dawson J, Fitzpatrick R, Murray D, Carr A . Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998; 80(1):63-9. DOI: 10.1302/0301-620x.80b1.7859. View

Dekkers O, Egger M, Altman D, Vandenbroucke J . Distinguishing case series from cohort studies. Ann Intern Med. 2012; 156(1 Pt 1):37-40. DOI: 10.7326/0003-4819-156-1-201201030-00006. View

Downs S, Black N . The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998; 52(6):377-84. PMC: 1756728. DOI: 10.1136/jech.52.6.377. View

10.

Efe T, Ahmed G, Heyse T, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S . Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord. 2011; 12:46. PMC: 3046001. DOI: 10.1186/1471-2474-12-46. View

11.

Escobar A, Quintana J, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I . Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2006; 15(3):273-80. DOI: 10.1016/j.joca.2006.09.001. View

12.

Feucht M, Mauro C, Brucker P, Imhoff A, Hinterwimmer S . The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. 2012; 21(1):134-45. DOI: 10.1007/s00167-012-1941-6. View

13.

Floerkemeier S, Staubli A, Schroeter S, Goldhahn S, Lobenhoffer P . Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients. Int Orthop. 2013; 38(1):55-60. PMC: 3890126. DOI: 10.1007/s00264-013-2082-3. View

14.

Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Fujita K, Yamamuro Y . Comparison of Clinical and Radiologic Outcomes Between Normal and Overcorrected Medial Proximal Tibial Angle Groups After Open-Wedge High Tibial Osteotomy. Arthroscopy. 2019; 35(10):2898-2908.e1. DOI: 10.1016/j.arthro.2019.04.030. View

15.

Goto N, Akasaki Y, Okazaki K, Kuwashima U, Iwasaki K, Kawamura H . The influence of post-operative knee coronal alignment parameters on long-term patient-reported outcomes after closed-wedge high tibial osteotomy. J Orthop. 2020; 20:177-180. PMC: 6997110. DOI: 10.1016/j.jor.2020.01.042. View

16.

Healy Z, Lee N, Gao X, Goldring M, Talalay P, Kensler T . Divergent responses of chondrocytes and endothelial cells to shear stress: cross-talk among COX-2, the phase 2 response, and apoptosis. Proc Natl Acad Sci U S A. 2005; 102(39):14010-5. PMC: 1236575. DOI: 10.1073/pnas.0506620102. View

17.

Hooper P, Jutai J, Strong G, Russell-Minda E . Age-related macular degeneration and low-vision rehabilitation: a systematic review. Can J Ophthalmol. 2008; 43(2):180-7. DOI: 10.3129/i08-001. View

18.

Insall J, Ranawat C, Aglietti P, Shine J . A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am. 1976; 58(6):754-65. View

19.

Irrgang J, Anderson A, Boland A, Harner C, Kurosaka M, Neyret P . Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001; 29(5):600-13. DOI: 10.1177/03635465010290051301. View

20.

Jacquet C, Pioger C, Khakha R, Steltzlen C, Kley K, Pujol N . Evaluation of the "Minimal Clinically Important Difference" (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020; 29(3):820-826. DOI: 10.1007/s00167-020-06026-0. View