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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2023

Open Access 20-06-2023 | Knee Osteoarthritis | KNEE

Clinical relevance of joint line obliquity after high tibial osteotomy for medial knee osteoarthritis remains controversial: a systematic review

Authors: Tianshun Xie, Reinoud W. Brouwer, Inge van den Akker-Scheek, Hugo C. van der Veen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2023

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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.
Literature
1.
Akamatsu Y, Kumagai K, Kobayashi H, Tsuji M, Saito T (2018) Effect of increased coronal inclination of the tibial plateau after opening-wedge high tibial osteotomy. Arthroscopy 34:2158-2169.e2152PubMedCrossRef
2.
Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S (2022) Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 30:688–697PubMedCrossRef
3.
Aoki Y, Yasuda K, Mikami S, Ohmoto H, Majima T, Minami A (2006) 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 88:1336–1340PubMedCrossRef
4.
Babis GC, An KN, Chao EY, Larson DR, Rand JA, Sim FH (2008) Upper tibia osteotomy: long term results—realignment analysis using OASIS computer software. J Orthop Sci 13:328–334PubMedCrossRef
5.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) 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 15:1833–1840PubMed
6.
Cheng HJ, Hsu WT, Chen CN, Li C (2020) Activation of NOTCH1 by shear force elicits immediate cytokine expression in human chondrocytes. Int J Mol Sci 21:4958PubMedPubMedCentralCrossRef
7.
Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63–69PubMedCrossRef
8.
Dekkers OM, Egger M, Altman DG, Vandenbroucke JP (2012) Distinguishing case series from cohort studies. Ann Intern Med 156:37–40PubMedCrossRef
9.
Downs SH, Black N (1998) 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 52:377–384PubMedPubMedCentralCrossRef
10.
Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S et al (2011) Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 12:46PubMedPubMedCentralCrossRef
11.
Escobar A, Quintana JM, Bilbao A, Aróstegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage 15:273–280PubMedCrossRef
12.
Feucht MJ, Mauro CS, Brucker PU, Imhoff AB, Hinterwimmer S (2013) The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 21:134–145PubMedCrossRef
13.
Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2014) 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 38:55–60PubMedCrossRef
14.
Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Fujita K, Yamamuro Y (2019) Comparison of clinical and radiologic outcomes between normal and overcorrected medial proximal tibial angle groups after open-wedge high tibial osteotomy. Arthroscopy 35:2898-2908.e2891PubMedCrossRef
15.
Goto N, Akasaki Y, Okazaki K, Kuwashima U, Iwasaki K, Kawamura H et al (2020) The influence of post-operative knee coronal alignment parameters on long-term patient-reported outcomes after closed-wedge high tibial osteotomy. J Orthop 20:177–180PubMedPubMedCentralCrossRef
16.
Healy ZR, Lee NH, Gao X, Goldring MB, Talalay P, Kensler TW et al (2005) 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 102:14010–14015PubMedPubMedCentralCrossRef
17.
Hooper P, Jutai JW, Strong G, Russell-Minda E (2008) Age-related macular degeneration and low-vision rehabilitation: a systematic review. Can J Ophthalmol 43:180–187PubMedCrossRef
18.
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14CrossRef
19.
Insall JN, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 58:754–765PubMedCrossRef
20.
Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613PubMedCrossRef
21.
Jacquet C, Pioger C, Khakha R, Steltzlen C, Kley K, Pujol N et al (2021) 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 29:820–826PubMedCrossRef
22.
Jin C, Song EK, Santoso A, Ingale PS, Choi IS, Seon JK (2020) Survival and risk factor analysis of medial open wedge high tibial osteotomy for unicompartment knee osteoarthritis. Arthroscopy 36:535–543PubMedCrossRef
23.
Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH et al (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30:72–79PubMedCrossRef
24.
Kawashima F, Takagi H (2022) Evaluation of postoperative orientation of the knee and ankle joint after open wedge high tibial osteotomy. Asia Pac J Sports Med Arthrosc Rehabil Technol 29:9–14PubMedPubMedCentral
25.
Keenan OJF, Clement ND, Nutton R, Keating JF (2019) Older age and female gender are independent predictors of early conversion to total knee arthroplasty after high tibial osteotomy. Knee 26:207–212PubMedCrossRef
26.
Kim CW, Seo SS, Lee CR, Gwak HC, Kim JH, Jung SG (2017) Factors affecting articular cartilage repair after open-wedge high tibial osteotomy. Knee 24:1099–1107PubMedCrossRef
27.
Kim GW, Kang JK, Song EK, Seon JK (2021) Increased joint obliquity after open-wedge high tibial osteotomy induces pain in the lateral compartment: a comparative analysis of the minimum 4-year follow-up outcomes using propensity score matching. Knee Surg Sports Traumatol Arthrosc 29:3495–3502PubMedCrossRef
28.
Kim JE, Won S, Jaffar MSA, Lee JI, Kim TW, Lee YS (2020) How does geometric change after open-wedge high tibial osteotomy affect anterior cruciate ligament status? Knee 27:940–948PubMedCrossRef
29.
Kim JS, Lim JK, Choi HG, Jeong HW, Park SB, Shim SJ et al (2022) Excessively increased joint-line obliquity after medial opening-wedge high tibial osteotomy is associated with inferior radiologic and clinical outcomes: what is permissible joint-line obliquity. Arthroscopy 38:1904–1915PubMedCrossRef
30.
Kim MS, Koh IJ, Choi YJ, Lee JY, In Y (2017) Differences in patient-reported outcomes between unicompartmental and total knee arthroplasties: a propensity score-matched analysis. J Arthroplasty 32:1453–1459PubMedCrossRef
31.
Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N (2018) The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Br J Sports Med 52:387–407PubMedCrossRef
32.
Kubota M, Kim Y, Sato T, Yamaguchi J, Ohno R, Kaneko K et al (2020) The actual knee function was not influenced by joint line obliquity after open-wedge high tibial osteotomy. Sicot J 6:4PubMedPubMedCentralCrossRef
33.
Kutzner I, Trepczynski A, Heller MO, Bergmann G (2013) Knee adduction moment and medial contact force–facts about their correlation during gait. PLoS ONE 8:e81036PubMedPubMedCentralCrossRef
34.
35.
Lee KM, Chang CB, Park MS, Kang SB, Kim TK, Chung CY (2015) Changes of knee joint and ankle joint orientations after high tibial osteotomy. Osteoarthritis Cartilage 23:232–238PubMedCrossRef
36.
Lee NK, Kim TW, Lee S, Choi YS, Kang SB, Chang CB (2022) Effect of distance between the feet on knee joint line orientation after total knee arthroplasty in standing full-limb radiographs. Knee Surg Sports Traumatol Arthrosc 30:3032–3040PubMedCrossRef
37.
Lee SJ, Kim JH, Choi W (2021) Factors related to the early outcome of medial open wedge high tibial osteotomy: coronal limb alignment affects more than cartilage degeneration state. Arch Orthop Trauma Surg 141:1339–1348PubMedCrossRef
38.
Lee WC, Kwan YH, Chong HC, Yeo SJ (2017) The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc 25:3354–3359PubMedCrossRef
39.
Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRef
40.
Mathes T, Pieper D (2017) Clarifying the distinction between case series and cohort studies in systematic reviews of comparative studies: potential impact on body of evidence and workload. BMC Med Res Methodol 17:107PubMedPubMedCentralCrossRef
41.
Moon HS, Choi CH, Yoo JH, Jung M, Lee TH, Byun JW et al (2021) An increase in medial joint space width after medial open-wedge high tibial osteotomy is associated with an increase in the postoperative weight-bearing line ratio rather than with cartilage regeneration: comparative analysis of patients who underwent second-look arthroscopic assessment. Arthroscopy 37:657-668.e654PubMedCrossRef
42.
Morgan RL, Whaley P, Thayer KA, Schünemann HJ (2018) Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int 121:1027–1031PubMedPubMedCentralCrossRef
43.
Nakayama H, Schröter S, Yamamoto C, Iseki T, Kanto R, Kurosaka K et al (2018) Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthrosc 26:1873–1878PubMedCrossRef
44.
Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K (2018) Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:1629–1635PubMedCrossRef
45.
Nishitani K, Yamamoto Y, Furu M, Kuriyama S, Nakamura S, Ito H et al (2019) The minimum clinically important difference for the Japanese version of the new Knee Society Score (2011KSS) after total knee arthroplasty. J Orthop Sci 24:1053–1057PubMedCrossRef
46.
Ogawa H, Matsumoto K, Akiyama H (2019) ACL degeneration after an excessive increase in the medial proximal tibial angle with medial open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:3374–3380PubMedCrossRef
47.
Ogawa H, Matsumoto K, Akiyama H (2018) Coronal tibiofemoral subluxation is correlated to correction angle in medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 26:3482–3490PubMedCrossRef
48.
Oh KJ, Ko YB, Bae JH, Yoon ST, Kim JG (2016) Analysis of knee joint line obliquity after high tibial osteotomy. J Knee Surg 29:649–657PubMedCrossRef
49.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 88:105906PubMedCrossRef
50.
51.
Patel S, Haunschild E, Gilat R, Knapik D, Evuarherhe A, Parvaresh KC et al (2021) Defining clinically significant outcomes following high tibial osteotomy with or without concomitant procedures. J Cartilage Joint Preservation 1:100014CrossRef
52.
Roos EM, Lohmander LS (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64PubMedPubMedCentralCrossRef
53.
Rosso F, Rossi R, Cantivalli A, Pilone C, Bonasia DE (2022) Joint line obliquity does not affect the outcomes of opening wedge high tibial osteotomy at an average 10-year follow-up. Am J Sports Med 50:461–470PubMedCrossRef
54.
Schober P, Boer C, Schwarte LA (2018) Correlation coefficients: appropriate use and interpretation. Anesth Analg 126:1763–1768PubMedCrossRef
55.
Schuster P, Geßlein M, Schlumberger M, Mayer P, Mayr R, Oremek D et al (2018) Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 46:1362–1370PubMedCrossRef
56.
Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2012) The new knee society knee scoring system. Clin Orthop Relat Res 470:3–19PubMedCrossRef
57.
Sekiya I, Sasaki S, Miura Y, Aoki H, Katano H, Okanouchi N et al (2022) Medial tibial osteophyte width strongly reflects medial meniscus extrusion distance and medial joint space width moderately reflects cartilage thickness in knee radiographs. J Magn Reson Imaging 56:824–834PubMedPubMedCentralCrossRef
58.
Sohn S, Koh IJ, Kim MS, In Y (2022) Risk factors and preventive strategy for excessive coronal inclination of tibial plateau following medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 142:561–569PubMedCrossRef
59.
Song JH, Bin SI, Kim JM, Lee BS (2020) What is an acceptable limit of joint-line obliquity after medial open wedge high tibial osteotomy? Analysis based on midterm results. Am J Sports Med 48:3028–3035PubMedCrossRef
60.
Sun X, Wang J, Su Z (2020) A meta-analysis of total knee arthroplasty following high tibial osteotomy versus primary total knee arthroplasty. Arch Orthop Trauma Surg 140:527–535PubMedPubMedCentralCrossRef
61.
Trac MH, McArthur E, Jandoc R, Dixon SN, Nash DM, Hackam DG et al (2016) Macrolide antibiotics and the risk of ventricular arrhythmia in older adults. CMAJ 188:E120-e129PubMedPubMedCentralCrossRef
62.
Trevino RL, Pacione CA, Malfait AM, Chubinskaya S, Wimmer MA (2017) Development of a cartilage shear-damage model to investigate the impact of surface injury on chondrocytes and extracellular matrix wear. Cartilage 8:444–455PubMedCrossRef
63.
van Wulfften Palthe AFY, Clement ND, Temmerman OPP, Burger BJ (2018) Survival and functional outcome of high tibial osteotomy for medial knee osteoarthritis: a 10–20-year cohort study. Eur J Orthop Surg Traumatol 28:1381–1389PubMedCrossRef
64.
Wang D, Willinger L, Athwal KK, Williams A, Amis AA (2021) Knee joint line obliquity causes tibiofemoral subluxation that alters contact areas and meniscal loading. Am J Sports Med 49:2351–2360PubMedPubMedCentralCrossRef
65.
Wang P, Zhu F, Tong Z, Konstantopoulos K (2011) Response of chondrocytes to shear stress: antagonistic effects of the binding partners Toll-like receptor 4 and caveolin-1. FASEB J 25:3401–3415PubMedPubMedCentralCrossRef
Metadata
Title
Clinical relevance of joint line obliquity after high tibial osteotomy for medial knee osteoarthritis remains controversial: a systematic review
Authors
Tianshun Xie
Reinoud W. Brouwer
Inge van den Akker-Scheek
Hugo C. van der Veen
Publication date
20-06-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07486-w

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