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Knee Surgery, Sports Traumatology, Arthroscopy

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01-12-2013 | Knee

Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes

Authors: Nurzat Elmalı, İrfan Esenkaya, Murat Can, Mustafa Karakaplan

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2013

Abstract

Purpose

We compared clinical and radiological results of two proximal tibial osteotomy (PTO) techniques: monoplanar medial open-wedge osteotomy and biplanar retrotubercle medial open-wedge osteotomy, stabilised by a wedged plate.

Methods

We evaluated 88 knees in 78 patients. Monoplanar medial open-wedge PTO was performed on 56 knees in 50 patients with a mean age of 55 ± 9 years. Biplanar retrotubercle medial open-wedge PTO was performed on 32 knees in 28 patients with a mean age of 57 ± 7 years. Mean follow-up periods were 40.6 ± 7 months for the monoplanar PTO group and 38 ± 5 months for the biplanar retrotubercle PTO group. Clinical outcome was evaluated using the hospital for special surgery scoring system, and radiological outcome was evaluated by the measurements of femorotibial angle (FTA), patellar height and tibial slope changes.

Results

In both groups, post-operative HSS scores increased significantly. No significant difference was found between groups in FTA alteration, but the FTA decreased significantly in both groups. Patellar index ratios decreased significantly in the monoplanar PTO group (Insall-Salvati Index by 0.07, Blackburne-Peel Index by 0.07), but not in the biplanar retrotubercle PTO group. Tibial slopes were increased significantly in the monoplanar PTO group, but not in the retrotubercle PTO group.

Conclusions

Biplanar retrotubercle medial open-wedge osteotomy and monoplanar medial open-wedge osteotomy are both clinically effective for the treatment for varus gonarthrosis. Retrotubercle osteotomy also prevents patella infera and tibial slope changes radiologically.

Level of evidence

Therapeutic study, prospective comparative study, Level II.

Agneskirchner JD, Hurschler C, Stukenborg-Colsman C et al (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584PubMedCrossRef

Ahlback S (1968) Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diag Suppl 277:7–72

Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Jt Surg Br 59:241–242

Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Jt Surg Br 87:1227–1232

Cullu E, Aydoğdu S, Alparslan B, Sur H (2005) Tibial slope after dome type high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13:38–43PubMedCrossRef

Debeyre J, Patte D (1962) Value of corrective osteotomies in the treatment of certain knee diseases with axial deviation. Rev Rhum Mal Osteoartic 29:722–729PubMed

Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture: two radiological tests compared. J Bone Jt Surg Br 76:745–749

El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Jt Surg Br 90:1193–1197

Esenkaya I, Elmali N (2006) Proximal tibia medial open-wedge osteotomy using plates with wedges: early results in 58 cases. Knee Surg Sports Traumatol Arthrosc 14:955–961PubMedCrossRef

10.

Esenkaya I, Misirlioglu M, Kelestemur MH, Elmali N, Fadillioglu E (2007) Biomechanical evaluation of different fixation plates in medial opening upper tibial osteotomy. Knee 14:46–50PubMedCrossRef

11.

Fowler PJ, Tan JL, Brown GA (2000) Medial opening wedge high tibial osteotomy: how I do it? Op Tech Sports Med 1:32–38CrossRef

12.

Gaasbeek RD, Sonneveld H, van Heerwaarden RJ et al (2004) Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. Knee 11:457–461PubMedCrossRef

13.

Giffin JR, Vogrin TM, Zantop T et al (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382PubMedCrossRef

14.

Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen year follow up study. J Bone Jt Surg Am 69:332–354

15.

Hernigou P, Roussignol X, Flouzat-Lachaniette CH et al (2010) Opening wedge tibial osteotomy for large varus deformity with Ceraver resorbable beta tricalcium phosphate wedges. Int Orthop 34:191–199PubMedCrossRef

16.

Hernigou P (2002) Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee 9:15–20PubMedCrossRef

17.

Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Jt Surg Am 66:1040–1048

18.

Jackson JP, Waugh W, Green JP (1969) High tibial osteotomy for osteoarthritis of the knee. J Bone Jt Surg Br 51:88–94

19.

Jacobi M, Jakob RP (2005) Open wedge osteotomy in the treatment of medial osteoarthritis of the knee. Tech Knee Surg 4:70–78CrossRef

20.

Kesmezacar H, Erginer R, Ogut T et al (2005) Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13:539–544PubMedCrossRef

21.

Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Jt Surg Am 85-A:78–85

22.

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

23.

Marshall JL, Fetto JF, Botero PM (1977) Knee ligament injuries: a standardized evaluation method. Clin Orthop Relat Res 123:115–129PubMed

24.

Marti CB, Gautier E, Wachtl SW et al (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372PubMedCrossRef

25.

Mont MA, Alexander N, Krackow KA, Hungerford DS (1994) Total knee arthroplasty after failed high tibial osteotomy. Orthop Clin North Am 25:515–525PubMed

26.

Niemeyer P, Schmal H, Hauschild O et al (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26:1607–1616PubMedCrossRef

27.

Outerbridge R (1961) The etiology of chondromalacia patella. J Bone Jt Surg Br 43:752–757

28.

Pape D, Lorbach O, Schmitz C et al (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18:204–211PubMedCrossRef

29.

Puddu G, Cerullo G, Cipolla M et al (2007) Technique and outcomes of opening wedge high tibial osteotomy. Semin Arthro 18:148–155CrossRef

30.

Rodner CM, Adams DJ, Diaz-Doran V et al (2006) Medial opening wedge tibial osteotomy and the sagittal plane the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med 34:1431–1441PubMedCrossRef

31.

Rudan JF, Simurda MA (1991) Valgus high tibial osteotomy, a long term follow up study. Clin Orthop Relat Res 268:157–160PubMed

32.

Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Jt Surg Am 71:245–248

33.

Sonneveld H, Wymenga AB, Lelivelt AB, Jacobs WC (2002) Distal tuberosity osteotomy in open wedge high tibial osteotomy prevents patella baja: a new technique. In: Abstract book 10th ESSKA 2000 congress, Rome, p 300

34.

Sterett WI, Steadman JR, Huang MJ et al (2010) Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 38:1420–1424PubMedCrossRef

35.

Terauchi M, Shirakura K, Kobuna Y et al (1995) Axial parameters affecting lower limb alignment after high tibial osteotomy. Clin Orthop Relat Res 317:141–149PubMed

36.

Ward SR, Terk MR, Powers CM (2007) Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Jt Surg Am 89:1749–1755CrossRef

Title: Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes
Authors: Nurzat Elmalı
İrfan Esenkaya
Murat Can
Mustafa Karakaplan
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2040-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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