Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2019

01-09-2019 | Knee

Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap in the medial biplanar open-wedge HTO

Authors: In Ho Jo, O-Sung Lee, Seung Hoon Lee, Kyung Wook Kim, Yong Seuk Lee

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2019

Login to get access

Abstract

Purpose

The purpose of this study was to investigate the causes of retro-tubercular gap widening and to confirm whether this widened gap causes instability of the osteotomy configuration during open-wedge high tibial osteotomy (OWHTO).

Methods

Operative records and radiologic findings of patients who underwent biplanar medial OWHTO between 2014 and 2016 were retrospectively evaluated. To identify the osteotomy configuration including lateral hinge fracture, postoperative simple radiographs and CT images were analyzed. Postoperative CT scan was used to evaluate the widening of the retro-tubercular gap, thickness, and axial angle of retro-tubercular osteotomy, as well as the ratios of anterior and posterior osteotomy, and hinge length. The correlation of each factor was evaluated and analyzed in accordance with the lateral hinge fracture (LHF).

Results

Widening of the retro-tubercular gap showed a significant correlation with the axial angle of retro-tubercular osteotomy, anterior osteotomy ratio, and opening gap distance, but not with the thickness of retro-tubercular osteotomy, posterior osteotomy ratio, and hinge length ratio. The LHF group showed significantly larger value than the non-LHF group with respect to the thickness of retro-tubercular osteotomy (P = 0.003), axial angle of retro-tubercular osteotomy (P = 0.033), retro-planar gap distance (P = 0.001), anterior osteotomy ratio (P = 0.000), and opening gap distance (P = 0.003). The hinge length ratio was smaller in the LHF group than in the non-LHF group (P = 0.001). However, the posterior osteotomy ratio was not different between the two groups (n.s.).

Conclusion

Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap distance, which can be related to LHF. Therefore, anterior cortical osteotomy may also be an important factor for preventing instability of the proximal fragment in biplanar OWHTO.

Level of Evidence

Case–control study, Level III.
Literature
1.
Baumgarten KM, Meyers KN, Fealy S, Wright TM, Wickiewicz TL (2007) The coronal plane high tibial osteotomy. Part II: a comparison of axial rotation with the opening wedge high tibial osteotomy. HSS J 3(2):155–158CrossRefPubMedPubMedCentral
2.
Hinterwimmer S, Feucht MJ, Paul J, Kirchhoff C, Sauerschnig M, Imhoff AB, Beitzel K (2016) Analysis of the effects of high tibial osteotomy on tibial rotation. Int Orthop 40(9):1849–1854CrossRefPubMed
3.
Hohmann E, Bryant A, Imhoff AB (2006) The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc 14(5):454–459CrossRefPubMed
4.
Jacobi M, Villa V, Reischl N, Demey G, Goy D, Neyret P, Gautier E, Magnussen RA (2015) Factors influencing posterior tibial slope and tibial rotation in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23(9):2762–2768CrossRefPubMed
5.
Jang KM, Lee JH, Park HJ, Kim JL, Han SB (2016) Unintended rotational changes of the distal tibia after biplane medial open-wedge high tibial osteotomy. J Arthroplasty 31(1):59–63CrossRefPubMed
6.
Kendoff D, Lo D, Goleski P, Warkentine B, O’Loughlin PF, Pearle AD (2008) Open wedge tibial osteotomies influence on axial rotation and tibial slope. Knee Surg Sports Traumatol Arthrosc 16(10):904–910CrossRefPubMed
7.
Lee BH, Ha CW, Moon SW, Chang M, Kim HY, Park SH, Wang JH (2017) Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy. Knee 24(2):362–371CrossRefPubMed
8.
Lee OS, Lee YS (2017) Diagnostic value of computed tomography and risk factors for lateral hinge fracture in the open wedge high tibial osteotomy. Arthroscopy 34:1032–1043
9.
Lee YS, Kang JY, Lee MC, Elazab A, Choi UH, Kang SG, Lee KJ, Lee S (2017) Osteotomy configuration of the proximal wedge and analysis of the affecting factors in the medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25(3):793–799CrossRefPubMed
10.
Lee YS, Kang JY, Lee MC, Oh WS, Elazab A, Song MK (2016) Effect of the osteotomy length on the change of the posterior tibial slope with a simple distraction of the posterior gap in the uni- and biplanar open-wedge high tibial osteotomy. Arthroscopy 32(2):263–271CrossRefPubMed
11.
Lee YS, Moon GH (2015) Comparative analysis of osteotomy accuracy between the conventional and devised technique using a protective cutting system in medial open-wedge high tibial osteotomy. J Orthop Sci 20(1):129–136CrossRefPubMed
12.
Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138CrossRefPubMed
13.
Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33(3):378–387CrossRefPubMed
14.
Pape D, Lorbach O, Schmitz C, Busch LC, Van Giffen N, Seil R, Kohn DM (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18(2):204–211CrossRefPubMed
15.
Rodner CM, Adams DJ, Diaz-Doran V, Tate JP, Santangelo SA, Mazzocca AD, Arciero RA (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(9):1431–1441CrossRefPubMed
16.
Song EK, Seon JK, Park SJ (2007) How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 30(10 Suppl):S127-131
17.
Sterett WI, Miller BS, Joseph TA, Rich VJ, Bain EM (2009) Posterior tibial slope after medial opening wedge high tibial osteotomy of the varus degenerative knee. J Knee Surg 22(1):13–16CrossRefPubMed
18.
Suero EM, Hawi N, Westphal R, Sabbagh Y, Citak M, Wahl FM, Krettek C, Liodakis E (2017) The effect of distal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints. Knee Surg Sports Traumatol Arthrosc 25(1):299–305CrossRefPubMed
19.
Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94CrossRefPubMed
20.
Teeter MG, Leitch KM, Pape D, Yuan X, Birmingham TB, Giffin JR (2015) Radiostereometric analysis of early anatomical changes following medial opening wedge high tibial osteotomy. Knee 22(1):41–46CrossRefPubMed
21.
Turkmen F, Kacira BK, Ozkaya M, Erkocak OF, Acar MA, Ozer M, Toker S, Demir T (2016) Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 25(9):2914–2920CrossRefPubMed
Metadata
Title
Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap in the medial biplanar open-wedge HTO
Authors
In Ho Jo
O-Sung Lee
Seung Hoon Lee
Kyung Wook Kim
Yong Seuk Lee
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-4991-6

Other articles of this Issue 9/2019

Knee Surgery, Sports Traumatology, Arthroscopy 9/2019 Go to the issue

ANKLE

Medical comorbidities increase the rate of surgical site infection in primary Achilles tendon repair

HIP

Reconstruction of chronic proximal hamstring avulsion injuries using ipsilateral distal hamstring tendons results in good clinical outcomes and patient satisfaction

KNEE

Release of the medial collateral ligament is mandatory in medial open-wedge high tibial osteotomy

Ankle

Injection with autologous conditioned serum has better clinical results than eccentric training for chronic Achilles tendinopathy

KNEE

Cartilage repair surgery prevents progression of knee degeneration

KNEE

Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up