Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy
- Authors
- Lee, D.; Wang, J.H.; Won, Y.; Min, Y.K.; Jaiswal, S.; Lee, B.H.; Kim, J.-Y.
- Issue Date
- May-2020
- Publisher
- SPRINGER
- Keywords
- Correction error; High tibial osteotomy; Joint line convergence angle (JLCA); Latent medial laxity; Overcorrection; Soft tissue laxity
- Citation
- Knee Surgery, Sports Traumatology, Arthroscopy, v.28, no.5, pp.1411 - 1418
- Journal Title
- Knee Surgery, Sports Traumatology, Arthroscopy
- Volume
- 28
- Number
- 5
- Start Page
- 1411
- End Page
- 1418
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/2067
- DOI
- 10.1007/s00167-019-05502-6
- ISSN
- 0942-2056
- Abstract
- Purpose: This study aimed to determine which preoperative factors affect the postoperative change in the joint line convergence angle (JLCA) by preoperatively quantifying soft tissue laxity. Methods: Thirty-four patients who underwent medial open-wedge high tibial osteotomy (HTO) with a navigation were analysed. The JLCA change after HTO was calculated using standing long-bone anteroposterior radiographs taken preoperatively and 6 months postoperatively. Latent soft tissue laxity was defined as the amount of soft tissue that can be extended to valgus or varus from the weight-bearing position, and calculated by subtracting the JLCA on weight-bearing standing radiographs from that on stress radiographs. Multiple linear regression was performed to determine the preoperative factors that statistically correlated with the postoperative JLCA change. Results: In multiple linear regression, JLCA change had a statistically significant correlation with latent medial laxity (R = 0.6) and a statistically borderline significant correlation with correction angle (R = 0.2). These imply that the postoperative JLCA change increased by 0.6° per 1° increase in latent medial laxity, and increased by 0.2° per 1° increase in correction angle. Latent medial laxity was the most crucial factor associated with postoperative JLCA changes. Conclusion: The JLCA change could be larger in patients with large latent medial laxity or severe varus deformity requiring a large correction, which could lead to unexpected overcorrection in HTO. Postoperative JLCA change should be considered in preoperative surgical planning. Target point shifting within the hypomochlion point could be a strategy to prevent overcorrection, especially in patients with large latent medial laxity. Level of evidence: Level IV. © 2019, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
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