ABSTRACT
The purpose of this study was to evaluate the accuracy of alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. A prospective case series of 56 consecutive patients underwent open-wedge high tibial osteotomy fixed with a TomoFix plate fixator (Synthes, West Chester, Pennsylvania). The correction angle was radiologically determined preoperatively and at 6 months postoperatively. The patients were clinically and radiologically examined preoperatively and at 3, 6, and 36 months postoperatively. The mechanical axis of 50 knees was corrected from an average of 5.7° varus to 1.3° valgus. Forty-three patients had an acceptable correction with Mikulicz line crossing the tibial plateau between 50% to 70% of the tibial plateau width measured from the medial border. Undercorrection (<50%, group II) and over-correction (>70%, group III) were found in 4 and 3 patients, respectively. The mean Lysholm-Gillquist score at 36 months had improved in all groups, with a statistically lower value for group II. Open-wedge high tibial osteotomy results in significant improvement of symptoms and function in all patients in the short term, even with under- and overcorrection of the osteotomy. Undercorrection was associated with a significantly lower clinical outcome in comparison to the accurate correction and overcorrection. Ligamentous laxity or soft tissue slackness of the knee can influence the overall correction after high tibial osteotomy and must be considered in preoperative planning. Patients with a high body mass index had inferior clinical results after open-wedge high tibial osteotomy.
Subject(s)
Bone Malalignment/diagnosis , Osteoarthritis, Knee/surgery , Osteotomy/methods , Tibia/surgery , Adult , Bone Malalignment/diagnostic imaging , Bone Malalignment/etiology , Bone Plates , External Fixators , Female , Humans , Joint Instability , Knee Joint/diagnostic imaging , Male , Middle Aged , Osteoarthritis, Knee/complications , Osteoarthritis, Knee/diagnostic imaging , Osteotomy/adverse effects , Prospective Studies , Radiography , Reproducibility of Results , Treatment Outcome , Weight-Bearing , Young AdultABSTRACT
This study was done to determine whether there is a correlation between the notch volume and the notch width index (NWI) as measured on the three most frequently used radiographic views: the Holmblad 45 degrees, Holmblad 70 degrees, and Rosenberg view. The notch volume of 20 cadaveric knees was measured using Computed Tomography (CT). The Holmblad 45 degrees, Holmblad 70 degrees, and Rosenberg notch view radiographs were digitally re-created from the CT scans for each specimen, and the NWI was measured by two observers. The Pearson correlation coefficient between the NWI and notch volume was calculated, as well as between the three views. An independent t test was performed to determine the difference in NWI and notch volume between male and female specimens. The reliability for each view was also determined. There was no correlation between the NWI as measured on the Holmblad 45 degrees, Holmblad 70 degrees, or Rosenberg view and the notch volume. All three radiographic views proved reliable, but showed only a moderate correlation with each other. Men had larger notch volumes than women, but there was no difference in NWI. A knee with a small intercondylar notch is often considered an increased risk for ACL rupture. The NWI is a frequently used two-dimensional method to determine notch size. However, in the present study, this index was not positively correlated with the overall volume of the notch. Based on the results of the current study, the authors would advice to use caution when using notch view radiographs in a clinical setting to predict risk of ACL rupture.
