Measurement of tibial slope angle after medial opening wedge high tibial osteotomy
case series
Keywords:
Knee, Osteoarthritis, Tibia, Osteotomy, RadiographyAbstract
CONTEXT AND OBJECTIVE: In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. DESIGN AND SETTING: Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, Brazil. METHODS: Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. RESULTS: There was an average increase in tibial slope angle after surgery of 2.38° (95% confidence interval: ± 0.73°). There was no correlation (r = -0.28) between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13). CONCLUSION: Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis.
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References
Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br. 1961;43-B:746-51.
Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am. 1973;55(1):23-48.
Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am. 1965;47:984-90.
Coventry MB. Upper tibial osteotomy. Clin Orthop Relat Res. 1984;(182):46-52.
Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am. 1993;75(2):196-201.
Insall JN, Joseph DM, Msika C. High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am. 1984;66(7):1040-8.
Jackson JP, Waugh W. The technique and complications of upper tibial osteotomy. A review of 226 operations. J Bone Joint Surg Br. 1974;56(2):236-45.
Koshino T, Yoshida T, Ara Y, Saito I, Saito T. Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee. 2004;11(6):439-44.
Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruc-tion for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med. 2000;28(3):282-96.
Sprenger TR, Doerzbacher JF. Tibial osteotomy for the treatment of varus gonarthrosis. Survi- val and failure analysis to twenty-two years. J Bone Joint Surg Am. 2003;85-A(3):469-74.
Aglietti P, Rinonapoli E, Stringa G, Taviani A. Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res. 1983;(176):239-51.
Andrade MAP, Souza AD, Leal JS. Osteoartrose medial do joelho: avaliação da osteotomia proximal de valgização da tíbia pela técnica de Weber. [Medial osteoarthritis of the knee: a valgus proximal tibial osteotomy with fixation by Weber’s technique evaluation]. Rev Bras Ortop. 1996;31(5):377-82.
Bauer GC, Insall J, Koshino T. Tibial osteotomy in gonarthrosis (osteo-arthritis of the knee). J Bone Joint Surg Am. 1969;51(8):1545-63.
Coventry MB. Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am. 1985;67(7): 1136-40.
Insall J, Shoji H, Mayer V. High tibial osteotomy. A five-year evaluation. J Bone Joint Surg Am. 1974;56(7):1397-405.
Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoar- thritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332-54.
Saggin JI, Severo A, Borges JLP. Osteotomia valgizante proximal da tíbia no tratamento da osteoartrose. [Valgus high tibial osteotomy for osteoarthritis treatment]. Rev Bras Ortop. 1996;31(5):383-8.
Rodner CM, Adams DJ, Diaz-Doran V, et al. Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med. 2006;34(9):1431-41.
Coventry MB, Bowman PW. Long-term results of upper tibial osteotomy for degenerative arthritis of the knee. Acta Orthop Belg. 1982;48(1):139-56.
Hernandez AJ, Amatuzzi MM, Albuquerque RFM, Laraya MHF, Rubin MLL, Martinelli Filho M. Estudo prospectivo controlado do tratamento das lesões isoladas do ligamento cruzado anterior com reconstrução e osteotomias concomitantes. [A controlled, prospective study on the treatment of isolated anterior cruciate ligament injuries with simultaneous recons- truction and osteotomy]. Rev Bras Ortop. 2004;39(7):371-81.
Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res. 1992;(274):248-64.
Tjörnstrand BA, Egund N, Hagstedt BV. High tibial osteotomy: a seven-year clinical and radiographic follow-up. Clin Orthop Relat Res. 1981;(160):124-36.
Hohmann E, Bryant A, Imhoff AB. The effect of closed wedge tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc. 2006;14(5):454-9.
Dejour H, Neyret P, Boileau P, Donell ST. Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res. 1994;(299):220-8.
Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med. 2004;32(2):376-82.
Hernigou P, Ovadia H, Goutallier D. Modélisation mathématique de l’ostéotomie tibiale d’ouverture et tables de correction. [Mathematical modelling of open-wedge tibial osteo- tomy and correction tables]. Rev Chir Orthop Reparatrice Appar Mot. 1992;78(4):258-63.
Marti CB, Gautier E, Wachtl SW, Jakob RP. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy. 2004;20(4):366-72.
Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med. 2005;33(3):378-87.
Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A. Evaluation des métho- des de mesure radiographique de la pente tibiale. Analyse de 83 genoux témoins. [Evalu- ation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees]. Rev Chir Orthop Reparatrice Appar Mot. 1996;82(3):195-200.
Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiologi- cal tests compared. J Bone Joint Surg Br. 1994;76(5):745-9.
Peccin MS, Ciconelli R, Cohen M. Questionário específico para sintomas do joelho “Lysholm Knee Scoring Scale”: tradução e validação para a língua portuguesa. Acta Ortop Bras. 2006;14(5):268-72.
Siegel S. Estatística não-paramétrica para ciências do comportamento. São Paulo: McGraw Hill do Brasil; 1997.
Jiang CC, Yip KM, Liu TK. Posterior slope angle of the medial tibial plateau. J Formos Med Assoc. 1994;93(6):509-12.
Genin P, Weill G, Julliard R. La pente tibiale. Proposition pour une méthode de mesure. [The tibial slope. Proposal for a measurement method]. J Radiol. 1993;74(1):27-33.
Julliard R, Genin P, Weil G, Palmkrantz P. La pente tibiale fonctionnelle médiane. Princi- pe. Technique de mesure. Valeur. Intérêt. [The median functional slope of the tibia. Prin- ciple. Technique of measurement. Value. Interest]. Rev Chir Orthop Reparatrice Appar Mot. 1993;79(8):625-34.
Naudie DD, Amendola A, Fowler PJ. Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med. 2004;32(1):60-70.
Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P. 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 Trau- ma Surg. 2004;124(9):575-84.
Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH. The biomechanical in- terdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med. 2001;29(2):226-31.
Jenny JY, Rapp E, Kehr P. La pente méniscale de l’extrémité proximale du tibia: comparaison avec la pente osseuse. [Proximal tibial meniscal slope: a comparison with the bone slope]. Rev Chir Orthop Reparatrice Appar Mot. 1997;84(5):435-8.
Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoar- thritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332-54.
Dejour H, Walch G, Deschamps G, Chambat P. Arthrose du genou sur laxité chronique anté- rieure. [Arthrosis of the knee in chronic anterior laxity]. Rev Chir Orthop Reparatrice Appar Mot. 1987;73(3):157-70.
Rodner CM, Adams DJ, Diaz-Doran V, et al. Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med. 2006;34(9):1431-41.