Ji Eui Kim1, Dong Hyun Kim1, Jae Ik Lee1, Han Gyeol Choi1, You Sun Jung1, Sang Hoon Lee1, Yong Seuk Lee2. 1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. 2. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. smcos1@daum.net.
Abstract
PURPOSE: This study aimed to evaluate (1) the efficacy of varus-valgus stress radiographs to adjust the preoperative soft-tissue imbalance and (2) ascertain whether varus-valgus stress radiographs are effective for the correction accuracy in the preoperative planning of the opening wedge high tibial osteotomy (OWHTO). METHODS: From February 2017 to December 2018, a total of 121 consecutive knees that underwent bi-planar OWHTO were enrolled in this retrospective analysis. Preoperative planning was performed using a weight-bearing line (WBL). Target WBL was determined according to the status of the medial compartments such as cartilage, meniscus, and preoperative arthritic grade. Preoperative varus-valgus stress radiographs were used to assess the preoperative mediolateral ligament imbalance. The final target correction length of the opening gap was determined by subtracting the difference between the varus-valgus stress radiographs (VVD). All patients were divided into two groups according to the preoperatively planned correction degree: (group A), smaller than average; (group B), larger than average. Patients were also divided into two other groups (VVD adjusted and neglected groups). RESULTS: Groups A and B were 56 and 54 knees, respectively. The preoperatively planned correction lengths of the opening gap were 9.33 ± 1.5 and 14.16 ± 3.96 mm, respectively (p < 0.01). Mean values of the VVD were 0.85 ± 0.72, and 1.27 ± 1.78 mm, respectively (p < 0.01). Correction errors were 2.17 ± 2.06 and 3.52 ± 2.16%, respectively (p < 0.01). Planned and final correction degrees were also significantly larger (p < 0.01, and p < 0.01, respectively), because the preoperative WBL ratio was significantly smaller in the VVD adjusted group (p < 0.01). CONCLUSION: The VVD values could reproduce the preoperative soft-tissue imbalance and it was more prominent as the correction degree increased. The strategy of subtracting the VVD as assumed soft-tissue imbalance in the preoperative planning worked well for the correction accuracy during OWHTO. LEVEL OF EVIDENCE: Level IV, retrospective study.
PURPOSE: This study aimed to evaluate (1) the efficacy of varus-valgus stress radiographs to adjust the preoperative soft-tissue imbalance and (2) ascertain whether varus-valgus stress radiographs are effective for the correction accuracy in the preoperative planning of the opening wedge high tibial osteotomy (OWHTO). METHODS: From February 2017 to December 2018, a total of 121 consecutive knees that underwent bi-planar OWHTO were enrolled in this retrospective analysis. Preoperative planning was performed using a weight-bearing line (WBL). Target WBL was determined according to the status of the medial compartments such as cartilage, meniscus, and preoperative arthritic grade. Preoperative varus-valgus stress radiographs were used to assess the preoperative mediolateral ligament imbalance. The final target correction length of the opening gap was determined by subtracting the difference between the varus-valgus stress radiographs (VVD). All patients were divided into two groups according to the preoperatively planned correction degree: (group A), smaller than average; (group B), larger than average. Patients were also divided into two other groups (VVD adjusted and neglected groups). RESULTS: Groups A and B were 56 and 54 knees, respectively. The preoperatively planned correction lengths of the opening gap were 9.33 ± 1.5 and 14.16 ± 3.96 mm, respectively (p < 0.01). Mean values of the VVD were 0.85 ± 0.72, and 1.27 ± 1.78 mm, respectively (p < 0.01). Correction errors were 2.17 ± 2.06 and 3.52 ± 2.16%, respectively (p < 0.01). Planned and final correction degrees were also significantly larger (p < 0.01, and p < 0.01, respectively), because the preoperative WBL ratio was significantly smaller in the VVD adjusted group (p < 0.01). CONCLUSION: The VVD values could reproduce the preoperative soft-tissue imbalance and it was more prominent as the correction degree increased. The strategy of subtracting the VVD as assumed soft-tissue imbalance in the preoperative planning worked well for the correction accuracy during OWHTO. LEVEL OF EVIDENCE: Level IV, retrospective study.
Authors: Hosam M El-Azab; Mario Morgenstern; Philip Ahrens; Tibor Schuster; Andreas B Imhoff; Stephan G F Lorenz Journal: Orthopedics Date: 2011-10-05 Impact factor: 1.390
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