Can medial stability be preserved after open wedge high tibial osteotomy?
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(2020) 32:51
Knee Surgery & Related Research
RESEARCH ARTICLE
Open Access
Can medial stability be preserved after open wedge high tibial osteotomy? Hee-June Kim1, Ji-Yeon Shin2, Hyun-Joo Lee1, Kyeong-Hyeon Park1, Chul-Hee Jung1 and Hee-Soo Kyung1*
Abstract Purpose: This study evaluated the medial joint stability after high tibial osteotomy (HTO) releasing the superficial medial collateral ligament (sMCL) without cutting and repairing. Methods: Twenty-one patients who performed HTO were enrolled. After an L-shaped incision was made in the pes anserinus, the sMCL was released from the distal portion during surgery. After plate fixation, the sMCL was reattached and the pes anserinus was repaired underneath the plate. Plate removal was performed after 31.1 ± 14.2 months. Before HTO, a valgus force of 40 N was exerted at extension for reference values. Before and after plate removal, a valgus force of 40 N was exerted at extension and at a flexion position of 20°. Medial stability was evaluated by measuring the joint line convergence angle (JLCA). Results: The JLCAs in the extension state before HTO and plate removal were 1.64° ± 1.15° and 1.83° ± 1.36°, respectively; there was no significant difference (p = 0.198). There was also no significant difference in JLCA before HTO and after plate removal (p = 0.835). There was also no significant difference in JLCA before and after plate removal both at a knee extension and flexion position of 20° (p = 0.348 and p = 0.456, respectively). Conclusions: Releasing the sMCL without cutting and repairing the pes anserinus underneath the plate during medial open wedge HTO could facilitate the maintenance of medial joint stability. Keywords: Pes anserinus, Medial laxity, High tibial osteotomy
Introduction High tibial osteotomy (HTO) is a useful surgical option for medial osteoarthritis combined with varus deformity in young active patients [1, 2]. Several surgical options for HTO exist, including the lateral closed wedge and medial open wedge osteotomy [3, 4]. Recently, medial open wedge HTO with locking plates has become favored to avoid co-morbidity associated with fibular osteotomy, which is required for closed wedge osteotomy [5]. During medial open wedge HTO, the medial soft structures should be exposed for the osteotomy site and * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea Full list of author information is available at the end of the article
released for gap opening. Among these structures, the superficial medial collateral ligament (sMCL) is the primary restraint of valgus stress and the pes anserinus also stabilizes the medial side of the knee joint [6, 7]. During HTO, some surgeons prefer subperiosteal elevation and pull-aside without transection. This technique, however, has disadvantages, including narrower view and incomplete correction over 10 mm of osteotomy gap [8]. Other surgeons prefer complete cutting or transection of the
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