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Influence of medial open wedge high tibial osteotomy on tibial tuberosity–trochlear groove distance

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Medial open wedge high tibial osteotomy (MOWHTO) is an effective treatment option for realignment of a varus knee. However, a simple supra-tuberositary osteotomy can lead to patella baja and potentially increases the tibial tuberosity–trochlear groove distance (TTTG). The purpose of this study was to quantify the influence of MOWHTO on TTTG.

Methods

Three-dimensional (3D) surface models of five lower extremities with a varus hip–knee–ankle angle (HKA) and a borderline TTTG (≥ 15 mm), five lower extremities with a varus HKA and a normal TTTG (< 15 mm) and a 3D statistical shape model (SSM) of a neutrally aligned healthy knee were analysed by simulating MOWHTO with a stepwise increment of one degree of valgisation from the preoperative coronal deformity (0°–15°) for each patient, resulting in a total of 165 simulations. Postoperative 3D TTTG and tibial torsion (TT) were measured for each simulation. A mathematical formula was developed to calculate the increase of TTTG after MOWHTO. Mean differences between simulated and calculated TTTG were analysed.

Results

Mean preoperative HKA was 6.5 ± 3.0° varus (range 0.8°–11.5°). Mean TTTG increased from 14.2 ± 3.2 mm (range 9.6–19.1) preoperatively to 18.8 ± 3.8 mm (range 14.5–25.0) postoperatively (p = 0.001). TTTG increased approximately linear by + 0.5 ± 0.2° (range 0.3–0.8) per 1° of valgisation with a high positive correlation (0.99, p = 0.001) from 0° to 15°. Mean difference between simulated and calculated TTTG was 0.03 ± 0.02 mm (range 0.01–0.07) per 1° of valgisation (p < 0.001).

Conclusion

MOWHTO results in an approximately linear increase in TTTG of + 0.5 mm per 1° of valgisation in the range from 0° to 15° and the lateralisation of the tibial tuberosity can be calculated reliably using the described formula. Preoperative analysis of TTTG in patients undergoing MOWHTO may prevent unintentional patellofemoral malalignment.

Level of evidence

III.

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References

  1. Albrecht T, Luthi M, Gerig T, Vetter T (2013) Posterior shape models. Med Image Anal 17:959–973

    Article  PubMed  Google Scholar 

  2. Brinkman JM, Freiling D, Lobenhoffer P, Staubli AE, van Heerwaarden RJ (2014) Supracondylar femur osteotomies around the knee: patient selection, planning, operative techniques, stability of fixation, and bone healing. Orthopade 43:988–999

    Article  PubMed  Google Scholar 

  3. Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Jt Surg Br 90:1548–1557

    Article  Google Scholar 

  4. DePuy Synthes (2017) TomoFix medial high tibial plate (MHT). Surgical technique. DSEM/TRM/0115/0288(3)

  5. Dietrich TJ, Betz M, Pfirrmann C (2014) End-stage extension of the knee and its influence on tibial tuberosity-trochlear groove distance (TTTG) in asymptomatic volunteers. Knee Surg Sports Traumatol Arthrosc 22:214–218

    Article  PubMed  Google Scholar 

  6. Flury A, Jud L, Hoch A, Camenzind RS, Fucentese SF (2020) Linear influence of distal femur osteotomy on the Q-angle: one degree of varization alters the Q-angle by one degree. Knee Surg Sports Traumatol Arthrosc 29:540–545

    Article  PubMed  Google Scholar 

  7. Fucentese SF, Meier P, Jud L, Köchli G-L, Aichmair A, Vlachopoulos L et al (2020) Accuracy of 3D-planned patient specific instrumentation in high tibial open wedge valgisation osteotomy. J Exp Orthop 7:7

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin N Am 10:585–608

    Article  CAS  Google Scholar 

  9. Gaasbeek RD, Sonneveld H, van Heerwaarden RJ, Jacobs WCH, Wymenga AB (2004) Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. Knee 11:457–461

    Article  CAS  PubMed  Google Scholar 

  10. Gaasbeek RD, Welsing R, Barink M, Verdonschot N, van Kampen A (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15:978–984

    Article  PubMed  Google Scholar 

  11. Goutallier D, Van Driessche S, Manicom O, Ali ES, Bernageau J, Radier C (2006) Influence of lower-limb torsion on long-term outcomes of tibial valgus osteotomy for medial compartment knee osteoarthritis. J Bone Jt Surg Am 88:2439–2447

    Article  Google Scholar 

  12. Haj-Mirzaian A, Guermazi A, Hakky M, Sereni C, Zikria B, Roemer FW et al (2018) Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative. Eur Radiol 28:4669–4680

    Article  PubMed  Google Scholar 

  13. Hantes ME, Natsaridis P, Koutalos AA, Ono Y, Doxariotis N, Malizos KN (2018) Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up. Knee Surg Sports Traumatol Arthrosc 26:3199–3205

    Article  PubMed  Google Scholar 

  14. Hinman RS, Crossley KM (2007) Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis. Rheumatology 46:1057–1062

    Article  CAS  PubMed  Google Scholar 

  15. Hopwood S, Khan W, Agarwal S (2016) The biplanar open wedge high tibial osteotomy preserving the tibial tubercle. J Orthop Sci 21:786–790

    Article  PubMed  Google Scholar 

  16. Jang K-M, Lee J-H, Park H-J, Kim JL, Han S-B (2016) Unintended rotational changes of the distal tibia after biplane medial open-wedge high tibial osteotomy. J Arthroplasty 31:59–63

    Article  PubMed  Google Scholar 

  17. Javidan P, Adamson GJ, Miller JR, Durand P, Dawson PA, Pink MM et al (2013) The effect of medial opening wedge proximal tibial osteotomy on patellofemoral contact. Am J Sports Med 41:80–86

    Article  PubMed  Google Scholar 

  18. Jud L, Fürnstahl P, Vlachopoulos L, Götschi T, Leoty LC, Fucentese SF (2020) Malpositioning of patient-specific instruments within the possible degrees of freedom in high-tibial osteotomy has no considerable influence on mechanical leg axis correction. Knee Surg Sports Traumatol Arthrosc 28:1356–1364

    Article  PubMed  Google Scholar 

  19. Jud L, Singh S, Tondelli T, Fürnstahl P, Fucentese SF, Vlachopoulos L (2020) Combined correction of tibial torsion and tibial tuberosity-trochlear groove distance by supratuberositary torsional osteotomy of the tibia. Am J Sports Med 48:2260–2267

    Article  PubMed  Google Scholar 

  20. Kaiser P, Loth F, Attal R, Kummann M, Schuster P, Riechelmann F et al (2020) Static patella tilt and axial engagement in knee extension are mainly influenced by knee torsion, the tibial tubercle-trochlear groove distance (TTTG), and trochlear dysplasia but not by femoral or tibial torsion. Knee Surg Sports Traumatol Arthrosc 28:952–959

    Article  CAS  PubMed  Google Scholar 

  21. Kesmezacar H, Erginer R, Ogut T, Seyahi A, Babacan M, Tenekecioglu Y (2005) Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13:539–544

    Article  PubMed  Google Scholar 

  22. Kim JI, Kim BH, Han HS, Lee MC (2020) Rotational changes in the tibia after high tibial valgus osteotomy: a comparative study of lateral closing versus medial opening wedge osteotomy. Am J Sports Med 48:3549–3556

    Article  PubMed  Google Scholar 

  23. Krause M, Drenck TC, Korthaus A, Preiss A, Frosch K-H, Akoto R (2018) Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc 26:1859–1866

    Article  PubMed  Google Scholar 

  24. Lee O-S, Ahn S, Lee YS (2018) Changes of sagittal and axial alignments of patella after open- and closed-wedge high-tibial osteotomy: a systematic review and meta-analysis. J Knee Surg 31:625–634

    Article  PubMed  Google Scholar 

  25. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    Article  PubMed  Google Scholar 

  26. Longino PD, Birmingham TB, Schultz WJ, Moyer RF, Giffin JR (2013) Combined tibial tubercle osteotomy with medial opening wedge high tibial osteotomy minimizes changes in patellar height: a prospective cohort study with historical controls. Am J Sports Med 41:2849–2857

    Article  PubMed  Google Scholar 

  27. Lu J, Tang S, Wang Y, Li Y, Liu C, Niu Y et al (2019) Clinical outcomes of closing- and opening-wedge high tibial osteotomy for treatment of anteromedial unicompartmental knee osteoarthritis. J Knee Surg 32:758–763

    Article  PubMed  Google Scholar 

  28. Otsuki S, Murakami T, Okamoto Y, Nakagawa K, Okuno N, Wakama H et al (2018) Risk of patella baja after opening-wedge high tibial osteotomy. J Orthop Surg 26:2309499018802484

    Article  Google Scholar 

  29. Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Jt Surg Br 43-B:752–757

    Article  CAS  Google Scholar 

  30. Paley D, Maar DC, Herzenberg JE (1994) New concepts in high tibial osteotomy for medial compartment osteoarthritis. Orthop Clin North Am 25:483–498

    Article  CAS  PubMed  Google Scholar 

  31. Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Traumatol Arthrosc 19:122–127

    Article  PubMed  Google Scholar 

  32. Schoettle PB, Zanetti M, Seifert B, Pfirrmann CWA, Fucentese SF, Romero J (2006) The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31

    Article  PubMed  Google Scholar 

  33. Stoffel K, Willers C, Korshid O, Kuster M (2007) Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 15:1094–1100

    Article  PubMed  Google Scholar 

  34. Tan SHS, Lim BY, Chng KSJ, Doshi C, Wong FKL, Lim AKS et al (2020) The difference between computed tomography and magnetic resonance imaging measurements of tibial tubercle-trochlear groove distance for patients with or without patellofemoral instability: a systematic review and meta-analysis. J Knee Surg 33:768–776

    Article  PubMed  Google Scholar 

  35. Tigani D, Ferrari D, Trentani P, Barbanti-Brodano G, Trentani F (2001) Patellar height after high tibial osteotomy. Int Orthop 24:331–334

    Article  CAS  PubMed  Google Scholar 

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Funding

Sandro Fucentese is a consultant for Medacta SA (Switzerland). The research is supported by the institutional research fund of Balgrist University Hospital.

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Authors and Affiliations

  1. Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Sandro Hodel, Christoph Zindel, Lukas Jud, Lazaros Vlachopoulos & Sandro F. Fucentese

  2. Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Philipp Fürnstahl

Authors
  1. Sandro Hodel
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  2. Christoph Zindel
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  3. Lukas Jud
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  4. Lazaros Vlachopoulos
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  6. Sandro F. Fucentese
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Correspondence to Sandro Hodel.

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No conflicts of interest exist for the conductance of this study.

Ethical approval

This study was approved by the local ethics committee (Zurich Cantonal Ethics Commission, 74 KEK 2018-02242) and written informed consent was available for all patients for their participation and the publication.

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Hodel, S., Zindel, C., Jud, L. et al. Influence of medial open wedge high tibial osteotomy on tibial tuberosity–trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 31, 1500–1506 (2023). https://doi.org/10.1007/s00167-021-06574-z

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  • DOI: https://doi.org/10.1007/s00167-021-06574-z

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