Biomechanical and radiographic advantages of double-level osteotomy over single-level osteotomy for medial knee osteoarthritis with double-level deformity: A retrospective analysis

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-21 DOI:10.1016/j.clinbiomech.2025.106469

Hiroaki Tsukamoto , Manabu Akagawa , Hidetomo Saito , Kimio Saito , Akira Komatsu , Takehiro Iwami , Hiroaki Kijima , Koji Nozaka , Naohisa Miyakoshi

{"title":"Biomechanical and radiographic advantages of double-level osteotomy over single-level osteotomy for medial knee osteoarthritis with double-level deformity: A retrospective analysis","authors":"Hiroaki Tsukamoto , Manabu Akagawa , Hidetomo Saito , Kimio Saito , Akira Komatsu , Takehiro Iwami , Hiroaki Kijima , Koji Nozaka , Naohisa Miyakoshi","doi":"10.1016/j.clinbiomech.2025.106469","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Double-level osteotomy is hypothesized to provide superior biomechanical outcomes compared to single-level osteotomy for medial knee osteoarthritis with double-level deformity. However, its advantages remain underexplored.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 20 knees treated with medial open wedge high tibial osteotomy alone or combined with lateral closed wedge distal femoral osteotomy. Patients were categorized into three groups: Single-level osteotomy for single deformity, single-level osteotomy for double deformity, and double-level osteotomy for double deformity. Radiographic parameters, including Hip-Knee-Ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle and joint line convergence angle, and gait biomechanics using nine-axis inertial measurement units were evaluated pre- and postoperatively.</div></div><div><h3>Findings</h3><div>The postoperative mechanical lateral distal femoral angle was better corrected in the double-level osteotomy for double deformity group compared to the single-level osteotomy for double deformity group (<em>P</em> = 0.012). Peak thigh varus acceleration was significantly reduced in both the double-level osteotomy for double deformity and single-level osteotomy for single deformity groups (<em>P</em> = 0.014), but not in the single-level osteotomy for double deformity group. No significant differences were observed in medial proximal tibial angle among groups.</div></div><div><h3>Interpretation</h3><div>Double-level osteotomy demonstrated superior biomechanical and radiographic outcomes in medial knee osteoarthritis with double-level deformity, emphasizing its role in mitigating joint line obliquity and in optimizing dynamic knee stability.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"123 ","pages":"Article 106469"},"PeriodicalIF":1.4000,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Biomechanics","FirstCategoryId":"5","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0268003325000415","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ENGINEERING, BIOMEDICAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Double-level osteotomy is hypothesized to provide superior biomechanical outcomes compared to single-level osteotomy for medial knee osteoarthritis with double-level deformity. However, its advantages remain underexplored.

Methods

This retrospective study analyzed 20 knees treated with medial open wedge high tibial osteotomy alone or combined with lateral closed wedge distal femoral osteotomy. Patients were categorized into three groups: Single-level osteotomy for single deformity, single-level osteotomy for double deformity, and double-level osteotomy for double deformity. Radiographic parameters, including Hip-Knee-Ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle and joint line convergence angle, and gait biomechanics using nine-axis inertial measurement units were evaluated pre- and postoperatively.

Findings

The postoperative mechanical lateral distal femoral angle was better corrected in the double-level osteotomy for double deformity group compared to the single-level osteotomy for double deformity group (P = 0.012). Peak thigh varus acceleration was significantly reduced in both the double-level osteotomy for double deformity and single-level osteotomy for single deformity groups (P = 0.014), but not in the single-level osteotomy for double deformity group. No significant differences were observed in medial proximal tibial angle among groups.

Interpretation

Double-level osteotomy demonstrated superior biomechanical and radiographic outcomes in medial knee osteoarthritis with double-level deformity, emphasizing its role in mitigating joint line obliquity and in optimizing dynamic knee stability.

查看原文本刊更多论文

双节段截骨术治疗双节段畸形膝内侧骨关节炎优于单节段截骨术的生物力学和影像学优势：回顾性分析

研究背景：与单节段截骨相比，双节段截骨治疗双节段畸形膝内侧骨关节炎的生物力学效果更好。然而，它的优势仍未得到充分发掘。方法回顾性分析20例膝关节单用内侧开放楔形胫骨高位截骨术或联合外侧封闭楔形股骨远端截骨术。患者分为单畸形单节段截骨术、双畸形单节段截骨术和双畸形双节段截骨术三组。术前和术后采用九轴惯性测量装置评估影像学参数，包括髋关节-膝关节-踝关节角、机械外侧股骨远端角、胫骨内侧近端角和关节线收敛角，以及步态生物力学。结果双水平截骨治疗双畸形组术后股骨远端机械外侧角矫正效果优于单水平截骨治疗双畸形组（P = 0.012）。双畸形双节段截骨组和单畸形单节段截骨组大腿内翻加速度峰值均显著降低（P = 0.014），双畸形单节段截骨组无显著降低。胫骨内侧近端角各组间无显著差异。解释：双节段截骨术在治疗伴有双节段畸形的膝内侧骨关节炎中表现出优异的生物力学和影像学结果，强调其在减轻关节线倾斜和优化膝关节动态稳定性方面的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.