Knee osteotomies significantly influence coronal ankle alignment: A radiographic analysis

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-05-05 DOI:10.1002/jeo2.70252

Alessio Maione, Carlo Minoli, Matteo Davide Parmigiani, Martino Travi, Filippo Calanna, Daniele Marcolli, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli

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Abstract

Purpose

This study aimed to evaluate the effect of lateral closing-wedge high tibial osteotomy (LCW-HTO) and medial closing-wedge distal femoral osteotomy (MCW-DFO) on tibio-talar inclination (TTI) and Mikulicz lateral distal tibial angle (M-LDTA). We hypothesized that knee osteotomies significantly alter ankle coronal alignment by modifying TTI and distal tibial alignment in relation to the mechanical axis.

Methods

A retrospective radiographic analysis was conducted on 60 knees from 52 patients (37 LCW-HTO and 23 MCW-DFO) treated between 2006 and 2020. Inclusion criteria included full-length weight-bearing radiographs pre- and post-operatively, no prior ipsilateral lower limb surgery, absence of shaft deformities or advanced ankle osteoarthritis (Takakura grade >1), and age ≥16 years with ≥2 years of follow-up. Radiographic parameters measured included LDTA, hip-knee-ankle angle, M-LDTA and TTI, with ankle realignment quantified through differences between LDTA and M-LDTA and between pre- and post-operative TTI.

Results

In the MCW-DFO group, the difference between LDTA and M-LDTA decreased from 3.5 ± 2.3° to 1.3 ± 1.1° (p < 0.0001), indicating improved alignment. The LCW-HTO group showed a smaller but significant reduction from 4.5 ± 1.8° to 2.2 ± 1.7° (p < 0.0001). TTI improved significantly in both groups, with a greater adjustment in MCW-DFO (ΔTTI = 7.0 ± 4.3°, p < 0.01) compared to LCW-HTO (ΔTTI = 4.2 ± 2.7°, p < 0.01). The difference between LDTA and TTI decreased in both groups, reflecting post-operative convergence of the mechanical and anatomical axes.

Conclusion

Knee osteotomies significantly influence ankle coronal alignment, particularly modifying TTI and M-LDTA. Higher-level osteotomies (MCW-DFO) exert a greater effect on ankle alignment than LCW-HTO. Preoperative valgus or varus knee deformities must be carefully evaluated to anticipate post-operative ankle imbalance. Surgeons should assess full-length radiographs to prevent unintended malalignment.

Level of Evidence

Level III.

Abstract Image

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膝关节截骨术显著影响踝关节冠状位对齐：影像学分析

目的探讨外侧闭合楔形胫骨高位截骨术（LCW-HTO）和内侧闭合楔形股骨远端截骨术（MCW-DFO）对胫骨距侧倾角（TTI）和Mikulicz胫骨远端外侧角（M-LDTA）的影响。我们假设膝关节截骨术通过改变TTI和胫骨远端相对于机械轴的对齐来显著改变踝关节冠状位对齐。方法对2006 ~ 2020年收治的52例患者（37例LCW-HTO， 23例MCW-DFO） 60个膝关节进行回顾性影像学分析。纳入标准包括术前和术后全长度负重x线片，既往无同侧下肢手术，无骨轴畸形或晚期踝关节骨关节炎（Takakura分级>；1），年龄≥16岁，随访≥2年。测量的影像学参数包括LDTA、髋关节-膝关节-踝关节角度、M-LDTA和TTI，通过LDTA和M-LDTA的差异以及术前和术后TTI的差异来量化踝关节复位。结果在MCW-DFO组，LDTA和M-LDTA之间的差值从3.5±2.3°减小到1.3±1.1°（p < 0.0001），表明对齐改善。LCW-HTO组从4.5±1.8°下降到2.2±1.7°（p < 0.0001）。两组TTI均有显著改善，与LCW-HTO （ΔTTI = 4.2±2.7°，p < 0.01）相比，MCW-DFO的调整更大（ΔTTI = 7.0±4.3°，p < 0.01）。两组LDTA和TTI之间的差异减小，反映了术后机械轴和解剖轴的收敛。结论膝关节截骨术显著影响踝关节冠状位，尤其是TTI和M-LDTA的改变。高位截骨术（MCW-DFO）比LCW-HTO对踝关节对齐的影响更大。术前外翻或膝内翻畸形必须仔细评估，以预测术后踝关节失衡。外科医生应评估全身x线片，以防止意外错位。证据等级三级。

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