Preoperative CPAK phenotype does not affect clinical and radiological outcomes after medial closing-wedge distal femoral osteotomy in valgus knees at 8-year follow-up

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-07-13 DOI:10.1002/ksa.12795

Alessio Maione, Pierrenzo Pozzi, Alessandra Menon, Filippo Calanna, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli

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Abstract

Purpose

To evaluate the distribution of coronal plane alignment of the knee (CPAK) phenotypes before and after medial closing-wedge distal femoral osteotomy (MCW-DFO) and assess their correlation with long-term clinical outcomes in valgus knee deformity.

Methods

This retrospective analysis included patients who underwent MCW-DFO for valgus knee correction between 2007 and 2022. Preoperative and post-operative knee alignment was assessed using standard long leg weight-bearing radiographs, and clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner and visual analogue scale (VAS). Patients were stratified based on preoperative and post-operative CPAK classification phenotypes. Outcomes were compared between the most common preoperative and post-operative CPAK phenotypes.

Results

Fifty-one patients (54 knees) were included in the study, with a mean age of 48.7 ± 13.2. The overall mean follow-up was 97 ± 57 months. Statistically significant improvements were observed in all clinical scores, and a statistically significant radiological correction of valgus was achieved following MCW-DFO. According to preoperative CPAK phenotype, the most prevalent groups, CPAK 6 and 3, showed no significant differences in clinical outcomes (final IKDC CPAK 3: 60.7 ± 12.2, CPAK 6: 62.9 ± 17 [p = 0.67]; final KOOS CPAK 3: 76.8 ± 6.9, CPAK 6: 77.3 ± 14.9 [p = 0.37]). Similarly, stratification by post-operative CPAK showed no significant differences between CPAK 5 and 8 (final IKDC CPAK 5: 63.3 ± 15.7, CPAK 8: 71.1 ± 10.2 [p = 0.12]; final KOOS CPAK 5: 79.8 ± 7.9, CPAK 8: 82.3 ± 9.3 [p = 0.53]). During the study period, one patient (1.8%) sustained a peri-implant fracture, one patient (1.8%) underwent re-intervention due to pseudoarthrosis and three patients (5.5%) underwent total knee arthroplasty.

Conclusions

MCW-DFO is a safe, effective treatment for symptomatic valgus knee deformity. Surgical correction achieved a neutral mechanical axis (CPAK 5 and 8), with no clinical differences for different JLO values.

Level of Evidence

Level III, case–control study.

Abstract Image

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在8年的随访中，术前CPAK表型不影响外翻膝关节内侧闭合楔形股骨远端截骨术后的临床和影像学结果。

目的：评价内侧闭合楔形股骨远端截骨术（MCW-DFO）前后膝关节冠状面排列（CPAK）表型的分布，并评估其与外翻膝关节畸形长期临床结局的相关性。方法：回顾性分析2007年至2022年间接受MCW-DFO膝关节外翻矫正的患者。术前和术后膝关节对齐采用标准长腿负重x线片进行评估，临床结果采用国际膝关节文献委员会（IKDC）、膝关节损伤和骨关节炎结局评分（oos）、Tegner和视觉模拟评分（VAS）进行评估。根据术前和术后CPAK分类表型对患者进行分层。比较最常见的术前和术后CPAK表型的结果。结果：纳入51例患者（54个膝关节），平均年龄48.7±13.2岁。总平均随访时间为97±57个月。所有临床评分均有统计学意义上的改善，MCW-DFO后外翻的影像学矫正也有统计学意义上的改善。根据术前CPAK表型，最流行的CPAK 6和3组的临床结果无显著差异(最终IKDC CPAK 3: 60.7±12.2,CPAK 6: 62.9±17 [p = 0.67]；最后三星CPAK 3: 76.8±6.9,77.3±14.9 CPAK 6: [p = 0.37])。同样，术后CPAK分层显示CPAK 5和CPAK 8之间无显著差异(最终IKDC CPAK 5: 63.3±15.7,CPAK 8: 71.1±10.2 [p = 0.12]；最后三星CPAK 5: 79.8±7.9,CPAK 8: 82.3±9.3 (p = 0.53)。在研究期间，1例（1.8%）患者发生假体周围骨折，1例（1.8%）患者因假关节再次干预，3例（5.5%）患者行全膝关节置换术。结论：MCW-DFO是一种安全、有效的治疗有症状的外翻膝关节畸形的方法。手术矫正获得中性机械轴（CPAK 5和8），不同JLO值无临床差异。证据等级：III级，病例对照研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).