Impact of mechanical axis position and coronal plane alignment phenotypes on clinical outcomes in medial opening wedge high tibial osteotomy.

IF 2.6 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2025-09-23 DOI:10.1007/s00264-025-06659-1

Ahmetcan Erdem, Vahdet Uçan, Gökhan Lebe, Muhammet Ali Geçkalan, Cemil Burak Demirkıran, Ali Toprak, Nurzat Elmalı

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引用次数: 0

Abstract

Introduction: In medial opening wedge high tibial osteotomy (MOWHTO), the goal extends beyond lateralizing the mechanical axis; restoring a horizontal joint line is crucial for optimal biomechanics. The Coronal Plane Alignment of the Knee (CPAK) classification, which incorporates mechanical axis deviation and joint line obliquity (JLO), offers a phenotype-based framework, though its application in MOWHTO remains underexplored.

Materials and methods: A retrospective review included 147 knees from 123 patients undergoing MOWHTO with at least 24 months of follow-up. Radiographic parameters assessed were mFTA, MPTA, mLDFA, JLCA, aHKA, and JLO. Knees were categorized based on postoperative weight-bearing line (WBL) positions, and CPAK phenotypes were recorded pre- and postoperatively. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee score.

Results: Preoperatively, CPAK type I (varus, apex distal JLO) predominated (82.3%). Postoperatively, many transitioned to Types V (neutral, apex neutral JLO, 24.5%) and VI (valgus, apex neutral JLO, 17.7%), both yielding significantly higher HSS scores (p < 0.001). Optimal outcomes were observed with a WBL between 50% and 60%. The mean aHKA improved from - 7.35° to + 1.59°, while JLO corrected from 172.4° to 180.8°.

Conclusion: This study demonstrates that transitions to CPAK Types V-VI, with 50-60% WBL and horizontal joint line restoration, are linked to improved HSS scores, highlighting the CPAK classification's potential for guiding individualized correction strategies in MOWHTO.

Level of evidence: Level III (retrospective comparative study).

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机械轴位置和冠状面排列表型对胫骨内侧开口楔形高位截骨临床结果的影响。

简介：在内侧开口楔形胫骨高位截骨术（MOWHTO）中，目标不仅仅是使机械轴偏侧；恢复水平关节线是最佳生物力学的关键。膝关节冠状面对齐（CPAK）分类，包括机械轴偏差和关节线倾角（JLO），提供了一个基于表型的框架，尽管其在MOWHTO中的应用仍未得到充分探索。材料和方法：回顾性研究包括123例MOWHTO患者的147个膝关节，随访至少24个月。评估的影像学参数为mFTA、MPTA、mLDFA、JLCA、aHKA和JLO。根据术后负重线（WBL）位置对膝关节进行分类，并记录术前和术后的CPAK表型。临床结果采用特殊外科医院（HSS）膝关节评分进行评估。结果：术前CPAK型（内翻，JLO尖端远端）为主（82.3%）。术后，许多过渡到V型（中立，顶点中立JLO， 24.5%）和VI型（外翻，顶点中立JLO， 17.7%），两者的HSS评分均显著提高(p)。结论：该研究表明，过渡到CPAK V-VI型，50-60%的WBL和水平关节线恢复，与HSS评分提高有关，突出了CPAK分类指导MOWHTO个体化矫正策略的潜力。证据等级：III级（回顾性比较研究）。

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

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.