膝关节截骨术显著影响踝关节冠状位对齐：影像学分析

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

{"title":"膝关节截骨术显著影响踝关节冠状位对齐：影像学分析","authors":"Alessio Maione, Carlo Minoli, Matteo Davide Parmigiani, Martino Travi, Filippo Calanna, Daniele Marcolli, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli","doi":"10.1002/jeo2.70252","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In the MCW-DFO group, the difference between LDTA and M-LDTA decreased from 3.5 ± 2.3° to 1.3 ± 1.1° (<i>p</i> < 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° (<i>p</i> < 0.0001). TTI improved significantly in both groups, with a greater adjustment in MCW-DFO (ΔTTI = 7.0 ± 4.3°, <i>p</i> < 0.01) compared to LCW-HTO (ΔTTI = 4.2 ± 2.7°, <i>p</i> < 0.01). The difference between LDTA and TTI decreased in both groups, reflecting post-operative convergence of the mechanical and anatomical axes.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 2","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70252","citationCount":"0","resultStr":"{\"title\":\"Knee osteotomies significantly influence coronal ankle alignment: A radiographic analysis\",\"authors\":\"Alessio Maione, Carlo Minoli, Matteo Davide Parmigiani, Martino Travi, Filippo Calanna, Daniele Marcolli, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli\",\"doi\":\"10.1002/jeo2.70252\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>In the MCW-DFO group, the difference between LDTA and M-LDTA decreased from 3.5 ± 2.3° to 1.3 ± 1.1° (<i>p</i> < 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° (<i>p</i> < 0.0001). TTI improved significantly in both groups, with a greater adjustment in MCW-DFO (ΔTTI = 7.0 ± 4.3°, <i>p</i> < 0.01) compared to LCW-HTO (ΔTTI = 4.2 ± 2.7°, <i>p</i> < 0.01). The difference between LDTA and TTI decreased in both groups, reflecting post-operative convergence of the mechanical and anatomical axes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level III.</p>\\n </section>\\n </div>\",\"PeriodicalId\":36909,\"journal\":{\"name\":\"Journal of Experimental Orthopaedics\",\"volume\":\"12 2\",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-05-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70252\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Experimental Orthopaedics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jeo2.70252\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Experimental Orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jeo2.70252","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

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。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Knee osteotomies significantly influence coronal ankle alignment: A radiographic analysis

查看原文本刊更多论文

Knee osteotomies significantly influence coronal ankle alignment: A radiographic analysis

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.