{"title":"远端胫骨高位截骨术可以改善髌股关节的保存，但与近端胫骨高位截骨术相比，其结果是胫骨后坡增加。","authors":"Yukio Akasaki, Yu Soejima, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Yasuharu Nakashima","doi":"10.1016/j.arthro.2025.05.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To compare the postoperative trajectory of posterior tibial slope (p-TS) after distal (DTO) versus proximal (PTO) biplanar open-wedge high tibial osteotomy performed with an identical, early weightbearing protocol.</p><p><strong>Methods: </strong>All consecutive open-wedge high tibial osteotomies performed from May 2015 to December 2020 were reviewed. Eligible knees had complete lateral radiographs (preoperative, 1 week, 1 month, 3 months, 6 months, 12 months) and a ≥24-month follow-up. p-TS and Caton-Deschamps index were measured. International Cartilage Repair Society cartilage grade at routine plate removal was recorded.</p><p><strong>Results: </strong>Thirty consecutive DTOs and 30 consecutive PTOs were retrospectively compared. The mean p-TS in the DTO group initially decreased after osteotomy but subsequently increased compared to the PTO group (P = .016). From 1 week to 12 months postoperatively, 9 of 30 knees (30%) that underwent DTO had a >2° increase in p-TS, compared with 2 of 30 knees (7%) that underwent PTO (P = .045). Of the 9 DTO knees with a >2° p-TS increase, 4 exhibited widening of the descending gap (the descending cut in the tibial tuberosity) and nonunion in the retrotubercle. The p-TS correction loss primarily occurred between 1 and 3 months postoperatively (P < .001). Arthroscopic assessment revealed patellofemoral cartilage deterioration in 8 of 28 knees (29%) in the PTO group, compared to only 1 of 28 knees (4%) in the DTO group (P = .024). A greater change in the Caton-Deschamps index was associated with patellofemoral cartilage deterioration at 12 months (P = .021).</p><p><strong>Conclusions: </strong>The p-TS changes during the postoperative course occurred more frequently in DTO compared to PTO. In DTO, p-TS increased for up to 12 months postoperatively, with the most substantial changes occurring between 1 and 3 months. While DTO has the advantage of preserving the patellofemoral joint, the increase in p-TS may require careful attention, as it could adversely impact bone union in the retrotubercle.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":5.4000,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Distal High Tibial Osteotomy Allows Improved Patellofemoral Joint Preservation but Results in Increased Posterior Tibial Slope Compared to Proximal High Tibial Osteotomy.\",\"authors\":\"Yukio Akasaki, Yu Soejima, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Yasuharu Nakashima\",\"doi\":\"10.1016/j.arthro.2025.05.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To compare the postoperative trajectory of posterior tibial slope (p-TS) after distal (DTO) versus proximal (PTO) biplanar open-wedge high tibial osteotomy performed with an identical, early weightbearing protocol.</p><p><strong>Methods: </strong>All consecutive open-wedge high tibial osteotomies performed from May 2015 to December 2020 were reviewed. Eligible knees had complete lateral radiographs (preoperative, 1 week, 1 month, 3 months, 6 months, 12 months) and a ≥24-month follow-up. p-TS and Caton-Deschamps index were measured. International Cartilage Repair Society cartilage grade at routine plate removal was recorded.</p><p><strong>Results: </strong>Thirty consecutive DTOs and 30 consecutive PTOs were retrospectively compared. The mean p-TS in the DTO group initially decreased after osteotomy but subsequently increased compared to the PTO group (P = .016). From 1 week to 12 months postoperatively, 9 of 30 knees (30%) that underwent DTO had a >2° increase in p-TS, compared with 2 of 30 knees (7%) that underwent PTO (P = .045). Of the 9 DTO knees with a >2° p-TS increase, 4 exhibited widening of the descending gap (the descending cut in the tibial tuberosity) and nonunion in the retrotubercle. The p-TS correction loss primarily occurred between 1 and 3 months postoperatively (P < .001). Arthroscopic assessment revealed patellofemoral cartilage deterioration in 8 of 28 knees (29%) in the PTO group, compared to only 1 of 28 knees (4%) in the DTO group (P = .024). A greater change in the Caton-Deschamps index was associated with patellofemoral cartilage deterioration at 12 months (P = .021).</p><p><strong>Conclusions: </strong>The p-TS changes during the postoperative course occurred more frequently in DTO compared to PTO. In DTO, p-TS increased for up to 12 months postoperatively, with the most substantial changes occurring between 1 and 3 months. While DTO has the advantage of preserving the patellofemoral joint, the increase in p-TS may require careful attention, as it could adversely impact bone union in the retrotubercle.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative case series.</p>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.4000,\"publicationDate\":\"2025-05-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arthro.2025.05.017\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2025.05.017","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Distal High Tibial Osteotomy Allows Improved Patellofemoral Joint Preservation but Results in Increased Posterior Tibial Slope Compared to Proximal High Tibial Osteotomy.
Purpose: To compare the postoperative trajectory of posterior tibial slope (p-TS) after distal (DTO) versus proximal (PTO) biplanar open-wedge high tibial osteotomy performed with an identical, early weightbearing protocol.
Methods: All consecutive open-wedge high tibial osteotomies performed from May 2015 to December 2020 were reviewed. Eligible knees had complete lateral radiographs (preoperative, 1 week, 1 month, 3 months, 6 months, 12 months) and a ≥24-month follow-up. p-TS and Caton-Deschamps index were measured. International Cartilage Repair Society cartilage grade at routine plate removal was recorded.
Results: Thirty consecutive DTOs and 30 consecutive PTOs were retrospectively compared. The mean p-TS in the DTO group initially decreased after osteotomy but subsequently increased compared to the PTO group (P = .016). From 1 week to 12 months postoperatively, 9 of 30 knees (30%) that underwent DTO had a >2° increase in p-TS, compared with 2 of 30 knees (7%) that underwent PTO (P = .045). Of the 9 DTO knees with a >2° p-TS increase, 4 exhibited widening of the descending gap (the descending cut in the tibial tuberosity) and nonunion in the retrotubercle. The p-TS correction loss primarily occurred between 1 and 3 months postoperatively (P < .001). Arthroscopic assessment revealed patellofemoral cartilage deterioration in 8 of 28 knees (29%) in the PTO group, compared to only 1 of 28 knees (4%) in the DTO group (P = .024). A greater change in the Caton-Deschamps index was associated with patellofemoral cartilage deterioration at 12 months (P = .021).
Conclusions: The p-TS changes during the postoperative course occurred more frequently in DTO compared to PTO. In DTO, p-TS increased for up to 12 months postoperatively, with the most substantial changes occurring between 1 and 3 months. While DTO has the advantage of preserving the patellofemoral joint, the increase in p-TS may require careful attention, as it could adversely impact bone union in the retrotubercle.
Level of evidence: Level III, retrospective comparative case series.
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