一种考虑关节线收敛角的有效方法减少了内侧开口楔形胫骨高位截骨术的规划误差。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-07-13 DOI:10.1002/ksa.12713

Takaaki Hiranaka, Christopher Davey, Samuel Grasso, Giacomo Dal Fabbro, Harbeer Ahedi, Brett Fritsch, David Parker

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引用次数: 0

摘要

目的：内侧开楔形高位胫骨截骨术（MOWHTO）矫正错误可能由计划或执行引起，或两者兼而有之。本研究旨在(1)识别导致规划误差的因素；(2)提出并评价一种新的规划方法以减少规划误差。方法：回顾性分析58例（平均年龄：46.7±7.2岁）内翻对准患者使用患者特异性植入物进行MOWHTO。术前和术后6个月影像学测量包括髋关节-膝关节-踝关节角（HKA）、胫骨内侧近端角（MPTA）、关节线收敛角（JLCA）和膝关节线倾角（KJLO）。HKA的总体误差和MPTA的手术误差计算计划误差（计划误差=总体误差-手术误差）。多变量逻辑回归分析确定了次优规划误差（绝对误差>.1°）的风险因素，并利用这些信息创建最小化规划误差的方法。结果：次优规划误差与站立JLCA增加相关(3.9±1.0°vs 2.0±1.4°；结论：术前站立JLCA≥2.8°是MOWHTO患者计划不理想的重要危险因素，这些患者过度矫正的风险增加。ΔJLCA方法通过术前使用站立和仰卧图像检测关节松弛来调整患者特定的计划，可以最大限度地减少计划错误并改善术后对齐。证据级别：四级，回顾性病例系列。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

A validated method accounting for joint line convergence angle reduces planning errors in medial opening wedge high tibial osteotomy

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A validated method accounting for joint line convergence angle reduces planning errors in medial opening wedge high tibial osteotomy

Purpose

Medial opening-wedge high tibial osteotomy (MOWHTO) correction error can result from either planning or execution, or both. This study aimed to (1) identify factors contributing to planning error, and (2) propose and evaluate a new planning method for reducing planning error.

Methods

A retrospective analysis was performed on 58 patients (mean age: 46.7 ± 7.2 years) with varus alignment who underwent MOWHTO using patient-specific implants. Radiographic measurements, including hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and knee joint line obliquity (KJLO), were made preoperatively and 6 months post-operatively. Overall error in HKA and surgical error in MPTA were used to calculate planning error (planning error = overall error − surgical error). A multivariable logistic regression analysis identified risk factors for suboptimal planning error (absolute error >1°), and this information was used to create a method to minimize it.

Results

Suboptimal planning error was associated with increased standing JLCA (3.9 ± 1.0° vs. 2.0 ± 1.4°; p < 0.001) and valgus KJLO (−0.6 ± 0.9° vs. 1.1 ± 2.5°; p = 0.005); however, multivariable logistic regression analysis identified increased standing JLCA as the only significant risk factor for suboptimal planning error (odds ratio: 3.27; p < 0.001). A preoperative JLCA cut-off of 2.8° yielded 94% sensitivity and 78% specificity for suboptimal planning error. Retrospective ΔJLCA adjustment, performed by subtracting ΔJLCA from post-operative HKA and recalculating planning error, reduced the mean planning error from 0.6 ± 1.0° to 0.2 ± 0.7° (p = 0.010).

Conclusion

Preoperative standing JLCA ≥ 2.8° is a significant risk factor for suboptimal planning in MOWHTO, with an increased risk of over-correction in these patients. The ΔJLCA method, which adjusts patient-specific planning by detecting joint laxity preoperatively using standing and supine images, may minimize planning error and improve post-operative alignment.

Level of Evidence

Level IV, retrospective case series.

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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).