Alessio Maione, Filippo Calanna, Alessandro Napolitano, Matteo Davide Parmigiani, Giuseppe Fedele, Alessandra Menon, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli
{"title":"不论畸形部位如何，高位胫骨截骨术在膝关节内翻矫正中均能获得充分的临床和影像学结果。","authors":"Alessio Maione, Filippo Calanna, Alessandro Napolitano, Matteo Davide Parmigiani, Giuseppe Fedele, Alessandra Menon, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli","doi":"10.1002/ksa.12793","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>High tibial osteotomy (HTO) can alleviate symptoms and slow osteoarthritis progression in selected patients with arthritic varus knees. However, the role of postoperative joint line obliquity (JLO) in correcting varus deformity remains unclear. The aim of this study was to evaluate clinical and radiological outcomes of HTO—lateral closing-wedge (LCW-HTO) and medial opening-wedge (MOW-HTO)—in treating varus knees with tibial- and femoral-based deformities, considering JLO boundaries (≤4°).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective analysis was performed on 99 patients (108 knees) with varus knees (preoperative hip-knee-ankle angle [HKA] ≤ 175°) undergoing HTO. Patients were classified into femoral-based (FEM-Var) or tibial-based (TIB-Var) varus groups, regardless of the surgical technique. Radiographs were analysed preoperatively and at the final follow-up (mean, 9 ± 4.2 years; range, 2–18 years). Clinical outcomes were assessed using the Hospital for Special Surgery score, International Knee Documentation Committee score, Tegner score, Numeric Rating Scale, and Crosby-Insall score.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The cohort had a mean age of 49.4 ± 10.2 years (range, 18–64 years) at the time of initial follow up. Sixty-eight knees (63%) underwent LCW-HTO, and 40 (37%) underwent MOW-HTO. The mean HKA improved from 172° ± 4.1° (range, 162°–175°) preoperatively to 178° ± 3° (range, 176°–180°) postoperatively. Most patients achieved a JLO ≤ 4° (TIB-Var: two patients > 4°; FEM-Var: five patients > 4°). The TIB-Var group demonstrated superior JLO correction (mean postoperative JLO: TIB-Var, 2.9° ± 1.5°; FEM-Var, 3.5° ± 1.6°; <i>p</i> < 0.01) and greater changes in the joint line congruency angle (JLCA). Both groups showed significant improvements in all clinical scores (<i>p</i> < 0.01), with no osteoarthritis progression at the last follow-up.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>HTO is an effective procedure for treating pathological varus knees, regardless of the site of the deformity. Both FEM-Var and TIB-Var groups showed comparable improvements in the clinical scores, development of osteoarthritis, and the restoration of a neutral mechanical axis. Notably, the TIB-Var group showed superior correction in JLO and achieved better postoperative JLCA than the FEM-Var ones.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level IV, cohort study.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3350-3360"},"PeriodicalIF":5.0000,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"High tibial osteotomy yields sufficient clinical and radiological results in varus knee correction regardless of the site of deformity\",\"authors\":\"Alessio Maione, Filippo Calanna, Alessandro Napolitano, Matteo Davide Parmigiani, Giuseppe Fedele, Alessandra Menon, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli\",\"doi\":\"10.1002/ksa.12793\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>High tibial osteotomy (HTO) can alleviate symptoms and slow osteoarthritis progression in selected patients with arthritic varus knees. However, the role of postoperative joint line obliquity (JLO) in correcting varus deformity remains unclear. The aim of this study was to evaluate clinical and radiological outcomes of HTO—lateral closing-wedge (LCW-HTO) and medial opening-wedge (MOW-HTO)—in treating varus knees with tibial- and femoral-based deformities, considering JLO boundaries (≤4°).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A retrospective analysis was performed on 99 patients (108 knees) with varus knees (preoperative hip-knee-ankle angle [HKA] ≤ 175°) undergoing HTO. Patients were classified into femoral-based (FEM-Var) or tibial-based (TIB-Var) varus groups, regardless of the surgical technique. Radiographs were analysed preoperatively and at the final follow-up (mean, 9 ± 4.2 years; range, 2–18 years). Clinical outcomes were assessed using the Hospital for Special Surgery score, International Knee Documentation Committee score, Tegner score, Numeric Rating Scale, and Crosby-Insall score.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The cohort had a mean age of 49.4 ± 10.2 years (range, 18–64 years) at the time of initial follow up. Sixty-eight knees (63%) underwent LCW-HTO, and 40 (37%) underwent MOW-HTO. The mean HKA improved from 172° ± 4.1° (range, 162°–175°) preoperatively to 178° ± 3° (range, 176°–180°) postoperatively. Most patients achieved a JLO ≤ 4° (TIB-Var: two patients > 4°; FEM-Var: five patients > 4°). The TIB-Var group demonstrated superior JLO correction (mean postoperative JLO: TIB-Var, 2.9° ± 1.5°; FEM-Var, 3.5° ± 1.6°; <i>p</i> < 0.01) and greater changes in the joint line congruency angle (JLCA). Both groups showed significant improvements in all clinical scores (<i>p</i> < 0.01), with no osteoarthritis progression at the last follow-up.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>HTO is an effective procedure for treating pathological varus knees, regardless of the site of the deformity. Both FEM-Var and TIB-Var groups showed comparable improvements in the clinical scores, development of osteoarthritis, and the restoration of a neutral mechanical axis. Notably, the TIB-Var group showed superior correction in JLO and achieved better postoperative JLCA than the FEM-Var ones.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level IV, cohort study.</p>\\n </section>\\n </div>\",\"PeriodicalId\":17880,\"journal\":{\"name\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"volume\":\"33 9\",\"pages\":\"3350-3360\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12793\",\"RegionNum\":2,\"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":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12793","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
High tibial osteotomy yields sufficient clinical and radiological results in varus knee correction regardless of the site of deformity
Purpose
High tibial osteotomy (HTO) can alleviate symptoms and slow osteoarthritis progression in selected patients with arthritic varus knees. However, the role of postoperative joint line obliquity (JLO) in correcting varus deformity remains unclear. The aim of this study was to evaluate clinical and radiological outcomes of HTO—lateral closing-wedge (LCW-HTO) and medial opening-wedge (MOW-HTO)—in treating varus knees with tibial- and femoral-based deformities, considering JLO boundaries (≤4°).
Methods
A retrospective analysis was performed on 99 patients (108 knees) with varus knees (preoperative hip-knee-ankle angle [HKA] ≤ 175°) undergoing HTO. Patients were classified into femoral-based (FEM-Var) or tibial-based (TIB-Var) varus groups, regardless of the surgical technique. Radiographs were analysed preoperatively and at the final follow-up (mean, 9 ± 4.2 years; range, 2–18 years). Clinical outcomes were assessed using the Hospital for Special Surgery score, International Knee Documentation Committee score, Tegner score, Numeric Rating Scale, and Crosby-Insall score.
Results
The cohort had a mean age of 49.4 ± 10.2 years (range, 18–64 years) at the time of initial follow up. Sixty-eight knees (63%) underwent LCW-HTO, and 40 (37%) underwent MOW-HTO. The mean HKA improved from 172° ± 4.1° (range, 162°–175°) preoperatively to 178° ± 3° (range, 176°–180°) postoperatively. Most patients achieved a JLO ≤ 4° (TIB-Var: two patients > 4°; FEM-Var: five patients > 4°). The TIB-Var group demonstrated superior JLO correction (mean postoperative JLO: TIB-Var, 2.9° ± 1.5°; FEM-Var, 3.5° ± 1.6°; p < 0.01) and greater changes in the joint line congruency angle (JLCA). Both groups showed significant improvements in all clinical scores (p < 0.01), with no osteoarthritis progression at the last follow-up.
Conclusion
HTO is an effective procedure for treating pathological varus knees, regardless of the site of the deformity. Both FEM-Var and TIB-Var groups showed comparable improvements in the clinical scores, development of osteoarthritis, and the restoration of a neutral mechanical axis. Notably, the TIB-Var group showed superior correction in JLO and achieved better postoperative JLCA than the FEM-Var ones.
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).
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