Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy
Abstract Background Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-02-01
|
| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-022-02976-y |
| _version_ | 1811307327459950592 |
|---|---|
| author | Tzu-Hao Tseng Han-Ying Wang Shi-Chien Tzeng Kuan-Hung Hsu Jyh-Horng Wang |
| author_facet | Tzu-Hao Tseng Han-Ying Wang Shi-Chien Tzeng Kuan-Hung Hsu Jyh-Horng Wang |
| author_sort | Tzu-Hao Tseng |
| collection | DOAJ |
| description | Abstract Background Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study aimed to investigate the capacity of the compensation by analyzing the correlation of the knee-ankle joint line angle (KAJA) and the knee joint line obliquity (KJLO). Patients and Methods Ninety-six patients undergoing MOWHTO were included. We measured potential predictors including preoperative or postoperative body mass index (BMI), weight-bearing line (WBL) ratio/correction amount, knee-ankle joint line angle(KAJA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), ankle joint line obliquity (AJLO), mechanical hip-knee-ankle angle (mHKA) and joint line convergence angle (JLCA). The correlations of these predictors and postoperative KJLO were determined using Pearson correlation coefficient. The contribution of significant predictors was further analyzed using multiple linear regression. Finally, the cutoff value of the most contributing factor resulting in decompensated KJLO was derived with receiver operating characteristic (ROC) curve analysis. Results Preoperative AJLO, JLCA, MPTA, mHKA and KJLO and postoperative KAJA and MPTA correlated with postoperative KJLO. After multiple linear regression, only preoperative AJLO and JLCA and postoperative KAJA still showed significant contribution to postoperative KJLO. Postoperative KAJA made the greatest contribution. The cutoff value of postoperative KAJA was at 9.6° after ROC analysis. The incidence rate of high-grade KJLO was 69.6% when postoperative KAJA exceeded 9.6°. Conclusions Postoperative KAJA is a significant contributor to high-grade KJLO after MOWHTO. The incidence was increased at angles greater than 9.6°. The results suggest that KAJA should be carefully assessed during preoperative planning or intraoperative evaluation. Postoperative KAJA < 9.6° can lower the rate of early high-degree KJLO. |
| first_indexed | 2024-04-13T09:02:40Z |
| format | Article |
| id | doaj.art-ba8ab2372c4a4d359be3579de9d1b704 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-13T09:02:40Z |
| publishDate | 2022-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-ba8ab2372c4a4d359be3579de9d1b7042022-12-22T02:53:05ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2022-02-011711810.1186/s13018-022-02976-yKnee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomyTzu-Hao Tseng0Han-Ying Wang1Shi-Chien Tzeng2Kuan-Hung Hsu3Jyh-Horng Wang4Department of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalAbstract Background Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study aimed to investigate the capacity of the compensation by analyzing the correlation of the knee-ankle joint line angle (KAJA) and the knee joint line obliquity (KJLO). Patients and Methods Ninety-six patients undergoing MOWHTO were included. We measured potential predictors including preoperative or postoperative body mass index (BMI), weight-bearing line (WBL) ratio/correction amount, knee-ankle joint line angle(KAJA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), ankle joint line obliquity (AJLO), mechanical hip-knee-ankle angle (mHKA) and joint line convergence angle (JLCA). The correlations of these predictors and postoperative KJLO were determined using Pearson correlation coefficient. The contribution of significant predictors was further analyzed using multiple linear regression. Finally, the cutoff value of the most contributing factor resulting in decompensated KJLO was derived with receiver operating characteristic (ROC) curve analysis. Results Preoperative AJLO, JLCA, MPTA, mHKA and KJLO and postoperative KAJA and MPTA correlated with postoperative KJLO. After multiple linear regression, only preoperative AJLO and JLCA and postoperative KAJA still showed significant contribution to postoperative KJLO. Postoperative KAJA made the greatest contribution. The cutoff value of postoperative KAJA was at 9.6° after ROC analysis. The incidence rate of high-grade KJLO was 69.6% when postoperative KAJA exceeded 9.6°. Conclusions Postoperative KAJA is a significant contributor to high-grade KJLO after MOWHTO. The incidence was increased at angles greater than 9.6°. The results suggest that KAJA should be carefully assessed during preoperative planning or intraoperative evaluation. Postoperative KAJA < 9.6° can lower the rate of early high-degree KJLO.https://doi.org/10.1186/s13018-022-02976-yKnee joint obliquityHigh tibial osteotomyAnkleCartilageCorrection |
| spellingShingle | Tzu-Hao Tseng Han-Ying Wang Shi-Chien Tzeng Kuan-Hung Hsu Jyh-Horng Wang Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy Journal of Orthopaedic Surgery and Research Knee joint obliquity High tibial osteotomy Ankle Cartilage Correction |
| title | Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy |
| title_full | Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy |
| title_fullStr | Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy |
| title_full_unstemmed | Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy |
| title_short | Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy |
| title_sort | knee ankle joint line angle a significant contributor to high degree knee joint line obliquity in medial opening wedge high tibial osteotomy |
| topic | Knee joint obliquity High tibial osteotomy Ankle Cartilage Correction |
| url | https://doi.org/10.1186/s13018-022-02976-y |
| work_keys_str_mv | AT tzuhaotseng kneeanklejointlineangleasignificantcontributortohighdegreekneejointlineobliquityinmedialopeningwedgehightibialosteotomy AT hanyingwang kneeanklejointlineangleasignificantcontributortohighdegreekneejointlineobliquityinmedialopeningwedgehightibialosteotomy AT shichientzeng kneeanklejointlineangleasignificantcontributortohighdegreekneejointlineobliquityinmedialopeningwedgehightibialosteotomy AT kuanhunghsu kneeanklejointlineangleasignificantcontributortohighdegreekneejointlineobliquityinmedialopeningwedgehightibialosteotomy AT jyhhorngwang kneeanklejointlineangleasignificantcontributortohighdegreekneejointlineobliquityinmedialopeningwedgehightibialosteotomy |