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. 2021 Oct 5;9(10):23259671211034151.
doi: 10.1177/23259671211034151. eCollection 2021 Oct.

Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy

Dong Jin Ryu  1 , Sung-Sahn Lee  2 , Eui Yub Jung  3 , Joo Hwan Kim  4 , Tae Soo Shin  4 , Joon Ho Wang  3   5   6
Affiliations

Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy

Dong Jin Ryu et al. Orthop J Sports Med. .

Abstract

Background: Soft tissue laxity around the knee joint has been recognized as a crucial factor affecting correction error during medial open-wedge proximal tibial osteotomy (MOWPTO). Medial laxity in particular, which represents the changes in joint-line convergence angle (JLCA), affects soft tissue correction.

Purpose: The purpose of this study was to quantify medial laxity and develop a preoperative planning method that considers medial laxity.

Study design: Cohort study; Level of evidence, 3.

Methods: This study retrospectively reviewed 139 knees in 117 patients who underwent navigation-assisted MOWPTO from January 2014 to July 2019 for symptomatic medial compartment osteoarthritis with varus alignment >5°. We compared the results of 2 preoperative planning methods: conventional Miniaci (n = 47) and latent medial laxity reduction (LMLR) (n = 92). We evaluated the incidence of undercorrection, acceptable correction, and overcorrection. The radiologic parameters were analyzed using multiple linear regression with a stepwise selection model to establish an equation for the optimal preoperative planning method. The intraclass correlation coefficients (ICCs) of intraobserver, interobserver, and intermethod reliability were calculated.

Results: The Miniaci method showed a higher incidence of overcorrection (55.3%) than the LMLR method (22.8%) at postoperative 6 months (P = .0006). Multiple linear regression with a stepwise selection model revealed a high correlation coefficient (R 2 = 0.888) for the following equation: Adjusted planned correction angle = 0.596 + 0.891 × Target correction angle - 0.255 × ΔJLCA valgus . Upon simplification, the following equation showed the highest intermethod ICC value (0.991): Target correction angle - ⅓ΔJLCA valgus , while the Miniaci method showed a relatively low ICC value of 0.875.

Conclusion: There was a risk of overcorrection after MOWPTO using the conventional Miniaci method. An equation that considers medial laxity may help during preoperative planning for optimal correction during MOWPTO.

Keywords: correction error; medial laxity; preoperative planning; proximal tibial osteotomy.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (NRF-2017R1A2B3007362 and 2015R1A2A1A15054779 to J.H.W.). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flowchart showing exclusion of the study participants.
Figure 2.
Figure 2.
(A) Preoperative planning using the Miniaci method. H, hinge point. White line: an extension line connecting the hip center and the calculated point of expected weightbearing line after osteotomy. Black dashed line: a line connecting the lateral tibial hinge site, H, and the center of the ankle joint. White dashed line: a line connecting the lateral tibial hinge site, H, and white line. White arrow: the angle formed by black dashed line and white dashed line, determined to be the predicted correction angle. Black line: planned osteotomy site. (B-F) Calculation of latent medial laxity and lateral laxity. White dotted line: a line tangential to the distal femoral condyle. White line: a line tangential to the tibial plateau. JLCA, joint-line convergence angle (angle formed between white dotted line and white line). If the apex of the JLCA was medial, it was recorded as negative (–, varus); if it was lateral, it was recorded as positive (+, valgus).
Figure 3.
Figure 3.
Measurement of the real correction angle in the navigation system. The real correction angle was confirmed as the difference between the (A) pre- and (B) postoperative hip-knee-ankle angles in the navigation system, as calculated in panel C.
Figure 4.
Figure 4.
Representative postoperative (A) standing whole-leg and (B) lateral radiographs using latent medial laxity reduction planning method at 6 months. The white line in panel A indicates the weightbearing axis.
Figure 5.
Figure 5.
Distribution of mechanical axis (MA) values in each preoperative planning method at 6 months postoperatively. LMLR, latent medial laxity reduction.
See this image and copyright information in PMC

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