Abstract
Background
Open-wedge high tibial osteotomy (OWHTO) produces three- dimensional (3D) geometric
changes. Among them, increased posterior tibial slope (PTS), and altered coronal inclination
that induces unintended tibial translation may affect anterior cruciate ligament (ACL)
status. The purpose of current study was to evaluate the geometric changes following
OWHTO, such as increasing PTS and decreasing tibial subluxation, which may affect
the status of ACL.
Methods
From April 2014 to December 2015, a total of 72 knees in 64 patients that underwent
OWHTO, second-look arthroscopy, and magnetic resonance imaging (MRI) assessment, were
enrolled. Preoperative and postoperative coronal and sagittal translation, joint line
orientation angle, the distance between medial femoral notch marginal line and medial
tibial spine, and PTS were evaluated. ACL status was arthroscopically graded from
grade 1 (best) to 4 (worst). The MRI signal of the graft in three portions (proximal,
middle, and distal) was graded from grade 1 (best) to 4 (worst).
Results
High grade (3: partial, and 4: complete rupture) was noted in 28 cases (38.9%) at
the second-look arthroscopy compared with 10 cases (13.9%) at index arthroscopy. The
MRI signal grade significantly increased at follow up MRI compared with preoperative
MRI (P<0.01). An increased signal was commonly noted in the middle and distal portions of
the graft.
Conclusions
Geometric changes after OWHTO were related to ACL deterioration. The ACL was commonly
affected at the middle and distal portions and rarely at the proximal portion. There
is a possibility of impingement because of the geometric changes.
Level of evidence: Level IV
Keywords
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Article info
Publication history
Published online: April 22, 2020
Accepted:
April 8,
2020
Received in revised form:
February 26,
2020
Received:
January 17,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
