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

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 ¼ 47) and latent medial laxity reduction (LMLR) (n ¼ 92). We evaluated the incidence of under-correction, 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 inter-method reliability were calculated.

Results

The Miniaci method showed a higher incidence of over-correction (55.3%) than the latent medial laxity reduction method (22.8%) at postoperative 6 months (p=0.0006). The multiple linear regression with a stepwise selection model revealed a high correlation coefficient for the following equation: adjusted preoperative planning correction angle = 0.596 + 0.891 x target correction angle (TCA) - 0.255 x ?JLCA valgus (R2 = 0.888). On simplifying, target correction angle (TCA) – 1/3?JLCA valgus showed the highest inter-method (ICC) value (0.991) with the proposed equation. While, the Miniaci method showed a relatively low ICC value of 0.875.

Conclusion

The Conventional Miniaci method has a risk of over-correction after MOWPTO. An equation that is considering medial laxity could help to set a preoperative planning for optimal correction during MOWPTO.

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

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

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

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

Background

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content