記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arthro.2023.03.032

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>To evaluate the expected postoperative total leg length change using preoperative radiographs during surgical planning of four different methods of double level osteotomy (DLO).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>This study included 34 patients (44 knees) who underwent DLO for varus knee osteoarthritis. Surgical planning was performed so that the postoperative weight bearing line ratio was 62.5%. In DLO, lateral closed or medial open wedge distal femoral osteotomy (LCWDFO, MOWDFO) was performed so that the postoperative mechanical lateral distal femoral angle was 85°, and residual deformity was corrected with medial open or lateral closed wedge high tibial osteotomy (MOWHTO, LCWHTO). Pre- and surgical planning X-rays in the one-leg standing position were compared to assess the change in leg length, and the factors affecting it, in the various surgical groups. The proportion of cases in which Δ total leg length was greater than 6 mm (symptomatic change) was investigated.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>The mean postoperative total leg length increased significantly with LCWDFO + MOWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, while it decreased with LCWDFO + LCWHTO. The proportion of cases with a postoperative total leg length change &gt; 6 mm was 72.7%, 2.3%, 100%, and 6.8% in LCWDFO + MOWHTO, LCWDFO + LCWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, respectively. In addition, the preoperative hip-knee-ankle angle correlated negatively with the postoperative total leg length change in LCWDFO + MOWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, but not in LCWDFO + LCWHTO.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>MOWDFO + MOWHTO had the largest postoperative leg length change and MOWDFO + LCWHTO had the smallest. Symptomatic leg length change (&gt; 6 mm) should be considered in MOWDFO + MOWHTO and LCWDFO + MOWHTO.</jats:p>
</jats:sec>

DOI： 10.1186/s43019-023-00198-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>Double level osteotomy (DLO) has been introduced to prevent increased postoperative joint line obliquity. However, although DLO is planned, knees with postoperative medial proximal tibial angle (MPTA) &gt; 95° in preoperative surgical planning are present. This retrospective study aimed to evaluate risk factors for an MPTA &gt; 95° in preoperative surgical planning for DLO in patients with varus knee osteoarthritis (OA).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>A total of 168 knees that underwent osteotomies around the knee for varus knee OA were enrolled. The hip-knee-ankle angle (HKA), weight-bearing line (WBL) ratio, mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and mechanical medial proximal tibial angle (mMPTA) were measured on preoperative radiographs. The postoperative WBL ratio was planned to be 62.5%. When the postoperative mMPTA was more than 95° in isolated high tibial osteotomy (HTO), (DLO) was planned so that the postoperative mLDFA was 85°, and residual deformity was corrected by HTO. Knees with postoperative mMPTA ≤ 95° and &gt; 95° were classified into the correctable group and uncorrectable group, respectively.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>DLO was required in 101 knees (60.1%). Among them, 41 knees (40.6%) were classified into the uncorrectable group. Binomial logistic regression analysis showed that preoperative JLCA and mMPTA were independent predictors in the uncorrectable group.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Even with DLO, postoperative mMPTA was more than 95° in approximately 40% of cases. Preoperative increased JLCA and decreased mMPTA were risk factors for a postoperative mMPTA of &gt; 95° after DLO.</jats:p>
</jats:sec>

DOI： 10.1186/s12891-022-06101-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Purpose</jats:title>
<jats:p>To evaluate whether the frequency of interference between locking screws for the plate fixation and tibial tunnels differs depending on the tibial tunnel positions in a surgical simulation of the transtibial pull-out repair of medial meniscus posterior root tears (MMPRTs) in patients undergoing biplanar open wedge high tibial osteotomy (OWHTO).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Sixty-five patients (75 knees) who underwent OWHTO with TomoFix small plate (Depuy Synthes, PA, USA) for medial knee osteoarthritis with varus malalignment were enrolled in this study. Surgical simulation of transtibial pull-out repair of MMPRTs was performed using postoperative computed tomography images. The tibial tunnel was created in the anatomical attachment area of the medial meniscus posterior root. Another aperture of the tibial tunnel was created on the anteromedial (AM) tibial cortex, the posteromedial (PM) tibial cortex, and the anterolateral (AL) tibial cortex in the proximal tibial fragment. The frequency of interference between the tibial tunnel and A–D locking screws was compared in the 3 tibial tunnel positions. In each tibial tunnel position, the locking plate position with and without interference between the tibial tunnel and at least one locking screw was compared.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>For screw A, the frequency of interference with the tibial tunnel in the AL position was higher than that in the AM (<jats:italic>P</jats:italic> = 0.048) and PM positions (<jats:italic>P</jats:italic> &lt;  0.001). For screws B and C, the frequency of interference with the tibial tunnel in the AM position was higher than that in the PM (<jats:italic>P</jats:italic> &lt;  0.001, <jats:italic>P</jats:italic> = 0.007) and AL positions (<jats:italic>P</jats:italic> &lt;  0.001, <jats:italic>P</jats:italic> = 0.001), respectively. For screw D, there was no difference in the frequency of interference with the tibial tunnel among the three positions. The frequency of interference between the tibial tunnel and at least one screw in the AM position was 100%, which was higher than that in the PM (<jats:italic>P</jats:italic> &lt;  0.001) and AL positions (<jats:italic>P</jats:italic> &lt;  0.001). In the PM position, the locking plate was placed more posteriorly in the group where the locking screw interfered with the tibial tunnel. In the AL position, the locking plate was placed more parallel to the medial/lateral axis of the tibial plateau in the interference group.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>Making the tibial tunnel in the AM position should be avoided because interference with locking screws was inevitable. When the tibial tunnel is created in the PM position, interference between the tibial tunnel and screw C should be paid attention. Anterior placement of the locking plate could be useful to prevent interference between locking screws and the tibial tunnel in the PM position. In addition, when the tibial tunnel is created in the AL position, interference between the tibial tunnel and especially screw A among screws A–C should be paid attention. Placing the locking plate in an anteromedial direction could be useful to prevent interference between locking screws and the tibial tunnel in the AL position.</jats:p>
</jats:sec><jats:sec>
<jats:title>Level of evidence</jats:title>
<jats:p>IV</jats:p>
</jats:sec>

DOI： 10.1186/s40634-022-00464-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>To evaluate the anterolateral cortex distance between the lateral edge of the flange and hinge point in surgical simulations of biplanar open wedge high tibial osteotomy (OWHTO) using computed tomography (CT) images.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>A total of 110 knees treated with OWHTO for medial knee osteoarthritis with varus malalignment were enrolled. Surgical simulations of biplanar OWHTO, including the transverse and ascending cuts, were performed in the standard manner using preoperative CT images. The distance between the lateral edge of the flange and the hinge point was measured. In addition, another plane of the ascending cut was defined through the hinge point. The angle between these two planes of the ascending cut was measured in the axial plane.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>The mean anterolateral cortex distance was 9.4 ± 4.6 mm (range, − 1.5 mm – 20.3 mm). In 3 knees, osteotomy of the anterolateral cortex was not needed. The mean value of the angle between the two ascending cut planes was 8.4 ± 3.6° (range, − 2.1° – 14.8°), which meant that osteotomy of anterolateral cortex was not needed when the ascending cut was performed at this angle. Moreover, these two values increased when the flange thickness was changed from one-third to one-fourth of the anteroposterior tibial diameter or the angle between the transverse and ascending cuts was changed from 110° to 120°.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>In biplanar OWHTO, anterolateral cortex osteotomy would be required. However, the range of the required anterolateral cortex osteotomy distance varied widely and the required anterolateral cortex osteotomy distance depended on the flange thickness and the angle between the transverse and ascending cuts. In addition, change of the ascending cut plane can change the necessity of anterolateral cortex osteotomy.</jats:p>
</jats:sec>

DOI： 10.1186/s12891-022-05283-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>To evaluate the difference in surgical planning of osteotomies around the knee between preoperative standing and supine radiographs and to identify risk factors for discrepancies in surgical planning.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>This study included 117 knees of 100 patients who underwent osteotomies around the knee for knee osteoarthritis with genu varum. Surgical planning was performed so that the target point of the postoperative weight-bearing line (WBL) ratio was 62.5% in preoperative standing and supine radiographs. If the opening gap would be &gt; 13 mm in open-wedge high tibial osteotomy (OWHTO), closed-wedge HTO (CWHTO) was planned. If the postoperative mMPTA would be &gt; 95° in isolated HTO, double-level osteotomy (DLO) was planned. In DLO, lateral closed-wedge distal femoral osteotomy was performed so that the postoperative mechanical lateral distal femoral angle (mLDFA) was 85°, and any residual varus deformity was corrected with HTO.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>Surgical planning differed between standing and supine radiographs in 43.6% of cases. In all knees for which surgical planning differed between standing and supine radiographs, a more invasive type of osteotomy was suggested by standing radiographs than by supine radiographs. The risk factors for discrepancies in surgical planning were a lower WBL ratio in standing radiographs and a lower joint line convergence angle in supine radiographs.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Surgical planning of DLO, CWHTO and OWHTO, in standing radiographs differed from that in supine radiographs in nearly half of the cases. Surgical planning based on standing radiographs leads to more invasive surgical procedures compared to supine radiographs.</jats:p>
</jats:sec>

DOI： 10.1186/s12891-022-05461-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>The purpose of this study was to evaluate the reproducibility of planned component positioning including tibial rotational alignment in patient-specific instrumentation (PSI) for total knee arthroplasty (TKA).
</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>A total of 100 knees of 100 patients underwent TKA using PSI (<jats:italic>n</jats:italic> = 50) or the conventional method (<jats:italic>n</jats:italic> = 50). Full-length anteroposterior radiographs of the lower limb were taken in the standing position, and the coronal alignments of the femoral and tibial components were measured. Computed tomography (CT) images of the lower limb were obtained preoperatively and postoperatively, and the rotational alignments of the femoral and tibial components were measured. The difference from the preoperative planning in tibial rotational alignment was measured using three-dimensionally merged pre- and postoperative images. The mean values and rates of outliers in each measurement were compared between the PSI group and the conventional group.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>There were no significant differences in coronal alignment of the femoral and tibial components and rotational alignment of the femoral component between the two groups. With respect to rotational alignment of the tibial component from the preoperatively planned reference axis, the PSI group showed a lower rate of outliers (internal rotation &gt; 10°) than the conventional group (<jats:italic>p</jats:italic> &lt; 0.05).</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>This study demonstrated that the difference from the preoperative planning in tibial rotational positioning was accurately evaluated using novel three-dimensional measurement method, and PSI could reduce outliers in rotational alignment of the tibial component (internal rotation &gt; 10°). PSI is a useful technique for improving the reproducibility of the planned tibial rotational positioning in TKA.</jats:p>
</jats:sec>

DOI： 10.1186/s13018-022-03298-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier {BV}  

DOI： 10.1016/j.jorep.2022.100059

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>We evaluated the relationship between the weight-bearing line (WBL) ratio and anatomical femorotibial angle (FTA) by simulated open wedge high tibial osteotomy (OWHTO). This study evaluated the correlation between the ‘‘Fujisawa point’’ and FTA, and identified factors which caused deviations between the two measurement methods. We hypothesized that the Fujisawa point corresponded with 170° of the FTA.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Preoperative antero-posterior full-length lower limb radiographs of 82 patients were obtained for the OWHTO to place the WBL ratio at a target of 62.5% of the width of the tibial plateau (Fujisawa point). The coronal alignment was measured pre- and post-planning. The patients were divided into two groups by the post-planning FTA: a correspondence group (168.5°≦FTA≦171.5°) and a non-correspondence group (FTA &lt; 168.5°, 171.5° &lt; FTA). The relationship between the Fujisawa point and the FTA was analyzed with multivariate regression analysis.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>The post-planning FTA was 169.8 ± 1.1° and within 170 ± 1.5° in 69 cases (84.1%) when the WBL ratio was 62.5%. The neck shaft angle was 128.1 ± 5.2° in the correspondence group, and 122.3 ± 6.3° in the non-correspondence group. The multivariate linear regression analysis revealed that the neck shaft angle was the only factor that predicted the correspondence of the Fujisawa point with the FTA at 170° (<jats:italic>p</jats:italic> = 0.006, odd 1.28).</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>The post-planning FTA converged at 170° when the WBL ratio passed through the Fujisawa point and the neck shaft angle was the only predictor.</jats:p>
</jats:sec>

DOI： 10.1186/s12891-022-05734-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00402-022-04523-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press ({OUP})  

<jats:title>ABSTRACT</jats:title>
<jats:sec>
<jats:title>Objectives</jats:title>
<jats:p>To evaluate joint orientation angles of the coronal plane in patients with rheumatoid arthritis (RA) in comparison with osteoarthritis (OA).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>In total, 72 patients with RA (90 knees) and 76 patients with OA (90 knees) who underwent total knee arthroplasty were enrolled. The hip–knee–ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative long-leg radiographs in the standing position. Student’s t-test was used to assess differences in radiographic data between patients with RA and OA.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>In knees with RA and OA, the mean HKA was −3.4 ± 9.4° and −10.6 ± 8.0°, the mean mLDFA was 86.6 ± 3.7° and 88.2 ± 2.7°, the mean mMPTA was 85.9 ± 4.0° and 84.3 ± 3.7°, and the mean JLCA was 2.7 ± 4.2° and 6.8 ± 4.1°. All parameters in the knees with RA were more valgus than those with OA.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Knees with RA had a great variability in joint orientation angles on the coronal plane; the whole lower limb alignment and the femur, tibia, and joint were more valgus in knees with RA than with OA.</jats:p>
</jats:sec>

DOI： 10.1093/mr/roab046

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

<jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this study was to evaluate the mid-term clinical outcomes of osteochondral autograft transplantation (OAT) with concomitant high tibial osteotomy (HTO) in spontaneous osteonecrosis of the knee (SONK) with a large lesion. </jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p> A total of 48 knees of 48 consecutive patients with SONK (lesion size ≥4 cm<jats:sup>2</jats:sup>, no age criteria) who underwent opening wedge HTO and concomitant OAT were retrospectively investigated, and those who were followed up postoperatively for at least 5 years were included in this case series study. Clinical outcomes were evaluated using knee and function scores of Knee Society Score, radiographic outcomes were evaluated using the anatomical femorotibial angle (FTA), and these outcomes were compared between patients aged ≥70 years and &lt;70 years. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of the 48 cases, a total of 43 cases were available for review at a minimum of 5 years, and 5 cases were excluded from the analysis. Overall, the mean knee score improved from preoperative 48.8 ± 13.3 to postoperative 87.9 ± 8.6 at 1 year ( P &lt; 0.05) and 85.0 ± 10.4 at final follow-up ( P &lt; 0.05 vs. preop., N.S. vs. 1 year). The mean function score also improved from preoperative 60.1 ± 10.9 to postoperative 87.3 ± 12.2 at 1 year ( P &lt; 0.05) and 84.2 ± 12.4 at final follow-up ( P &lt; 0.05 vs. preop., N.S. vs. 1 year). The mean standing FTA was corrected significantly from 181.1° ± 2.7° preoperatively to 169.7° ± 2.4° at 1 year ( P &lt; 0.05) and 169.4° ± 3.1° at final follow-up ( P &lt; 0.05 vs. preop., N.S. vs. 1 year). There were no significant differences in clinical and radiographic outcomes between patients aged ≥70 years and &lt;70 years. There were 4 cases of lateral hinge fracture around the osteotomy site and 1 case of delayed union. None of the patients underwent revision surgery during the follow-up period (survival rate of 100%). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Mid-term clinical outcomes of patients with SONK who underwent HTO and OAT with a relatively large lesion were good. </jats:p></jats:sec>

DOI： 10.1177/19476035221126341

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

<jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this study was to evaluate the postoperative status of spontaneous osteonecrosis of the knee (SONK) after high tibial osteotomy (HTO) with concomitant bone marrow stimulation (BMS) using synovial fluid (SF) biomarkers. </jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p> Twenty patients with SONK who underwent opening wedge HTO were enrolled. Paired SF samples from the affected knee were collected at the time of HTO surgery and at the time of plate removal. SF concentrations of interleukin (IL)-6, IL-8, and matrix metalloproteinase (MMP)-13 were measured by enzyme-linked immunosorbent assays. The Knee Society Score (KSS) and hip-knee-ankle (HKA) angle were assessed before and 2 years after HTO. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The KSS knee and function scores were significantly improved after HTO (mean changes of 33.8 and 29.4, respectively). The mean HKA angle was changed from mechanical varus (−8.6°) to valgus (5.2°). Concentrations of IL-6, IL-8, and MMP-13 were significantly decreased after HTO (mean changes of −73.7%, −32.4%, and −47.9% from preoperative baseline, respectively). Significant correlations were found between lesion size and concentrations of biomarkers, except for preoperative MMP-13. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> SF levels of biomarkers of inflammation and cartilage degradation were reduced after HTO with a concomitant BMS procedure, suggesting a biological improvement in SONK. </jats:p></jats:sec>

DOI： 10.1177/19476035221118171

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00167-020-06430-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>The purpose of this study was to evaluate return to sports (RTS) after opening wedge high tibial osteotomy (OWHTO) in elderly patients and associated factors affecting RTS.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Seventy-four patients (mean age 68 years) who underwent OWHTO were enrolled. Clinical outcomes were evaluated using the Knee Society Score (KSS). Patients were asked regarding types of sports activities and their levels of participation within preoperative 1 year and postoperative 1 year. Levels of participation in sports and recreational activities were examined using the Tegner activity scale. The outcomes were compared between two age groups (≥ 70 years vs. &lt; 70 years).</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>Of the 74 patients overall, 59 participated in at least one sport preoperatively, and 55 returned to sports postoperatively (RTS 93%). The KSS knee score and function score were significantly improved after surgery in both age groups (<jats:italic>P</jats:italic> &lt; 0.05), but no significant differences were found between the age groups. The Tegner activity scales for ≥ 70 years and &lt; 70 years were 2.9 ± 1.1 and 4.0 ± 1.9 preoperatively (<jats:italic>P</jats:italic> &lt; 0.01) and 2.7 ± 1.2 and 3.3 ± 1.4 postoperatively (<jats:italic>P</jats:italic> = 0.16), respectively. RTS was reported by 24 of 25 (96.0%) in the age &lt; 70 years group and 31 of 34 (91.2%) in the age ≥ 70 years group. Majority of age ≥ 70 years participated in low-impact sports preoperatively and returned to the same impact level postoperatively.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>The rate of RTS after OWHTO was high in patients aged 70 years and older with low-impact level. OWHTO is a preferred surgical option for elderly patients who desire RTS.</jats:p>
</jats:sec>

DOI： 10.1186/s13018-021-02718-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>The purpose of this study was to investigate the correction error associated with soft tissue balance in high tibial osteotomy (HTO) and the difference between opening wedge HTO (OWHTO) and closed wedge HTO (CWHTO).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>A total of 170 knees of 130 patients (85 knees of 68 patients in OWHTO and 85 knees of 62 patients in CWHTO) were evaluated. Anteroposterior radiographs of the knee and full-length leg were taken preoperatively, immediately under general anesthesia postoperatively, 2 days, and 1 and 12 months postoperatively. The femorotibial angle (FTA), joint line convergence angle (JLCA), and medial proximal tibial angle (MPTA) were measured.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>The postoperative FTA was decreased from 170.5 ± 2.1° at 0 day to 168.6 ± 2.2° at 2 days in OWHTO (<jats:italic>P</jats:italic> &lt; 0.05), whereas it was not changed from 168.7 ± 2.4° at 0 day to 168.1 ± 2.8° at 2 days in CWHTO. The JLCA was 4.8 ± 1.8° preoperatively, 4.2 ± 1.9° at 0 day, 2.2 ± 1.8° at 2 days (<jats:italic>P</jats:italic> &lt; 0.05 vs 0 day), 2.6 ± 1.7° at 1 month, and 2.7 ± 1.6° at 12 months in OWHTO, and 7.1 ± 3.2° preoperatively, 4.1 ± 2.4° at 0 day (<jats:italic>P</jats:italic> &lt; 0.05 vs preoperative), 3.4 ± 2.5° at 2 days, 3.9 ± 2.3° at 1 month, and 4.2 ± 2.6° at 12 months in CWHTO. Multiple regression analysis showed that preoperative factors affecting change of the JLCA from preoperative to postoperative 1 month were the correction angle in OWHTO (<jats:italic>P</jats:italic> = 0.001) and the preoperative standing JLCA in OWHTO (<jats:italic>P</jats:italic> &lt; 0.001) and CWHTO (<jats:italic>P</jats:italic> &lt; 0.001).</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>A significant decrease of the JLCA occurred immediately after osteotomy under anesthesia in CWHTO, whereas in OWHTO there was no decrease under anesthesia, but it decreased several days postoperatively.</jats:p>
</jats:sec>

DOI： 10.1186/s13018-021-02214-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00167-020-06296-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier {BV}  

DOI： 10.1016/j.joca.2021.03.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier {BV}  

PURPOSE: To determine whether medialization of the proximal tibia due to a varus deformity is related to lateralization of the tibial tuberosity in varus knee osteoarthritis (OA). METHODS: A total of 120 knees that underwent osteotomies around the knee for varus knee OA were enrolled. Mechanical medial proximal tibial angle (mMPTA) was measured on radiographs. The angle between the mechanical and anatomical axes of the tibia (angle MA) and the distance between the centre of the tibial plateau and the anatomical axis (distance MA) were measured in the coronal plane on computed tomography images. The tibial tuberosity-posterior cruciate ligament (TT-PCL) distance, the distance between the midpoint of the tibial tuberosity and the centre of the tibial plateau (TT-centre distance), and the angle between the line through the midpoint of the tibial tuberosity and the centre of the tibial plateau and the anteroposterior axis (TT-centre angle) were measured in the axial plane. The correlations of these parameters were evaluated. RESULTS: mMPTA correlated negatively with angle MA (r = -0.37, P < 0.01) and distance MA (r = -0.55, P < 0.01). Angle MA and distance MA correlated with TT-PCL distance (r = 0.39, P < 0.01, r = 0.42, P < 0.01), TT-centre distance (r = 0.35, P < 0.01, r = 0.38, P < 0.01) and TT-centre angle (r = 0.36, P < 0.01, r = 0.36, P < 0.01). CONCLUSIONS: Medialization of the proximal tibia due to a varus deformity may induce lateralization of the tibial tuberosity.

DOI： 10.1016/j.knee.2021.03.023

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：{SAGE} Publications  

<jats:sec><jats:title>Purpose:</jats:title><jats:p> The aim of this study was to assess differences in clinical outcomes and postoperative cartilage repair between opening wedge high tibial osteotomy (OWHTO) and closed wedge HTO (CWHTO) for medial osteoarthritis (OA) of the knee. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A total of 90 knees of 76 patients who underwent OWHTO (45 knees of 40 patients) and CWHTO (45 knees of 36 patients) was followed-up for 2 years. Cartilage repair at the medial compartment was arthroscopically classified into the following stages: Stage 1 (no reparative change); Stage 2 (partial coverage with white cartilaginous tissue); and Stage 3 (full coverage with white cartilaginous tissue). Clinical outcomes were assessed using Knee Society scores, and radiographic assessment was carried out by anatomical femorotibial angle (aFTA). </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Regarding preoperative OA grade, varus alignment, and function score, CWHTO patients showed more advanced OA status than OWHTO patients. Knee scores and function scores were significantly improved after surgery with both HTO procedures (P &lt; 0.05), with no significant difference between the two procedures. Cartilage repair of stage 2 or 3 was found in more than 80% of the subjects in the medial femoral condyle and more than 60% in the medial tibial condyle. However, there were no significant differences between the two HTO procedures. Multivariate logistic regression analysis showed that preoperative International Cartilage Repair Society (ICRS) grade was the only factor affecting cartilage repair. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> CWHTO improved clinical outcomes and cartilage status as much as OWHTO. Although the effects of cartilage repair on clinical outcomes are unknown, HTO is an effective treatment option even for severe medial OA of the knee. </jats:p></jats:sec>

DOI： 10.1177/23094990211020366

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00402-020-03738-3

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00167-020-06025-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Hindawi Limited  

<jats:p>The present study is aimed at assessing the changes in tibial rotation at the osteotomy site after an open-wedge, high-tibial osteotomy (OWHTO) and analysing the factors that affect rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the same site. This study involved 53 patients (60 knees; 16 males and 37 females) with medial osteoarthritis (OA) who underwent OWHTO and preoperative and 3-month postoperative computed tomography (CT) scans. Rotational angles of the distal tibia were measured using Stryker OrthoMap 3D by comparing preoperative and postoperative CTs. The mean rotational angle yielded an external rotation of<jats:inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" id="M1"><msup><mrow><mn>2.9</mn></mrow><mrow><mo>°</mo></mrow></msup><mo>±</mo><msup><mrow><mn>4.8</mn></mrow><mrow><mo>°</mo></mrow></msup></math></jats:inline-formula>. There were 17 knees with internal rotations, 37 knees with external rotations, and one knee with no rotation. The rotational angle significantly correlated with the resultant change in the femorotibial angle (correction angle) and the angle between the ascending and transverse osteotomy lines on the anterior osteotomised surface on which a flange was formed with the distal tibial osteotomised surface (flange angle). The flange angle affected the rotation, but it may have been affected by our surgical technique. The rotational angle did not significantly correlate with the change in the angle of the posterior tibial slope or body mass index. There were significant correlations between the rotational angle and correction angle (<jats:inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" id="M2"><mi>r</mi><mo>=</mo><mn>0.42</mn></math></jats:inline-formula>,<jats:inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" id="M3"><mi>p</mi><mo>&lt;</mo><mn>0.05</mn></math></jats:inline-formula>). Additionally, the rotational angle correlated with the flange angle (<jats:inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" id="M4"><mi>r</mi><mo>=</mo><mo>−</mo><mn>0.41</mn></math></jats:inline-formula>,<jats:inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" id="M5"><mi>p</mi><mo>&lt;</mo><mn>0.05</mn></math></jats:inline-formula>).</jats:p>

DOI： 10.1155/2021/6357109

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00167-020-06000-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00402-020-03419-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (<jats:italic>P</jats:italic> &lt;  0.05), and a greater soft tissue correction than OWHTO (<jats:italic>P</jats:italic> &lt;  0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (<jats:italic>P</jats:italic> &lt;  0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.</jats:p>
</jats:sec>

DOI： 10.1186/s12891-020-03703-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>To investigate the relationship between femoral or tibial torsion and hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), or mechanical medial proximal tibial angle (mMPTA) in patients with medial knee osteoarthritis (OA).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>A total of 75 knees were enrolled. Femoral and tibial torsions were measured by superimposing the axial planes of computed tomography images. The relationship between femoral or tibial torsion and HKA, mLDFA, or mMPTA on radiographs was examined.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>The mean femoral torsion was 12.2 ± 8.5° internally; femoral internal and external torsions were observed in 70 and 5 knees, respectively. The mean tibial external torsion was 18.0 ± 7.4° externally; tibial external torsion was observed in all 75 knees. Femoral internal and tibial external torsions increased with lower mMPTA (<jats:italic>r</jats:italic> = 0.33, <jats:italic>P</jats:italic> = 0.003; <jats:italic>r</jats:italic> = − 0.32, <jats:italic>P</jats:italic> = 0.005, respectively) but were not related to HKA or mLDFA.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>Femoral and tibial torsions were correlated with varus inclination of the proximal tibia in patients with medial knee OA.</jats:p>
</jats:sec>

DOI： 10.1186/s12891-020-03286-2

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記述言語：日本語   出版者・発行元：日本リウマチの外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier {BV}  

BACKGROUND: The purpose of this study was to investigate the healing process of synthetic bone grafts in opening wedge high tibial osteotomy (OWHTO) and to identify the factors that affect bone healing in OWHTO. It was hypothesized that lateral hinge fracture (LHF) is associated with delayed bone healing after OWHTO with synthetic bone grafting. METHODS: The subjects included 350 knees of 283 patients who underwent OWHTO using two wedged blocks of beta-tricalcium phosphate (β-TCP) with 60% porosity. The healing of the osteotomy gap using a radiologic rating system for OWHTO with synthetic bone grafts and the presence of an LHF were assessed up to postoperative 24 months. RESULTS: LHFs were found in 49 knees (14%). The osteotomy gap showed slower progression of radiographic healing with an LHF than without an LHF (P < .05). In the knees with LHFs, initial radiographic change in the osteotomy gap was observed almost at the same time as healing of the LHF. Multivariate logistic regression analysis identified LHF as the factor preventing the progression of bone healing (OR = 46.78, P < .05). CONCLUSIONS: LHF is associated with delayed bone healing after OWHTO with synthetic bone grafting.

DOI： 10.1016/j.knee.2019.10.027

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12891-018-2257-6

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