Association Between Joint Line Convergence Angle and Patient-Reported Outcomes of Opening-Wedge High Tibial Osteotomy

Abstract

Background:

A larger joint line convergence angle (JLCA) increases the stress load on the medial compartment. Few reports, however, have discussed the effect of the JLCA on the cartilage status and clinical outcomes after opening-wedge high tibial osteotomy (OWHTO).

Purpose/Hypothesis:

To reveal the effect of the JLCA on clinical results after OWHTO. We hypothesized that a smaller JLCA improves cartilage status and clinical outcomes by reducing mechanical stress in the medial compartment.

Study Design:

Cohort study: Level of evidence, 3.

Methods:

This retrospective study included 106 knees that underwent OWHTO and second-look arthroscopy during implant removal 1 year after OWHTO. The mean follow-up period was 5.5 (SD, 2.9) years. The pre- and postoperative JLCAs were measured radiographically. The International Cartilage Repair Society (ICRS) grades of the medial femoral condyle (MFC) and the medial tibial plateau (MTP) were evaluated during the initial and second-look arthroscopy. The relationship between the JLCA and cartilage status, and the Knee injury and Osteoarthritis Outcome Score (KOOS) at the final follow-up were evaluated.

Results:

Preoperative JLCA was related to improvements in the ICRS grade of the MFC and the MTP, with cutoff values of 2.6° (sensitivity, 0.700; specificity, 0.561; P = .016) and 2.4° (sensitivity, 0.704; specificity, 0.595; P = .028), respectively. In addition, the preoperative JLCA was related to KOOS Pain (P = .037), Symptoms (P < .001), Activities of Daily Living (P = .005), Sports Activities (P = .005), and Quality of Life (P = .006) subscales using multivariable linear regression analysis. The postoperative JLCA was not related to the improvement in the ICRS grade of the MFC but was related to the improvement in the ICRS grade of the MTP, with a cutoff value of 1.6° (sensitivity, 0.704; specificity, 0.603; P = .015). Furthermore, postoperative JLCA was related to the KOOS Pain (P = .004), Symptoms (P = .002), Activities of Daily Living (P = .031), Sports Activities (P < .001), and Quality of Life (P = .015) subscales.

Conclusion:

A smaller pre- and postoperative JLCA was related to improvements in the ICRS grade and favorable clinical outcomes, with a mean 5.5-year follow-up after OWHTO.

Keywords

cartilage improvement clinical outcomes joint line convergence angle open-wedge high tibial osteotomy

Get full access to this article

View all access options for this article.

References

Agneskirchner

Hurschler

Stukenborg-Colsman

Imhoff

Lobenhoffer

Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg. 2004;124(9):575-584.

Agneskirchner

Hurschler

Wrann

Lobenhoffer

The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy. 2007;23(8):852-861.

Fujisawa

Masuhara

Shiomi

The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585-608.

Gielis

Rayegan

Arbabi

, et al. Predicting the mechanical hip-knee-ankle angle accurately from standard knee radiographs: a cross-validation experiment in 100 patients. Acta Orthop. 2020; 91(6):732-737.

Glyn-Jones

Palmer

AJR

Agricola

, et al. Osteoarthritis. Lancet. 2015;386(9991):376-387.

Goshima

Sawaguchi

Shigemoto

, et al. Factors associated with patient satisfaction after opening-wedge high tibial osteotomy. Orthop J Sports Med. 2020;8(11):2325967120967964.

Goto

Okazaki

Akiyama

, et al. Alignment factors affecting the medial meniscus extrusion increase the risk of osteoarthritis development. Knee Surg Sports Traumatol Arthrosc. 2019;27(8):2617-2623.

Herman

Giffin

. High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis. J Orthop Traumatol. 2016; 17(3):277-285.

Iseki

Takahashi

Takeda

, et al. Defining the load-bearing axis of the lower extremity obtained from anterior-posterior digital radiographs of the whole limb in stance. Osteoarthritis Cartilage. 2009; 17(5):586-591.

10.

Iwasaki

Ohkoshi

Hosokawa

, et al. Higher association of pelvis-knee-ankle Angle compared with hip-knee-ankle angle with knee adduction moment and patient-reported outcomes after high tibial osteotomy. Am J Sports Med. 2023;51(4):977-984.

11.

Jeong

Shim

Park

Lee

YS.

Analysis of the determinant factor of the medial joint space width after medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg. 2023;143(8):4879-4888.

12.

Kanto

Nakayama

Iseki

, et al. Return to sports rate after opening wedge high tibial osteotomy in athletes. Knee Surg Sports Traumatol Arthrosc. 2021;29(2):381-388.

13.

Katagiri

Shioda

Nakagawa

, et al. Risk factors affecting return to sports and patient-reported outcomes after opening-wedge high tibial osteotomy in active patients. Orthop J Sports Med. 2022;10(9):23259671221118836.

14.

Katayama

Nakashima

Takahara

, et al. Effect of hardware removal and second-look arthroscopy after open-wedge high tibial osteotomy. Arch Orthop Trauma Surg. 2024;144(1):73-79.

15.

Kim

Son

Koh

Bahk

. Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg. 2017;137(8):1035-1045.

16.

Koshino

Wada

Ara

Saito

. Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee. 2003;10(3):229-236.

17.

Kozaki

Fukui

Yamamoto

, et al. Medial meniscus extrusion and varus tilt of joint line convergence angle increase stress in the medial compartment of the knee joint in the knee extension position-finite element analysis. J Exp Orthop. 2022;9(1):49.

18.

Kwak

Lee

Han

. The large meniscus extrusion ratio is a poor prognostic factor of conservative treatment for medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc. 2018;26(3):781-786.

19.

Lee

Park

Han

SB.

Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2016;24(12): 3704-3712.

20.

Lee

Wang

Won

, et al. Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28(5):1411-1418.

21.

Lee

Kim

Choi

Factors related to the early outcome of medial open wedge high tibial osteotomy: coronal limb alignment affects more than cartilage degeneration state. Arch Orthop Trauma Surg. 2021;141(8):1339-1348.

22.

Lee

Bin

Kim

Lee

Suh

Song

JH.

Joint space width increases medially and decreases laterally at different time points after medial open-wedge high tibial osteotomy. Arthroscopy. 2021;37(11):3316-3323.

23.

Mabrouk

Kley

Jacquet

Fayard

Olivier

Outcomes of slope-reducing proximal tibial osteotomy combined with a third anterior cruciate ligament reconstruction procedure with a focus on return to impact sports. Am J Sports Med. 2023; 51(13):3454-3463.

24.

Matsubara

Onodera

Iwasaki

, et al. Discrepancy in the distribution patterns of subchondral bone density across the ankle joint after medial opening-wedge and lateral closing-wedge high tibial osteotomy. Am J Sports Med. 2022;50(2):478-485.

25.

Micicoi

Khakha

Kley

Wilson

Cerciello

Ollivier

Managing intra-articular deformity in high tibial osteotomy: a narrative review. J Exp Orthop. 2020;7(1):65.

26.

Mina

Garrett

Jr Pietrobon

Glisson

Higgins

High tibial osteotomy for unloading osteochondral defects in the medial compartment of the knee. Am J Sports Med. 2008;36(5):949-955.

27.

Bae

Yoon

Kim

JG.

Analysis of knee joint line obliquity after high tibial osteotomy. J Knee Surg. 2016;29(3):649-657.

28.

Otsuki

Ikeda

Ishitani

, et al. Impact of the weightbearing line on cartilage regeneration of the medial knee compartment after open-wedge high tibial osteotomy, based on second-look arthroscopy. Cartilage. 2022;13(4):87-93.

29.

Saragaglia

Rouchy

Krayan

Refaie

Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritis. Int Orthop. 2014;38(10):2109-2114.

30.

Schroter

Ihle

Mueller

Lobenhoffer

Stockle

van Heerwaarden

Digital planning of high tibial osteotomy: interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):189-196.

31.

S-Y

Lee

S-S

Jung

Kim

Wang

JH.

Difference in joint line convergence angle between the supine and standing positions is the most important predictive factor of coronal correction error after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28(5):1516-1525.

32.

Steffen

Ihle

Mueller

Lobenhoffer

Stöckle

Heerwaarden

Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):189-196.

33.

Takagawa

Kobayashi

Yukizawa

Oishi

Tsuji

Inaba

Preoperative soft tissue laxity around knee was associated with less accurate alignment correction after hybrid closed-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28(9): 3022-3030.

34.

Tsushima

Sasaki

Sakamoto

Kimura

Tsuda

Ishibashi

Joint line convergence angle is the most associated alignment factor with the severity of medial knee osteoarthritis. J Exp Orthop. 2024;11(3):e70007.

35.

Wang

Cai

Liu

, et al. Exploring biomarkers associated with severity of knee osteoarthritis in Southern China using widely targeted metabolomics. BMC Musculoskelet Disord. 2023;24(1):953.