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Osseous factors influencing distal tibial rotation in biplane medial opening wedge high tibial osteotomy

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Abstract

Purpose

There is a lack of studies investigating the distal tibial rotation (DTR) during medial opening wedge high tibial osteotomy (MOWHTO). This study was designed to evaluate osseous factors influencing DTR in patients who underwent biplane MOWHTO.

Methods

A total of 106 knee joints in 69 patients who underwent surgery for varus malalignment of knee were reviewed. Based on several software, standard and actual hinge positions were defined in pre-operative and post-operative CT data. Pearson’s correlation and Spearman’s correlation analysis were performed with DTR change as the dependent variable. Independent variables included angles between standard and actual hinge in the sagittal (ASAHS) and axial (ASAHA) planes, pre-operative and post-operative medial proximal tibial angle, opening width (OW), tuberosity osteotomy angle, flange angle (FA), gap ratio, and hinge fracture.

Results

The distal tibia rotated approximately 0.35° internally. Pearson’s and Spearman’s correlation analysis showed that DTR change was associated with ASAHS, OW, and FA. Larger OW and FA resulted in higher external rotation angles.

Conclusions

DTR change was significantly associated with ASAHS, followed by OW and FA rather than ASAHA if only considering osseous factors in biplane MOWHTO. The distal tibia tended to rotate externally when the actual hinge was inclined posteriorly to the standard hinge in the sagittal planes, but rotate externally or internally when the actual hinge was inclined anteriorly.

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Data availability

The data are available from the corresponding author on reasonable request.

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Funding

This work was supported by grants from China Research and Promotion of Traditional Chinese Medicine (2021-18) and grants from the Traditional Chinese Medicine Technology of Shandong Province (2021M173).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shandong Provincial Hospital, Shandong University, **an, 250021, Shandong Province, China

    Lizhong **g & Jian Wang

  2. Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, **an, 250011, Shandong Province, China

    Lizhong **g, Weiguo Wang, Le Yu & Jiushan Yang

  3. Department of Radiology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, **an, 250011, Shandong Province, China

    **a Zhao

Authors
  1. Lizhong **g
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  2. **a Zhao
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  3. Weiguo Wang
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  4. Le Yu
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  5. Jiushan Yang
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  6. Jian Wang
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Contributions

LZJ contributed to the literature search, data analysis, and manuscript preparation. WGW contributed to data collection. LY contributed to statistics analysis and manuscript editing. XZ contributed to the data collection and analysis. JSY contributed to the conceptualization and manuscript review. JW contributed to the substantial conceptualization, supervision, and final approval of the draft version. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Jiushan Yang or Jian Wang.

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Ethics approval

This study was approved by the Board of Research Ethics of our hospital (2021-059-KY).

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Every patient signed informed consent in this study.

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The authors declare no competing interests.

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**g, L., Zhao, X., Wang, W. et al. Osseous factors influencing distal tibial rotation in biplane medial opening wedge high tibial osteotomy. International Orthopaedics (SICOT) 48, 465–471 (2024). https://doi.org/10.1007/s00264-023-05968-7

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  • DOI: https://doi.org/10.1007/s00264-023-05968-7

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