Does Medial Joint Opening Explain PROMs after HTO Better Than Mechanical-axis Deviation?

PROMs were better in the group achieving medial joint opening (ΔJLCA >1° in the abstract; all P < 0.05).

Research structure

01
Subject
101 patients · 121 knees.
02
Methods
A retrospective analysis of 121 knees compared opening- and closing-wedge osteotomy. It assessed 1-year PROMs, JLCA and the standing–supine JLCA difference (JLCAPD), and derived ROC thresholds.
03
Reported Results
PROMs were better in the group achieving medial joint opening (ΔJLCA >1° in the abstract; all P < 0.05).

An explanatory schematic separating the study population, methods, and results. It is not an original paper figure.

Evidence & Original Source

Abstract commentary

Participants and Methods

A retrospective analysis of 121 knees compared opening- and closing-wedge osteotomy. It assessed 1-year PROMs, JLCA and the standing–supine JLCA difference (JLCAPD), and derived ROC thresholds. 101 patients · 121 knees.

Main Findings

PROMs were better in the group achieving medial joint opening (ΔJLCA >1° in the abstract; all P < 0.05). PROMs did not differ between the group deviating by more than 10% from the mechanical-axis target and the group within the acceptable range (all P > 0.05). The effect of JLCAPD on postoperative mechanical-axis deviation was greater with closing-wedge osteotomy.

The point of reading on surgery

The findings support studying differences between HTO techniques and accounting for joint laxity and opening, alongside the amount of bone correction, in surgical planning.

Limitations

These are associations from nonrandomized observations. They do not establish a causal effect of a particular correction target or a universal surgical rule. The sign of ΔJLCA must not be interpreted using definitions from other papers.

Let's put it briefly.

What did this study confirm?

PROMs were better in the group achieving medial joint opening (ΔJLCA >1° in the abstract; all P < 0.05).

Can it be applied directly to individual patients' treatment decisions?

Keywords

Knee Joint
Osteoarthritis, Knee
Retrospective Studies
Tibia
Osteotomy
HTO
JLCA
soft tissue laxity

Abstract · Original text

Sung E Kim, Junpyo Kwak, Du H Ro, Myung C Lee, Hyuk-Soo Han. The use of medial joint opening rather than mechanical axis deviation to determine the clinical outcomes after high tibial osteotomy. The bone & joint journal. 2024;106-B(3):240-248. doi:10.1302/0301-620X.106B3.BJJ-2023-0337.R3.

Excerpt from the original abstract

The aim of this study was to evaluate whether achieving medial joint opening, as measured by the change in the joint line convergence angle (∆JLCA),…

Read abstract on PubMed

The original paper.

The use of medial joint opening rather than mechanical axis deviation to determine the clinical outcomes after high tibial osteotomy

Sung Eun Kim, Junpyo Kwak, Du Hyun Ro, Myung Chul Lee, Hyuk-Soo Han
Bone & Joint Journal · 2024

DOI · 10.1302/0301-620X.106B3.BJJ-2023-0337.R3 PubMed Based data

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