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Improved Coronal Alignment Using the Preemptive Joint Line Convergence Angle Compensation Method in Medial Open Wedge

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Summary

The preemptive joint line convergence angle (JLCA) compensation method significantly improves coronal alignment accuracy in medial open wedge high tibial osteotomy (MOWHTO). This method achieved 95% acceptable alignment, compared to 60% with the conventional approach.

Keywords:
correction anglehigh tibial osteotomyjoint line convergence angleosteoarthritis

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Radiology

Background:

  • Accurate coronal alignment is critical for medial open wedge high tibial osteotomy (MOWHTO) outcomes.
  • Postoperative joint line convergence angle (JLCA) changes can lead to coronal alignment errors.
  • The clinical utility of a preemptive JLCA compensation method for MOWHTO requires further investigation.

Purpose of the Study:

  • To evaluate the accuracy of a preemptive JLCA compensation method in calculating the correction angle for MOWHTO.
  • To compare the radiologic and functional outcomes of MOWHTO using the preemptive JLCA compensation method versus the conventional Miniaci method.

Main Methods:

  • A cohort study (Level of evidence, 3) compared MOWHTO patients using the conventional Miniaci method versus a preemptive JLCA compensation method.
  • Propensity score matching was used for baseline variables including hip-knee-ankle (HKA) angle and Kellgren-Lawrence grade.
  • Radiologic outcomes (weightbearing ratio) and functional scores (Lysholm, IKDC) were analyzed at 1-year postoperative follow-up.

Main Results:

  • After matching, 20 patients were in each group with similar preoperative alignment.
  • The preemptive JLCA method resulted in 95.0% of patients achieving acceptable target alignment, significantly higher than the 60.0% in the conventional group (P = .014).
  • No significant differences in functional outcomes (Lysholm, IKDC scores) were observed between the groups at short-term follow-up.

Conclusions:

  • The preemptive JLCA compensation method significantly enhances the accuracy of coronal alignment correction in MOWHTO.
  • While short-term functional outcomes were similar, the improved alignment accuracy suggests potential long-term benefits.
  • This method offers a valuable improvement for achieving precise coronal alignment in MOWHTO procedures.