Impact of lower limb weightbearing line ratio on motor function recovery after high tibial osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Zhaoqi ¹ ,  YANG Weiyi ² , PAN Jianke ² , HAN Yanhong ²

1. The Second School of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
2. Department of Sports Medicine, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou Guangdong, 510120, P. R. China;

Corresponding author：

YANG Weiyi, Email: czyangwy@163.com

Keywords：

Knee osteoarthritis; high tibial osteotomy; lower limb weightbearing line ratio; receiver operating characteristic curve; motor function recovery

DOI：

10.7507/1002-1892.202507055

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Objective To determine the impact of the lower limb weight-bearing line ratio (WBLR) on motor function recovery after high tibial osteotomy (HTO). Methods A retrospective analysis was conducted on 55 patients with unilateral compartment knee osteoarthritis who underwent open-wedge HTO between August 2020 and October 2023 and met the selection criteria. Based on the postoperative Lysholm score, patients were divided into two groups: the good knee function group (Lysholm score≥90, group A) and the poor knee function group (Lysholm score<90, group B). Lysholm score, American Knee Society (AKS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and visual analogue scale (VAS) score for pain were compared between the two groups. Univariate analysis was performed on baseline data including gender, age, body mass index (BMI), affected side, disease duration, Kellgren-Lawrence grade, and radiographic parameters including preoperative and postoperative medial proximal tibial angle, lateral distal femoral angle, femorotibial angle, hip-knee-ankle angle (HKA), WBLR, posterior tibial slope angle, and joint line convergence angle to identify factors influencing functional recovery. Multivariate logistic regression analysis was further used to identify independent factors. Additionally, receiver operating characteristic (ROC) curve analysis was employed to determine the optimal cut-off value of postoperative WBLR for predicting motor function recovery, and the area under curve (AUC) was calculated to assess diagnostic performance. Results All 55 patients were followed up 10-14 months (mean, 11.8 months). According to the postoperative Lysholm score, there were 30 patients in group A and 25 in group B. All postoperative clinical scores in group A were significantly better than those in group B (P<0.05). Univariate analysis indicated that age, BMI, postoperative HKA, and postoperative WBLR were influencing factors for motor function recovery (P<0.1). Further multivariate logistic regression analysis identified a postoperative WBLR≤55.5% as an independent factor influencing motor function recovery (P<0.05). ROC curve analysis yielded an AUC of 0.788 and determined the optimal postoperative WBLR cut-off value for predicting motor function recovery to be 55.5% (P<0.001).Conclusion A postoperative WBLR of 55.5% is associated with optimal motor function recovery after HTO.

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2.	Flandry F, Hommel G. Normal anatomy and biomechanics of the knee. Sports Med Arthrosc Rev, 2011, 19(2): 82-92.
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5.	Kim KI, Seo MC, Song SJ, et al. Change of chondral lesions and predictive factors after medial open-wedge high tibial osteotomy with a locked plate system. Am J Sports Med, 2017, 45(7): 1615-1621.
6.	Antonescu DN. L’ostéotomie du genou est-elle encore indiquée dans la gonarthrose? [Is knee osteotomy still indicated in knee osteoarthritis?]. Acta Orthop Belg, 2000, 66(5): 421-432.
7.	Agneskirchner JD, Hurschler C, Wrann CD, et al. 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.
8.	Saragaglia D, Rouchy RC, Krayan A, et al. Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritis. Int Orthop, 2014, 38(10): 2109-2114.
9.	Kanto R, Nakayama H, Iseki T, et al. Return to sports rate after opening wedge high tibial osteotomy in athletes. Knee Surg Sports Traumatol Arthrosc, 2021, 29(2): 381-388.
10.	Alzahrani AA. Impaction of rehabilitations and strengthening programs before and after anterior cruciate ligament reconstruction in return to the fitness level. J Environ Public Health, 2022, 2022: 7906341. doi: 10.1155/2022/7906341.
11.	Fujisawa Y, Masuhara K, Shiomi S. 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.
12.	Koshino T, Wada S, Ara Y, et al. Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee, 2003, 10(3): 229-236.
13.	Kumagai K, Akamatsu Y, Kobayashi H, et al. Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 779-784.
14.	Otsuki S, Ikeda K, Ishitani T, 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.
15.	Jung WH, Takeuchi R, Chun CW, et al. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy, 2014, 30(1): 72-79.
16.	Lee SS, Kim JH, Kim S, et al. Avoiding overcorrection to increase patient satisfaction after open wedge high tibial osteotomy. Am J Sports Med, 2022, 50(9): 2453-2461.

1. Mobasheri A, Batt M. An update on the pathophysiology of osteoarthritis. Ann Phys Rehabil Med, 2016, 59(5-6): 333-339.
2. Flandry F, Hommel G. Normal anatomy and biomechanics of the knee. Sports Med Arthrosc Rev, 2011, 19(2): 82-92.
3. Murray R, Winkler PW, Shaikh HS, et al. High tibial osteotomy for varus deformity of the knee. J Am Acad Orthop Surg Glob Res Rev, 2021, 5(7): e21.00141. doi: 10.5435/JAAOSGlobal-D-21-00141.
4. Schuster P, Geßlein M, Schlumberger M, et al. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med, 2018, 46(6): 1362-1370.
5. Kim KI, Seo MC, Song SJ, et al. Change of chondral lesions and predictive factors after medial open-wedge high tibial osteotomy with a locked plate system. Am J Sports Med, 2017, 45(7): 1615-1621.
6. Antonescu DN. L’ostéotomie du genou est-elle encore indiquée dans la gonarthrose? [Is knee osteotomy still indicated in knee osteoarthritis?]. Acta Orthop Belg, 2000, 66(5): 421-432.
7. Agneskirchner JD, Hurschler C, Wrann CD, et al. 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.
8. Saragaglia D, Rouchy RC, Krayan A, et al. Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritis. Int Orthop, 2014, 38(10): 2109-2114.
9. Kanto R, Nakayama H, Iseki T, et al. Return to sports rate after opening wedge high tibial osteotomy in athletes. Knee Surg Sports Traumatol Arthrosc, 2021, 29(2): 381-388.
10. Alzahrani AA. Impaction of rehabilitations and strengthening programs before and after anterior cruciate ligament reconstruction in return to the fitness level. J Environ Public Health, 2022, 2022: 7906341. doi: 10.1155/2022/7906341.
11. Fujisawa Y, Masuhara K, Shiomi S. 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.
12. Koshino T, Wada S, Ara Y, et al. Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee, 2003, 10(3): 229-236.
13. Kumagai K, Akamatsu Y, Kobayashi H, et al. Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 779-784.
14. Otsuki S, Ikeda K, Ishitani T, 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.
15. Jung WH, Takeuchi R, Chun CW, et al. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy, 2014, 30(1): 72-79.
16. Lee SS, Kim JH, Kim S, et al. Avoiding overcorrection to increase patient satisfaction after open wedge high tibial osteotomy. Am J Sports Med, 2022, 50(9): 2453-2461.

Chinese Journal of Reparative and Reconstructive Surgery

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