Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy.

PURPOSE: To determine the classification scheme for osteoarthritis severity grading that most closely correlates with postoperative clinical outcomes and to identify the positive and negative prognostic factors for medial open-wedge high-tibial osteotomy (OWHTO). METHODS: Seventy-nine consecutive patients with primary varus osteoarthritis were treated using OWHTO. Arthritic grading was determined by arthroscopic assessment according to the modified Outerbridge classification and by radiographic classification according to the Kellgren-Lawrence (KL) grading scale on standing anteroposterior (AP) and 45° posteroanterior (PA) flexion weight-bearing radiography. Clinical outcome was assessed using the Oxford Knee Score (OKS), which was evaluated both preoperatively and at the postoperative 2-year follow-up after OWHTO. Multivariate regression analyses were used to explore and quantify the influence of baseline patient demographics, variables related to arthroscopic and radiological grades of arthritis, as well as postoperative alignment changes on the OKS. RESULTS: At the 2-year follow-up, the mean OKS had improved from 20 ± 4 to 39 ± 5 points (p < 0.001). The average mechanical femorotibial and mechanical medial proximal tibial angle (MPTA) changed from 6.9° ± 3.4° to valgus 2.7° ± 2.8° and from 85.6° ± 2.4° to 92.9° ± 3.7° (all p < 0.001). The osteoarthritis severity grade based on the KL scale was 2.4 ± 0.9 on standing AP radiography, 2.8 ± 0.9 on 45° PA flexion weight-bearing radiography (p = 0.003), and 3.4 ± 0.7 according to the modified Outerbridge classification. In the multivariate analyses, the KL grade on 45° PA flexion weight-bearing radiography (p = 0.01) and postoperative MPTA (p = 0.01) showed significant negative correlations with postoperative OKS at the 2-year follow-up. CONCLUSION: The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest significant negative correlation with postoperative OKS after the OWHTO procedure using three different common OA classification schemes, which should be considered to determine the surgical indication of HTO. The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest correlation with high-tibial osteotomy-surgical indications and the counselling of patients with advanced osteoarthritis. LEVEL OF EVIDENCE: IV.

A Retrospective Comparison of Union Rates After Open Wedge High Tibial Osteotomies With and Without Synthetic Bone Grafts (Hydroxyapatite and ß-tricalciumphosphate) at 2 Years.

PURPOSE: To evaluate the clinical and radiological results of no bone graft (NBG) after opening wedge high tibial osteotomy (OWHTO) with a locking plate and to compare the bone union rate between the synthetic bone graft (SBG) group and the NBG group after OWHTO using serial radiographs. METHODS: From 2012 to 2015, OWHTOs were performed with SBG or without bone graft using long locking plates. Inclusion criteria were: (1) OWHTO for disease of the medial compartment with varus deformity, and (2) minimum 2-year follow-up and radiographs taken serially to 2 years. Exclusion criteria were: (1) follow-up period <2 years (n = 8) or (2) absence of at least 1 radiograph taken at each follow-up point (n = 14). We retrospectively reviewed radiographs taken preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Groups comprised those filled with a synthetic bone [hydroxyapatite (HA) and ß-tricalciumphosphate (TCP), n=33, SBG group] or without a bone graft (n = 38, NBG group). We compared bone union rate between the 2 groups by measuring the union zone from zone 1 to zone 5 in serial radiographs using Fisher's exact test. RESULTS: OWHTO was performed in a total of 93 knees and 71 knees were included in this study. Both groups showed good clinical and radiological results without correction loss at 2 years. The entire NBG group and 93.9% of the SBG group showed union over zone 3 at 2 years. However, the NBG group showed significantly more incorporation than the SBG group at 6 months (P = .006), 1 year (P = .0003), and 2 years (P = .0003). CONCLUSIONS: Union without correction loss was obtained after OWHTO without bone graft. The NBG group showed significantly more incorporation than the SBG group (HA and ß-TCP) within 2 years. LEVEL OF EVIDENCE: Level IV, case series.

A ligament reattachment technique for high-demand athletes with chronic ankle instability.

The present prospective study was conducted to evaluate the clinical outcomes of the new ligament reattachment procedure for chronic lateral ankle instability in high-demand athletes. A total of 24 athletes <30 years old were followed for >2 years after undergoing the modified Brostrom procedure using the suture bridge technique. The clinical evaluation included the Karlsson score, the Sefton grading system, and the period to return to exercise. As an evaluation of mechanical stability, the talar tilt angle and anterior talar translation were measured on stress radiographs. The Karlsson score had improved significantly from a preoperative average of 43.5 points to 92.2 points. Using the Sefton grading system, 22 (91.7%) patients achieved satisfactory results. The period to return to exercise was as follows: a mean of 8.4 weeks for jogging, 12.5 weeks for spurt running, 10.5 weeks for jumping, 9.2 weeks for 1 leg standing for >1 minute, 10.6 weeks for walking on uneven ground, and 11.2 weeks for going downstairs. The talar tilt angle and anterior talar translation had improved significantly from the preoperative average of 15.4° and 13.3 mm to 3.8° and 4.2 mm at 2 months postoperatively and 4.9° and 4.8 mm at the final follow-up visit, respectively. The modified Brostrom procedure using the suture bridge technique resulted in satisfactory clinical outcomes comparable to those with conventional ligament reattachment techniques. The suture bridge technique appears to be an effective treatment option for chronic ankle instability in high-demand athletes.