Axial rotation of the hinge axis can cause changes in coronal tibial alignment in anterior tibial closing wedge osteotomy in a 3D simulation model

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-03-07 DOI:10.1002/jeo2.70198

Julius Watrinet, Philipp Blum, Lukas Willinger, Julian Mehl, Sebastian Siebenlist, Markus Bormann, Wolfgang Böcker, Boris Holzapfel, Julian Fürmetz

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Abstract

Purpose

Clinical evidence indicates that an unintended increase in the medial proximal tibial angle (MPTA) can occur during slope-reducing tibial osteotomies, which is most relevant in anterior cruciate ligament (ACL) deficient knees. Therefore, the purpose of this three-dimensional (3D) simulation study is to assess how axial or coronal hinge axis rotation affect alignment parameters in anterior tibial closing wedge osteotomies (ACWO). The hypothesis states that a neutral hinge axis (NHA) in ACWO prevents changes in coronal and axial alignment.

Methods

A 3D surgical simulation was used to perform ACWO with a stepwise increment of one-degree (1°–5°) rotation around thirteen different hinge axes. Surface models were created from CT scans of 49 individuals (mean PTS 11.5° ± 3.8°) resulting in 3185 simulations. A NHA not changing the coronal or axial alignment was defined as oriented parallel to the posterior tibial plateau 1 cm underneath the articular surface. Anatomical landmarks were determined for each simulation to measure the PTS, MPTA, hip-knee-ankle angle (HKA), and tibial torsion (TT). The effects of the initial MPTA or PTS on the resulting alignment parameters and the effects of axial and sagittal rotation of the joint axis were analysed for their effects on postsimulation PTS, MPTA and TT.

Results

Clinically relevant hinge axis rotation in the coronal or axial plane below 20° did not significantly influence PTS correction (p > 0.05). Axial rotation of the hinge axis exceeding 10° led to significant MPTA changes (> +1.7° ± 0.03°) compared to the NHA (p < 0.001). Pre-simulation MPTA had no influence on post-simulation MPTA changes (p > 0.05).

Conclusion

NHA aligned parallel to the posterior tibial plateau below the articular surface prevents significant changes in MPTA during ATCWO. This 3D simulation suggest, that hinge axis orientation requires meticulous consideration during slope-reducing osteotomies to preserve alignment integrity.

Level of Evidence

Level V, retrospective simulation study.

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在三维模拟模型中，胫骨前闭合楔形截骨术中铰链轴的轴向旋转可引起胫骨冠状面对齐的变化

目的临床证据表明，在胫骨减坡截骨术中，可能会出现胫骨内侧近端角（MPTA）的意外增加，这与前交叉韧带（ACL）缺陷的膝关节最为相关。因此，本三维（3D）模拟研究的目的是评估轴向或冠状面铰链轴旋转如何影响胫骨前闭合楔形截骨术（ACWO）中的对准参数。假设认为ACWO的中性铰链轴（NHA）阻止冠状和轴向的变化。方法采用三维手术模拟，在13个不同的铰链轴上逐步增加1度（1°-5°）旋转进行ACWO。从49个个体的CT扫描（平均PTS 11.5°±3.8°）中创建表面模型，产生3185次模拟。不改变冠状或轴向的NHA被定义为平行于关节面下1cm的胫骨后平台。为每个模拟确定解剖标志，以测量PTS、MPTA、髋关节-膝关节-踝关节角（HKA）和胫骨扭转（TT）。分析了初始MPTA或PTS对最终对准参数的影响，以及关节轴轴向和矢状面旋转对模拟后PTS、MPTA和TT的影响。结果临床相关枢轴在冠状面或轴向面旋转小于20°对PTS矫正无显著影响（p > 0.05）。与NHA相比，铰链轴向旋转超过10°导致MPTA显著变化（> +1.7°±0.03°）（p < 0.001）。模拟前MPTA对模拟后MPTA变化无影响（p > 0.05）。结论关节面以下平行于胫骨后平台的NHA可防止ATCWO期间MPTA的显著变化。该三维模拟表明，在减坡截骨术中，铰链轴方向需要仔细考虑以保持对齐完整性。证据等级V级，回顾性模拟研究。

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