Abstract:

Objective

To explore the specific changes in the posterior tibial slope angle (PTSA)of medial and lateral sides after distal tibial tubercle-high tibial osteotomy combined with arthroscopy in the treatment of moderate to severe varus knee osteoarthritis.

Method

A total of 62 patients with moderate to severe varus knee osteoarthritis treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from November 2022 to December 2023 were retrospectively analyzed. Inclusion criteria: unilateral varus knee osteoarthritis with complete postoperative follow-up data. Exclusion criteria: other surgical treatment of the contralateral knee during follow-up; severe other bone diseases; the operative limb was complicated with secondary injury. All the patients were treated with distal tibial tubercle-high tibial osteotomy combined with arthroscopy. All the patients completed the operation and were followed up. Referring to the tibial posterior cortical line in Brazier measurement method, the posterior slope angle of the medial and lateral tibial plateau and the active flexion range of the knee joint at different time points before and after the operation were measured and evaluated by DIGIMIZER digital software on the lateral X-ray film of the surgical knee joint.Pain visual analogue scale (VAS), Western Ontario and McMaster University osteoarthritis index (WOMAC)and Lysholm score were used to evaluate the knee pain and function at different time points before and after operation. Statistical analysis was performed using repeated measurement analysis of variance.

Results

All 62 patients were followed up for (12.5±0.5) months.The medial PTSA was (9.3±1.4)° before operation, and there was no significant change in the medial PTSA at one month, six and 12 months after operation compared with that before operation (F=0.317, P>0.05). The preoperative lateral PTSA was (8.2±1.4)°, and there was no significant change in the lateral PTSA at one month, six and 12 months after operation when compared with that before operation (F=0.096, P>0.05). The knee active flexion range of motion increased from (97±4)°before operation to (103±4)°, (112±4)°, (117±4)° at one month, six and 12 months after operation, and the knee active flexion range of motion gradually increased compared with that before operation. There were significant differences at each time point (F=314.984, P<0.05). The VAS score, WOMAC score and Lysholm score at one month, six and 12 months after operation were significantly improved compared with those before operation(F=1012.288, 822.45, 673.422, all P<0.05).

Conclusion

The distal tibial tubercle-high tibial osteotomy combined with arthroscopy can relieve the pain of moderate to severe varus knee osteoarthritis, improve the knee joint function, increase the range of motion of the knee joint, and has no significant effect on the medial and lateral posterior tibial slope angle in the short term.

Key words: Osteotomy, Tibia, Knee joint, Osteoarthritis, Arthroscope