ArticleSICOT-J2026
An increase in the medial proximal tibial angle of 95° or greater after opening wedge high tibial osteotomy does not necessarily lead to excessive knee joint line obliquity of 5° or greater.
Article in SICOT-J, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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9 authors.
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Abstract
introductionThe relationship between medial proximal tibial angle (MPTA) overcorrection and knee joint line obliquity (KJLO) after opening wedge high tibial osteotomy (OWHTO) remains controversial. Though excessive valgus correction (MPTA ≥ 95°) has been associated with abnormal joint line inclination, the extent to which this affects postoperative alignment and whether overcorrection necessarily results in excessive KJLO (≥5°), which has been associated with increased shear stress on the articular cartilage, is unclear.
methodsA total of 300 knees undergoing isolated OWHTO were retrospectively reviewed. Postoperative KJLO and MPTA were measured using full-length standing radiographs. Knees were stratified into MPTA <95° and ≥95° groups. Correlations between postoperative MPTA and KJLO were analyzed, and in the overcorrected (MPTA ≥ 95°) group, logistic regression and receiver-operating characteristic (ROC) curve analyses were performed to identify preoperative predictors of postoperative KJLO ≥ 5°.
resultsPostoperative MPTA showed a significant positive correlation with KJLO (r = 0.61, p < 0.001). However, 52.5% of knees with MPTA ≥ 95° maintained KJLO < 5°, indicating that overcorrection does not necessarily cause excessive joint line inclination. Multivariable analysis identified preoperative lateral distal femoral angle (LDFA), knee joint line convergence angle (KJLCA), and ankle joint line obliquity (AJLO) as independent predictors of postoperative KJLO ≥ 5° in knees with MPTA ≥ 95° (p < 0.01). ROC curve analyses showed that AJLO ≥ 5.6°, LDFA ≥ 88.9°, and KJLCA ≥ 4.5° were the cutoff values predicting KJLO ≥ 5°.
conclusionsAlthough postoperative MPTA correlates with KJLO, more than half of the overcorrected cases maintained acceptable joint line inclination. Preoperative AJLO, LDFA, and KJLCA are key parameters for predicting postoperative KJLO ≥ 5° in knees with MPTA ≥ 95°, highlighting the importance of comprehensive preoperative alignment assessment when planning OWHTO.
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