Reposition mechanism of the subluxed knee by high tibial osteotomy in medial osteoarthritis.

CHIBA Goji, 高木 信吾, 田代 宏一郎, 藤田 雅章, 寺本 司, 岩崎 勝郎

doi:10.11551/jsjd1982.15.125

Advanced OA of the knee showed severe joint space narrowing, opening of the lateral facet, and medial subluxation of the femur, hence bilateral adaptation of the medial and lateral facets might be difficult by HTO. The most serious cause of wear of the joint cartilage was the load placed on the medial facet of the knee owing to a biased Mikulicz line. HTO reduces subluxations by changing the alignment from varus to valgus. Twenty-four unstable knees of 80 knees which underwent HTO were selected for this study. The lateral facet of 13 knees of 24 knees was reduced by HTO (reduced group) and 11 knees were stationary (subluxed group) . Radiographical evaluations were performed on the width of the medial and lateral joint space (MJS, LJS), deviation of the Mikulicz line (DEVM), medial subluxation of the femur (MSBF), inclination of the femur (INCA), joint convergence angle (JCA), condylar plateau angle (CPA), and the ratio of width of the tibia and femur (RTFW), denoting the index of femoral rotation. The MJS in the reduced group showed an increase of more than 1 mm (average 1.88 mm) but the LJS showed 0.42 mm. The INCA of the reduced group was 3° greater than that of the subluxed group. There were no remarkable changes in position of the Mikulicz line in the knees and CPA, JCA, MSBF and RTFW between the two groups: the degree of the response to HTO varied among the knees. These findings suggest that various subluxations were reduced via different complex ways by HTO, and it is difficult to predict the reposition of the lateral facet and the opening of the medial joint with pre-operative Xp.

Reposition mechanism of the subluxed knee by high tibial osteotomy in medial osteoarthritis.

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