Coronal and sagittal alignment of ankle joint is significantly affected by high tibial osteotomy

Byung Hak Oh; Kyung Deok Seo; Youn Moo Heo; Tae Kyun Kim; Jae Kyu Choi; Jae Hwang Song

doi:10.1007/s00167-023-07531-8

Coronal and sagittal alignment of ankle joint is significantly affected by high tibial osteotomy

Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4878-4885. doi: 10.1007/s00167-023-07531-8. Epub 2023 Aug 12.

Authors

Byung Hak Oh^#¹, Kyung Deok Seo^#¹, Youn Moo Heo¹, Tae Kyun Kim¹, Jae Kyu Choi¹, Jae Hwang Song²

Affiliations

¹ Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea.
² Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea. songjajj@hanmail.net.

^# Contributed equally.

PMID: 37572140
DOI: 10.1007/s00167-023-07531-8

Abstract

Purpose: Changes in coronal and sagittal alignment of the knee joint after HTO have been reported in several previous studies. However, only few of them investigated the changes only on coronal alignment of the ankle joint. The purpose of this study was to investigate changes in both coronal and sagittal alignment of the ankle joint after HTO.

Methods: 46 patients (49 cases) who underwent HTO were retrospectively analyzed. Preoperative and postoperative lower extremity scanogram and EOS imaging system were investigated. The hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and knee tibia plafond angle (KTPA) were measured by scanogram to evaluate coronal alignment of the knee. Tibial anterior surface angle (TAS), talar tilt (TT), tibial plafond inclination (TPI), and ankle joint axis point on the weight-bearing-line (AAWBL) ratio were measured by scanogram to investigate coronal alignment of the ankle. Knee lateral ankle surface angle (KLAS) and tibial lateral surface angle (TLS) were measured by EOS to evaluate sagittal alignment of the ankle.

Results: Varus alignment of the knee was corrected by significant change of the HKA angle (5.8 ± 3.1° vs. - 2.1 ± 2.8°, p < 0.001), MPTA (85.7 ± 2.9° vs. 91.7 ± 3.3°, p < 0.001), and KTPA (5.0 ± 3.5° vs. - 2.1 ± 4.2°, p < 0.001) after HTO. Regarding the ankle coronal alignment, there was significant change in TPI (3.9 ± 3.4° vs. - 0.9 ± 3.8°, p < 0.001) and AAWBL ratio (45.5 ± 14.7% vs. 61.6 ± 13.3%, p < 0.001). In sagittal alignment of the ankle, KLAS (4.5 ± 3.1° vs. 7.7 ± 3.7°, p < 0.001) significantly increased. Among the variables, the amount of correction in AAWBL ratio (R = 0.608, p < 0.01) showed strongest relationship with tibial correction angle.

Conclusion: Based on the present study, coronal and sagittal alignment of ankle joint was significantly affected by HTO. After HTO, AAWBL ratio increased due to lateralization of the ankle joint axis, and KLAS increased due to increased posterior tibial slope.

Level of evidence: III.

Keywords: Alignment; Ankle joint; Coronal; EOS; High tibial osteotomy; Knee; Osteoarthritis; Sagittal; Scanogram.