Medial Açık Kama Yüksek Tibial Osteotomide Monoplanar ve Biplanar Tekniklerin Radyolojik ve Klinik Sonuçlarının Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı medial kompartman osteoartriti ve varus dizilimi bulunan hastalarda uygulanan monoplanar ve biplanar medial açık kama yüksek tibial osteotomilerin patellar yükseklik, posterior tibial eğim, kaynama süresi ve klinik sonuçlar üzerine etkilerini karşılaştırmaktır. Gereç ve Yöntem: 2015–2020 yılları arasında medial açık kama yüksek tibial osteotomi uygulanan 57 hastanın 59 dizi retrospektif olarak incelendi. Hastalar osteotomi tekniğine göre monoplanar (n=27) ve biplanar (n=32) olmak üzere iki gruba ayrıldı. Preoperatif ve postoperatif mekanik aks açıları, patellar yükseklik indeksleri (Caton–Deschamps, Blackburne–Peel, Insall–Salvati), posterior tibial eğim ve kaynama süreleri radyografik olarak değerlendirildi. Klinik sonuçlar Diz Yaralanması ve Osteoartrit Sonuç Skoru (KOOS) ile analiz edildi. Bulgular: Her iki teknikte de varus dizilimi anlamlı şekilde düzeltilmiş olup postoperatif mekanik aks değerleri arasında fark saptanmadı (p>0,05). Patellar yükseklik her iki grupta hafif azalma göstermekle birlikte tüm ölçümler normal sınırlar içinde kaldı ve gruplar arasında anlamlı fark bulunmadı. Posterior tibial eğimdeki değişiklikler minimal olup istatistiksel olarak anlamlı değildi. Ortalama kaynama süresi her iki grupta yaklaşık 9 hafta olup biplanar teknikte kaynamanın nispeten daha erken olduğu gözlendi. KOOS skorları her iki grupta postoperatif dönemde anlamlı şekilde arttı (p<0,01). Postoperatif KOOS değerleri biplanar grupta daha yüksek olmasına rağmen iyileşme miktarı açısından teknikler arasında fark saptanmadı. Sonuç: Medial açık kama yüksek tibial osteotomi uygun hasta seçimi ile medial kompartman osteoartriti tedavisinde etkili bir yöntemdir. Monoplanar ve biplanar teknikler patellar yükseklik, posterior tibial eğim ve fonksiyonel sonuçlar açısından benzer sonuçlar vermektedir. Biplanar teknik kaynama süresi açısından sınırlı bir avantaj sağlayabilir.

Anahtar Kelimeler

• Osteotomi
• Osteoartrit
• Diz
• Patella
• Posterior Tibial Eğim

Destekleyen Kurum

Bu çalışma için herhangi bir kurum veya kuruluştan finansal destek alınmamıştır.

Etik Beyan

Bu çalışma, Yerel Etik Kurulu tarafından onaylanmıştır. Çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür. Çalışma retrospektif olarak tasarlandığından bilgilendirilmiş gönüllü onam formu kullanılmamıştır.

Comparison of Radiological and Clinical Outcomes Between Monoplanar and Biplanar Medial Open-Wedge High Tibial Osteotomy

Öz

ABSTRACT Background: The aim of this study was to compare the effects of monoplanar and biplanar medial open-wedge high tibial osteotomy on patellar height, posterior tibial slope, union time, and clinical outcomes in patients with medial compartment osteoarthritis and varus alignment. Materials and Methods: Fifty-nine knees of 57 patients who underwent medial open-wedge high tibial osteotomy between 2015 and 2020 were retrospectively evaluated. Patients were divided into two groups according to the osteotomy technique: monoplanar (n=27) and biplanar (n=32). Preoperative and postoperative mechanical axis, patellar height indices (Caton–Deschamps, Blackburne–Peel, Insall–Salvati), posterior tibial slope, and union time were assessed radiographically. Clinical outcomes were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: Both techniques provided significant correction of varus alignment, and no difference was found between postoperative mechanical axis values (p>0.05). Although patellar height slightly decreased in both groups, all measurements remained within normal limits and no significant difference was detected between the groups. Changes in posterior tibial slope were minimal and not statistically significant. The mean union time was approximately 9 weeks in both groups, with a tendency toward earlier union in the biplanar group. KOOS scores improved significantly postoperatively in both groups (p<0.01). Although postoperative KOOS scores were higher in the biplanar group, the magnitude of improvement was similar. Conclusion: Medial open-wedge high tibial osteotomy is an effective treatment for medial compartment osteoarthritis in properly selected patients. Monoplanar and biplanar techniques yield comparable radiological and functional outcomes in terms of patellar height, posterior tibial slope, and clinical scores. The biplanar technique may provide a slight advantage in union time.

Anahtar Kelimeler

• Osteotomy
• Osteoarthritis
• Knee
• Patella
• Tibial Slope

Destekleyen Kurum

No financial support was received from any institution or organization for this study.

Etik Beyan

This study was approved by the Local Ethics Committee. The study was conducted in accordance with the principles of the Helsinki Declaration. Since the study was designed as a retrospective, an informed consent form was not used.

Kaynakça

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