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Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis

BACKGROUND: Open-wedge high tibial osteotomy (OWHTO) is commonly performed for the treatment of medial compartment knee osteoarthritis (KOA), and is classified into proximal tibial tubercle osteotomy (PTO) and distal tibial tubercle osteotomy (DTO). The PTO osteotomy point is generally located about...

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Autores principales: Song, Min, Lin, Xiaodong, Han, Weichang, Li, Jingyi, Liu, Wengang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10041769/
https://www.ncbi.nlm.nih.gov/pubmed/36967435
http://dx.doi.org/10.1186/s13018-023-03725-5
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author Song, Min
Lin, Xiaodong
Han, Weichang
Li, Jingyi
Liu, Wengang
author_facet Song, Min
Lin, Xiaodong
Han, Weichang
Li, Jingyi
Liu, Wengang
author_sort Song, Min
collection PubMed
description BACKGROUND: Open-wedge high tibial osteotomy (OWHTO) is commonly performed for the treatment of medial compartment knee osteoarthritis (KOA), and is classified into proximal tibial tubercle osteotomy (PTO) and distal tibial tubercle osteotomy (DTO). The PTO osteotomy point is generally located about 3–4 cm below the joint of the proximal tibia, and the osteotomy line points to the upper part of the proximal tibiofibular joint. The DTO osteotomy point is generally located about 0.5–1.0 cm below the tibial tubercle, and the osteotomy line points to the contralateral cortex. However, there is currently no consensus on which surgical technique is superior. The purpose of our study was to investigate which among the two is superior for medial KOA, with respect to knee joint parameters, clinical function, and complications. METHODS: This study was conducted as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Central Library, MEDLINE, Embase, PubMed, CNKI, and WanFang databases were systematically searched for trials comparing PTO and DTO in patients with medial compartment KOA, from inception until March 2022. The meta-analysis was conducted using RevMan 5.2 software. The Cochrane risk-of-bias tool was used to assess methodological quality. Statistical analysis was performed with Stata 12.0. Outcomes of interest included the Insall-Salvati index (ISI), Caton-Deschamps index (CDI), Blackburne-Peel index (BPI), posterior tibial slope (PTS), and the Hospital for Special Surgery (HSS) knee-rating scale. RESULTS: A total of 15 retrospective studies (910 knees) were included. There were no significant differences in the age or sex of included patients. There was a significant difference in the ISI, CDI, BPI, and PTS between the two groups (all p ≤ 0.05). Further, DTO was associated with a significantly greater number of postoperative complications (p < 0.05) compared to PTO. However, there was no significant difference in the femorotibial angle (FTA), mechanical medial proximal tibial angle (mMPTA), and HSS knee score (all p > 0.05). CONCLUSIONS: Compared with DTO, PTO is associated with a greater incidence of postoperative patella baja and increased PTS, whereas DTO is associated with more postoperative complications. Nevertheless, both can significantly correct knee varus deformity and improve knee function; their early knee function scores are also similar. Trial Registration. Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42021284443.
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spelling pubmed-100417692023-03-28 Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis Song, Min Lin, Xiaodong Han, Weichang Li, Jingyi Liu, Wengang J Orthop Surg Res Research Article BACKGROUND: Open-wedge high tibial osteotomy (OWHTO) is commonly performed for the treatment of medial compartment knee osteoarthritis (KOA), and is classified into proximal tibial tubercle osteotomy (PTO) and distal tibial tubercle osteotomy (DTO). The PTO osteotomy point is generally located about 3–4 cm below the joint of the proximal tibia, and the osteotomy line points to the upper part of the proximal tibiofibular joint. The DTO osteotomy point is generally located about 0.5–1.0 cm below the tibial tubercle, and the osteotomy line points to the contralateral cortex. However, there is currently no consensus on which surgical technique is superior. The purpose of our study was to investigate which among the two is superior for medial KOA, with respect to knee joint parameters, clinical function, and complications. METHODS: This study was conducted as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Central Library, MEDLINE, Embase, PubMed, CNKI, and WanFang databases were systematically searched for trials comparing PTO and DTO in patients with medial compartment KOA, from inception until March 2022. The meta-analysis was conducted using RevMan 5.2 software. The Cochrane risk-of-bias tool was used to assess methodological quality. Statistical analysis was performed with Stata 12.0. Outcomes of interest included the Insall-Salvati index (ISI), Caton-Deschamps index (CDI), Blackburne-Peel index (BPI), posterior tibial slope (PTS), and the Hospital for Special Surgery (HSS) knee-rating scale. RESULTS: A total of 15 retrospective studies (910 knees) were included. There were no significant differences in the age or sex of included patients. There was a significant difference in the ISI, CDI, BPI, and PTS between the two groups (all p ≤ 0.05). Further, DTO was associated with a significantly greater number of postoperative complications (p < 0.05) compared to PTO. However, there was no significant difference in the femorotibial angle (FTA), mechanical medial proximal tibial angle (mMPTA), and HSS knee score (all p > 0.05). CONCLUSIONS: Compared with DTO, PTO is associated with a greater incidence of postoperative patella baja and increased PTS, whereas DTO is associated with more postoperative complications. Nevertheless, both can significantly correct knee varus deformity and improve knee function; their early knee function scores are also similar. Trial Registration. Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42021284443. BioMed Central 2023-03-27 /pmc/articles/PMC10041769/ /pubmed/36967435 http://dx.doi.org/10.1186/s13018-023-03725-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/ Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Song, Min
Lin, Xiaodong
Han, Weichang
Li, Jingyi
Liu, Wengang
Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis
title Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis
title_full Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis
title_fullStr Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis
title_full_unstemmed Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis
title_short Is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? A meta-analysis
title_sort is proximal tibial tubercle osteotomy superior to distal tibial tubercle osteotomy for medial compartmental osteoarthritis? a meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10041769/
https://www.ncbi.nlm.nih.gov/pubmed/36967435
http://dx.doi.org/10.1186/s13018-023-03725-5
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