Influence of Alignment Changes in Different Planes During Supra-Tubercular Biplanar Medial Opening Wedge High Tibial Osteotomy on Tibial Tubercle–Trochlear Groove Distance

Abstract

Objective: Changes in the coronal, sagittal, and axial alignments during supra-tubercular biplanar medial opening wedge high tibial osteotomy (STB-MOWHTO) may have different influences on tibial tubercle–trochlear groove (TT–TG) distance, but few pieces of literature have addressed this specific concern. We aimed to analyze the impacts of changes in alignments in different planes during STB-MOWHTO on the TT–TG distance.

Methods: Patients who underwent STB-MOWHTO for varus knee deformity at our hospital were reviewed retrospectively from January 2020 to December 2022. Radiographic parameters, including opening width (OW), distal tibial rotation (DTR), posterior tibial slope (PTS), and TT–TG distance, were assessed before operation and directly postoperatively. Multivariate mixed linear regression analyses were employed to investigate the relationships between OW, the changes in DTR, PTS, and TT–TG distance. Restricted cubic spline curve fitting and threshold effects were used to assess potential non-linear relationships between the independent variables and changes in TT–TG distance. Stratification analysis was conducted to assess the stability of the results.

Results: One hundred and two knee joints from 66 patients were included. TT–TG distance change was positively correlated with OW (β = 0.551, 95% CI: 0.340, 0.762, p < 0.001) and DTR change (β = 0.284, 95% CI: 0.196, 0.371, p < 0.001). Restricted cubic spline curve fitting and threshold effect analyses did not identify any non-linear relationships or inflection points between OW, DTR change, and TT–TG distance change. Further, stratification analysis of DTR in various directions confirmed the stability of the linear relationship between DTR change and TT–TG distance change.

Conclusions: The TT–TG distance change exhibited a positively correlated linear relationship with OW and DTR change during STB-MOWHTO. For every 1 mm increase in OW, TT–TG distance increased by an average of 0.551 mm. For every 1° increase in DTR, TT–TG distance increased by an average of 0.284 mm.

Level of Evidence: Level III.

Keywords

distal tibial rotation / MOWHTO / opening width / posterior tibial slope / TT–TG distance

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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.