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Three-dimensional analysis of lateral cortical hinge in medial open-wedge high tibial osteotomy: A computational simulation study of adult cadaversopen access

Authors
Jung, Gu-HeeLee, Kyung-HoWang, Lih
Issue Date
Sep-2020
Publisher
Hong Kong Academy of Medicine Press
Keywords
cortical hinge point; high tibial osteotomy; medial open wedge osteotomy; safe zone; tibia
Citation
Journal of Orthopaedic Surgery, v.28, no.3
Indexed
SCIE
SCOPUS
Journal Title
Journal of Orthopaedic Surgery
Volume
28
Number
3
URI
https://scholarworks.gnu.ac.kr/handle/sw.gnu/6223
DOI
10.1177/2309499020959172
ISSN
1022-5536
2309-4990
Abstract
Purpose: The objective of this study was to improve the three-dimensional (3D) understanding of optimal lateral cortical hinge in medial open-wedge high tibial osteotomy (MOWHTO) via a computational cadaveric simulation of actual size. Methods: The computed tomography data of 117 adult cadavers were imported into Mimics (R) software to design 3D models of tibia and fibula. To simulate the MOWTHO, a virtual cutting plane was developed inside the safe zone based on established landmarks. After splitting and distracting through the cutting plane, the 10-mm cylinder (o 30 mm; height 10 mm) was placed vertically to be occupied properly in the nonosteotomized lateral cortex. The cross points between the round cylinder and cutting plane represented the anterior and posterior hinge points, which were used to validate the 3D position and direction of cortical hinge. Results: A 10-mm cylinder did not violate the proximal tibiofibular joint (PTFJ) and the protruding segment of the condylar area was less than 2 mm in 115 models. The connecting line between anterior and posterior hinge points was an average of 12.1 degrees (range 0-24.1 degrees, SD 4.64) to the lateral side. In the nonoverlapping anteroposterior projection between proximal fibula and tibia, the posterior hinge point was laid over the PTFJ as close as possible. Based on free 360 degrees rotation and magnification without any tilt, no posterior cortical disruption of PTFJ was observed while securing a minimum width of 10 mm. Conclusion: If the posterior hinge point was placed immediately above the PTFJ without involvement, the nonosteotomized portion carried sufficient width greater than 10 mm, despite lateral rotation at an average hinge direction of 12.1 degrees.
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