Influences of Tibial Plateau Morphology on JLCA Change, Clinical Outcomes and Cartilage Regeneration After Medial Opening Wedge High Tibial Osteotomy
Journal
Orthopaedic Journal of Sports Medicine
Series/Report No.
Orthopaedic Journal of Sports Medicine
Journal Volume
14
Journal Issue
7
ISSN
2325-9671
2325-9671
Date Issued
2026-07
Author(s)
Lo, Yao-Chang
Liu, Jen-Hao
Chen, Chien-Lin
Abstract
Background: Medial opening wedge high tibial osteotomy (MOWHTO) is widely used to treat medial compartment osteoarthritis with varus malalignment. Variations in proximal tibial intra-articular morphology may influence alignment correction during osteotomy, but their clinical significance remains unclear.
Purpose/hypothesis: The purpose of this study was to evaluate whether different plateau morphologies are associated with differences in radiographic changes, clinical outcomes, and cartilage regeneration. It was hypothesized that proximal tibial plateau morphology does not significantly influence clinical outcomes or cartilage regeneration after MOWHTO.
Study design: Cohort study; Level of evidence, 3.
Methods: That data of 186 patients who underwent unilateral MOWHTO between 2016 and 2022 were retrospectively reviewed. Based on the angular relationship between the medial and lateral tibial plateaus, knees were classified as depressed (n = 60), flat (n = 83), or convex (n = 43). Radiographic parameters including medial proximal tibial angle, hip-knee-ankle angle, joint line convergence angle (JLCA), and weightbearing line ratio were measured preoperatively and postoperatively. Changes in JLCA were analyzed using repeated-measures analysis of variance. Clinical outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Cartilage regeneration was evaluated arthroscopically according to the International Cartilage Regeneration & Joint Preservation Society grading system during second-look arthroscopy.
Results: Baseline characteristics and postoperative radiographic parameters were comparable among groups. A significant group × time interaction was observed for JLCA (P = .016), with the convex type showing greater JLCA change than the depressed (P = .018) and flat (P = .049) types; however, the magnitude of the difference was small (<1°). Postoperative KOOS values were similar among groups, and plateau inclination analyzed as a continuous variable was not correlated with KOOS (Pearson r = 0.112; P = .13). Second-look arthroscopy was performed in 103 patients, demonstrating cartilage improvement in 53.1%, 58.3%, and 52.2% of the depressed, flat, and convex groups, respectively (P = .790).
Conclusion: Proximal tibial plateau morphology did not significantly affect clinical outcomes or changes in cartilage status after MOWHTO.
Subjects
cartilage
clinical outcome
high tibial osteotomy
osteoarthritis
tibial morphology
Publisher
SAGE Publications
Type
journal article