PURPOSE The current study aimed to evaluate how open-wedge high tibial osteotomy (OWHTO) without the release of medial collateral ligament (MCL) changes in vivo intra-articular joint space after the surgery. METHODS Patients with varus malalignment of the knee with an indication for OWHTO were included in this study. The intra-articular gap was measured before and 30 min after OWHTO without MCL release using a series of calibrated nerve hooks. The association of post-operative gap size with varus angle, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA) and joint line convergence angle (JLCA) was also assessed. RESULTS A total of 42 knees from 38 patients were evaluated. The mean size of the intra-articular gap of the medial compartment was 5.2 ± 1 mm before the osteotomy and 3.1 ± 2.2 mm at 30 min post-osteotomy. The size of the intra-articular gap decreased post-operatively in 30 knees (71.5%), increased in eight knees (19%) and remained the same in the remaining four knees (9.5%). Smaller MPTA and more correction were associated with a decrease in gap size after the osteotomy (p = 0.01 and p = 0.03, respectively). A significant negative correlation was observed between the correction size and the gap size after osteotomy (r = - 0.317, p = 0.04). CONCLUSION Intra-articular pressure of the medial compartment increases in the majority of cases following OWHTO without MCL release. Until the factors affecting this increased pressure are thoroughly identified, MCL release seems to be a wiser option during OWHTO. LEVEL OF EVIDENCE III.

中文翻译：

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在高胫骨内侧开放楔形截骨术中保留内侧副韧带通常会导致术后关节间隙缩小。

目的当前的研究旨在评估在手术后体内不释放内侧副韧带（MCL）的情况下楔入式高位胫骨截骨术（OWHTO）如何改变。方法本研究纳入了膝内翻畸形并伴有OWHTO指征的患者。使用一系列校准的神经钩在OWHTO之前和之后30分钟（未释放MCL）测量关节间隙。还评估了术后间隙大小与内翻角，胫骨近端内侧角（MPTA），股骨远端外侧角（LDFA）和关节线会聚角（JLCA）的关系。结果对38例患者的42膝进行了评估。切骨术前，内侧腔室的关节间隙的平均大小为5.2±1 mm，切骨术后30分钟为3.1±2.2 mm。术后30膝关节间隙缩小大小（71.5％），8膝关节增大（19％），其余4膝保持不变（9.5％）。较小的MPTA和更多的矫正与切骨术后间隙大小的减少有关（分别为p = 0.01和p = 0.03）。截骨后的矫正尺寸与间隙尺寸之间存在显着的负相关（r =-0.317，p = 0.04）。结论OWHTO术后未释放MCL的大多数情况下，内侧腔室的关节内压升高。在彻底确定影响压力增加的因素之前，在OWHTO期间释放MCL似乎是一个更明智的选择。证据级别III。8个膝盖（19％）保持增长，其余4个膝盖（9.5％）保持不变。较小的MPTA和更多的矫正与切骨术后间隙大小的减少有关（分别为p = 0.01和p = 0.03）。截骨后的矫正尺寸与间隙尺寸之间存在显着的负相关（r =-0.317，p = 0.04）。结论OWHTO术后未释放MCL的大多数情况下，内侧腔室的关节内压升高。在彻底确定影响压力增加的因素之前，在OWHTO期间释放MCL似乎是一个更明智的选择。证据级别III。8个膝盖（19％）保持增长，其余4个膝盖（9.5％）保持不变。较小的MPTA和更多的矫正与切骨术后间隙大小的减少有关（分别为p = 0.01和p = 0.03）。在矫正尺寸和截骨后的间隙尺寸之间观察到显着的负相关（r =-0.317，p = 0.04）。结论OWHTO术后未释放MCL的大多数情况下，内侧腔室的关节内压升高。在彻底确定影响压力增加的因素之前，在OWHTO期间释放MCL似乎是一个更明智的选择。证据级别III。在矫正尺寸和截骨后的间隙尺寸之间观察到显着的负相关（r =-0.317，p = 0.04）。结论OWHTO术后未释放MCL的大多数情况下，内侧腔室的关节内压升高。在彻底确定影响压力增加的因素之前，在OWHTO期间释放MCL似乎是一个更明智的选择。证据级别III。在矫正尺寸和截骨后的间隙尺寸之间观察到显着的负相关（r =-0.317，p = 0.04）。结论OWHTO术后未释放MCL的大多数情况下，内侧腔室的关节内压升高。在彻底确定影响压力增加的因素之前，在OWHTO期间释放MCL似乎是一个更明智的选择。证据级别III。