PURPOSE The purpose of this study was to determine the ideal coronal alignment under dynamic conditions after open-wedge high tibial osteotomy (OWHTO). It was hypothesised that, although the classical target alignment was based on experimental evidence, it would demonstrate biomechanical validity. METHODS Musculoskeletal computer models were analysed with various degrees of coronal correction in OWHTO during gait and squat, specifically with the mechanical axis passing through points at 40%, 50%, 60%, 62.5%, 70%, and 80% of the tibial plateau from the medial edge, defined as the weight-bearing line percentage (WBL%). The peak load on the lateral tibiofemoral (TF) joint, the medial collateral ligament (MCL), and anterior cruciate ligament (ACL) tensions, and knee kinematics with or without increased posterior tibial slope (PTS) were evaluated. RESULTS The classical alignment with WBL62.5% achieved sufficient load on the lateral TF joint and maintained normal knee kinematics after OWHTO. However, over-correction with WBL80% caused an excessive lateral load and non-physiological kinematics. Increased WBL% resulted in increased MCL tension due to lateral femoral movement against the tibia. With WBL80%, abnormal contact between the medial femoral condyle and the medial intercondylar eminence of the tibia occurred at knee extension. The screw-home movement around knee extension and the TF rotational angle during flexion were reduced as WBL% increased. Increased PTS was associated with increased ACL tension and decreased TF rotation angle because of ligamentous imbalance. CONCLUSIONS The classical target alignment demonstrated validity in OWHTO, and over-correction should be avoided as it negatively impacts clinical outcome. LEVEL OF EVIDENCE IV.

中文翻译：

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胫骨高度截骨术中的经典目标冠状动脉对准在计算机模型的膝关节运动学和动力学方面证明了有效性。

目的本研究的目的是确定楔形高位胫骨截骨术（OWHTO）后动态条件下的理想冠状动脉对准。有人假设，尽管经典的目标对准是基于实验证据，但仍将证明其生物力学有效性。方法分析了步态和下蹲过程中OWHTO中不同程度的冠状矫正的肌肉骨骼计算机模型，特别是机械轴通过了胫骨平台40％，50％，60％，62.5％，70％和80％的点从内侧边缘开始，定义为负重线百分比（WBL％）。评估胫骨外侧（TF）关节，内侧副韧带（MCL）和前交叉韧带（ACL）张力以及膝关节运动学的峰值负荷（有或没有后胫骨坡度（PTS）增加）。结果与WBL62.5％的经典对齐在OWHTO后在外侧TF关节上获得了足够的负载并保持了正常的膝关节运动学。但是，使用WBL80％的过度校正会导致过多的侧向载荷和非生理运动学。由于针对胫骨的股骨外侧运动，增加的WBL％导致MCL张力增加。使用WBL80％时，在膝关节伸展时，股内侧media与胫骨media内侧隆起之间发生异常接触。随着WBL％的增加，绕膝盖延伸的螺钉原点移动和屈曲期间的TF旋转角度均减小。由于韧带不平衡，PTS增加与ACL张力增加和TF旋转角度降低有关。结论经典目标对准在OWHTO中证明了有效性，并且应避免过度校正，因为它会对临床结果产生负面影响。证据级别IV。