CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis.,Knee Surgery, Sports Traumatology, Arthroscopy

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CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis.
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.8 ) Pub Date : 2020-09-10 , DOI: 10.1007/s00167-020-06253-5
S Cerciello _{1,

2} , M Ollivier ₃ , K Corona ₄ , B Kaocoglu ₅ , R Seil _{6,

7,

8}

Affiliation

Purpose

Medial open-wedge high tibial osteotomy (MOWHTO) is an accepted option in the treatment of medial compartment osteoarthritis of the knee in young and active patients. Functional results are closely correlated to the correction of the mechanical axis of the lower limb. Although several angular and geometrical methods and values have been proposed in the past, the ideal target is still debated. In addition, it is important to have a deep correlation between the planned correction and the achieved correction after surgery. The aim of the present systematic review was to identify the ideal coronal correction after MOWHTO and the most accurate method to achieve it.

Methods

A systematic review of the literature was completed on July 3rd 2020 in the Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the Medical Subject Headings (MeSH) terms: “high tibial osteotomy” AND “accuracy” OR “planning”.

Results

28 studies were included; 18 were focused on computer-assisted surgery (CAS) and 10 on patient-specific instrumentation (PSI). There were 598 patients in the CAS group and 501 in the control group; the rate of outliers was 16% and 38.2% respectively (P = 0.04), while there was no significant difference between the two groups (SMD = − 0.10; 95% CI 1.31 to 1.12; P = n.s.) in terms of coronal accuracy. Likewise, there were 318 patients in the PSI group and 40 in the control group; the rate of outliers was 15% and 40% respectively (P = 0.98), while there was no significant difference between the two groups (SMD = 0.01; 95% CI 0.58 to 0.59; P = 0.98).

Conclusions

A statistically significant reduced outlier rate and a non-significant increased accuracy emerged with the use of CAS when compared to the traditional surgical technique, whereas the results of PSI were still inconclusive. In addition, it emerged clearly that no consensus still exists on the ideal correction target to be achieved after surgery.

Level of evidence

III.

中文翻译：

与传统的内侧开放楔形高位胫骨截骨术相比，CAS 和 PSI 提高了冠状位对齐精度并减少了异常值：一项荟萃分析。

目的

内侧开放楔形高位胫骨截骨术（MOWHTO）是治疗年轻和活跃患者膝关节内侧间室骨关节炎的公认选择。功能结果与下肢机械轴的矫正密切相关。尽管过去已经提出了几种角度和几何方法和值，但理想的目标仍然存在争议。此外，重要的是要在计划的矫正和手术后实现的矫正之间建立深度相关性。本系统评价的目的是确定 MOWHTO 后理想的冠状校正以及实现该校正的最准确方法。

方法

2020 年 7 月 3 日，在 Pubmed、Medline、Cochrane 评论和 Google Scholar 数据库中使用医学主题词 (MeSH) 术语：“胫骨高位截骨术”和“准确性”或“计划”完成了对文献的系统回顾。

结果

纳入 28 项研究；18 个专注于计算机辅助手术 (CAS)，10 个专注于患者专用仪器 (PSI)。CAS组598例，对照组501例；异常值率分别为 16% 和 38.2%（P = 0.04），而两组在冠状面准确度方面无显着差异（SMD = - 0.10；95% CI 1.31 至 1.12；P = ns）。同样，PSI 组有 318 名患者，对照组有 40 名患者；异常值率分别为15%和40%（P =0.98），而两组间差异无统计学意义（SMD=0.01；95% CI 0.58～0.59；P =0.98）。