Background:Accumulating evidence suggests that synovial inflammation plays a pivotal role in knee osteoarthritis. Although biomechanical findings have shown that medial open-wedge proximal tibial osteotomy (OWPTO) decreases medial compartment loading by correcting knee alignment, the relationship between knee alignment and synovial inflammation in the biological microenvironment has not yet been elucidated.Purposes:To investigate the relationship between preoperative and postoperative knee alignment and synovial gene expression and to determine the cutoff point of postoperative knee alignment at which gene expression of synovial inflammation improves.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 36 patients with osteoarthritis who underwent OWPTO between June 2018 and May 2020 were enrolled. Synovial tissue was collected from affected knees during initial OWPTO and plate removal surgeries, and gene expression associated with the pathogenesis of osteoarthritis in the synovial tissue was investigated using real-time polymerase chain reaction. The correlation between weightbearing line ratio (WBLR) and synovial gene expression was determined. Receiver operating characteristic curve analysis was used to determine the cutoff values of WBLR for improving gene expression. The participants were divided into 2 groups, according to the cutoff values of their WBLR, and compared according to Knee injury and Osteoarthritis Outcome Score (KOOS) and synovial gene expression.Results:Postoperative WBLR was correlated with gene expression of interleukin 1β ( IL1B) (ρ = −0.43; P = .008) and of interleukin 6 ( IL6) (ρ = −0.41; P = .01). The cutoff value to predict improvement of IL6 was postoperative WBLR of 52%, with an area under the curve of 0.74 ( P = .03). Patients with WBLR of <52% showed higher postoperative inflammatory gene ( IL1B [ P = .04] and IL6 [ P = .03]) and inferior postoperative KOOS values compared with those with WBLR of >52%.Conclusion:The novel cutoff alignment for biological improvement after OWPTO in patients with medial compartment osteoarthritis was determined to be WBLR of 52%, and WBLR of <52% was associated with higher residual intra-articular inflammation and poor clinical outcomes. After accounting for surgical errors, the surgeon should set the target surgical alignment so that the postoperative WBLR does not fall below 52%.

中文翻译：

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矫正不足与内侧开放楔形胫骨近端截骨术后残余促炎基因表达及临床结局的关系


背景： 越来越多的证据表明，滑膜炎症在膝骨关节炎中起关键作用。尽管生物力学研究结果表明，内侧开楔形胫骨近端截骨术 （OWPTO） 通过矫正膝关节力线来减少内侧隔室负荷，但膝关节力线与生物微环境中滑膜炎症之间的关系尚未阐明。目的： 探讨术前和术后膝关节力线与滑膜基因表达的关系，并确定术后膝关节力线的临界点，滑膜炎症基因表达改善。研究设计： 队列研究;证据水平， 3.方法： 共纳入 2018年6月至 2020年5月接受 OWPTO 的 36 例骨关节炎患者。在初始 OWPTO 和钢板移除手术期间从受影响的膝关节收集滑膜组织，并使用实时聚合酶链反应研究与滑膜组织中骨关节炎发病机制相关的基因表达。测定负重线比 （WBLR） 与滑膜基因表达的相关性。采用受试者工作特征曲线分析确定 WBLR 改善基因表达的临界值。根据参与者的 WBLR 截断值将参与者分为 2 组，并根据膝关节损伤和骨关节炎结果评分 （KOOS） 和滑膜基因表达进行比较。结果： 术后 WBLR 与白细胞介素 1β （ IL1B） 基因表达相关 （ρ = −0.43;P = .008） 和白细胞介素 6 （IL6） （ρ = −0.41;P = .01）。预测 IL6 改善的临界值为术后 WBLR 为 52%，曲线下面积为 0.74 （P = .03）。 与 WBLR 为 >52% 的患者相比，WBLR 为 <52% 的患者术后炎症基因 （ IL1B [ P = .04] 和 IL6 [ P = .03]）较高，术后 KOOS 值较低。结论： 内侧骨关节炎患者 OWPTO 后生物学改善的新型临界对准确定为 WBLR 为 52%，而 <52% 的 WBLR 与较高的残余关节内炎症和不良临床结局相关。在考虑手术错误后，外科医生应设置目标手术对位，以便术后 WBLR 不低于 52%。