{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:12:54Z","timestamp":1788444774851,"version":"build-2803163510"},"reference-count":32,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP21zf0127004"],"award-info":[{"award-number":["JP21zf0127004"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24K12344"],"award-info":[{"award-number":["24K12344"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>High tibial osteotomy (HTO) for medial knee osteoarthritis corrects lower limb alignment, redistributing knee joint stress from the medial to the lateral compartment and improving clinical outcomes. Subchondral bone density reflects joint stress distribution. While redistribution of subchondral bone density after HTO has been reported, the relationship between computed tomography\u2013osteoabsorptiometry (CT OAM)\u2013derived changes in subchondral bone density distribution and postoperative clinical outcomes has not been well-established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To investigate the relationship between subchondral bone density distribution across the knee joint and clinical outcomes at 2 years after opening-wedge HTO (OW HTO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective study included 27 patients (27 knees) with medial knee osteoarthritis who underwent OW HTO. Radiographic parameters and clinical outcomes were assessed preoperatively and 2 years postoperatively. Subchondral bone density was evaluated using CT OAM, analyzing the high-density area (HDA) in the medial and lateral tibial compartments. The medial ratio was defined as the proportion of HDA in the medial compartment relative to total HDA. Correlations between changes in the medial ratio (\u0394 medial ratio) and clinical outcomes were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Postoperative alignment and medial ratio were significantly altered, with a reduced medial ratio compared with preoperative values (preoperative, 82.2%; postoperative, 74.6%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Change in medial ratio correlated with postoperative percentage of mechanical axis (%MA) (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.414;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03) and change in hip-knee-ankle angle (\u0394HKA angle) (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.502;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .008). Partial correlation analysis revealed that \u0394 medial ratio significantly correlated with postoperative Lysholm score (partial\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.463;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02) and Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation subscale (partial\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.538;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .006), and Quality of Life subscales (partial\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.558;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .004) and KOOS summary (42-item weighted mean) (partial\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.527;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .006), after adjusting for postoperative %MA and \u0394 HKA angle.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our study demonstrated that a greater reduction in the medial ratio after OW HTO is associated with improved clinical outcomes, indicating that CT OAM\u2013based subchondral bone density redistribution may reflect mechanical adaptation to postoperative load redistribution. Overall, \u0394 medial ratio may serve as a potential imaging marker of medial compartment unloading after OW HTO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261444313","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T16:20:26Z","timestamp":1788193226000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Correlation Between Changes in Subchondral Bone Density Distribution and Clinical Outcomes at 2 Years After Opening-Wedge High Tibial Osteotomy"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8955-7048","authenticated-orcid":false,"given":"Taku","family":"Ebata","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4525-9150","authenticated-orcid":false,"given":"Koji","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"},{"name":"Department of Functional Reconstruction for the Knee Joint, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1479-3892","authenticated-orcid":false,"given":"Dai","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatake","family":"Matsuoka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Onodera","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2139-5059","authenticated-orcid":false,"given":"Eiji","family":"Kondo","sequence":"additional","affiliation":[{"name":"Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norimasa","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2007.05.018"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2016.03.010"},{"issue":"8","key":"e_1_3_4_4_2","doi-asserted-by":"crossref","DOI":"10.1177\/23259671251366424","article-title":"The relationship of meniscal extrusion to subchondral bone density in medial knee osteoarthritis","volume":"13","author":"Ebata T","year":"2025","unstructured":"Ebata T, Iwasaki K, Sato T, et al. 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