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Open Wedge High Tibial Osteotomy with Distal Tubercle Osteotomy Lessens Change in Patellar Position.

ABSTRACT: The purpose of this study was to investigate the change in patellar position after open wedge high tibial osteotomy (OWHTO) with distal tubercle osteotomy (DTO), comparing outcomes of conventional OWHTO in young adults with proximal tibia varus deformity but no arthritic manifestations. Thirty-three patients (mean age, 31.8 years) subjected to OWHTO/DTO were matched with 30 patients (mean age, 33.5 years) undergoing conventional OWHTO. Patellar position, as measured in pre- and postoperative standing lateral radiographs, was compared. Patellar height was assessed via Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel (BP) index, Caton-Deschamps (CD) index, and modified Miura-Kawamura index. Computed tomography was used to measure lateral patellar tilt and shift. In the OWHTO group, all patellar height indices decreased significantly following surgery. Although mean values of BP and CD indices decreased significantly in the OWHTO/DTO group, other determinants of patellar height showed no significant postoperative differences. Significant postoperative declines in average lateral patellar tilt were also evident in both groups, but pre- and postoperative lateral patellar shift did not differ significantly. OWHTO/DTO can be performed without significant changes in patellar height. The results obtained support that OWHTO/DTO is suitable for relatively young patients with proximal tibia vara but no arthritic change.

SUBMITTER: Park H

PROVIDER: S-EPMC5540386 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:BackgroundOpen-wedge high tibial osteotomy (OWHTO) may cause adverse changes in the mechanical environment of the patellofemoral joint. For patients with lateral patellar compression syndrome or patellofemoral arthritis, intraoperative management is still challenging. The effect of lateral retinacular release (LRR) on patellofemoral joint mechanics after OWHTO remains unclear. Our study aimed to evaluate the effect of OWHTO and LRR on the patellar position based on lateral and axial radiographs of the knee joint.MethodsThe study comprised 101 knees (OWHTO group) undergoing OWHTO alone and 30 knees (LRR group) undergoing OWHTO and concomitant LRR. The following radiological parameters were statistically analyzed preoperatively and postoperatively: femoral tibial angle (FTA), medial proximal tibial angle (MPTA), weight-bearing line percentage (WBLP), Caton-Deschamps index (CDI), Insall-Salvati index (ISI), lateral patellar tilt angle (LPTA), and lateral patellar shift (LPS). The follow-up duration ranged from 6 to 38 months, with a mean of 13.51±6.84 months in the OWHTO group and 12.47±7.81 months in the LRR group. The Kellgren-Lawrence (KL) grading system was used to evaluate changes in patellofemoral osteoarthritis (OA).ResultsRegarding the patellar height, preliminary analysis demonstrated a statistically significant decrease in the CDI and ISI in both groups (P<0.05). However, there was no significant difference in changes in CDI or ISI between the groups (P>0.05). In the OWHTO group, although there was a significant increase in the LPTA (P=0.033), the postoperative decrease in the LPS was not significant (P=0.981). In the LRR group, both the LPTA and LPS significantly decreased postoperatively (P=0.000). The mean changes in LPS were 0.03 mm in the OWHTO group and 1.44 mm in the LRR group, indicating a significant change in LPS (P=0.000). However, there was no significant difference in changes in LPTA between the groups, which was contrary to our expectations. Imaging showed no change in patellofemoral OA in the LRR group and progressive changes (from KL grade I to II) in patellofemoral OA in 2 (1.98%) patients in the OWHTO group.ConclusionsOWHTO can cause a significant decrease in patellar height and an increase in lateral tilt. LRR can significantly improve the lateral tilt and shift of the patella. The concomitant arthroscopic LRR should be considered for the treatment of patients with lateral patellar compression syndrome or patellofemoral arthritis.

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Open Wedge High Tibial Osteotomy with Distal Tubercle Osteotomy Lessens Change in Patellar Position.

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