Observations on patellar height after proximal tibial osteotomy.

Scuderi, G R; Windsor, Russell E.; Insall, John N.

doi:10.2106/00004623-198971020-00011

Cited by 161 publications

(129 citation statements)

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“…As described in other series [13,15,16], we confirm with our series of patients that after a closed osteotomy with severe overcorrection technical difficulties needing release [2,8], and sometimes snipping of the quadriceps [6] or osteotomy of the anterior tibial tuberosity were more common. A reduced rate of satisfactory results and increased difficulty in exposing the knee was reported by Windsor et al [18] as early as the mid-1980s.…”

Section: Discussionsupporting

confidence: 90%

Outcome of Total Knee Arthroplasty After High Tibial Osteotomy: Does Malalignment Jeopardize the Results when Using a Posterior-Stabilized Arthroplasty?

et al. 2013

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Background: The controversy regarding the outcome of total knee arthroplasties after high tibial osteotomy may relate to malalignment secondary to overcorrection after high tibial osteotomy (HTO) [1,2] and to the type of arthroplasty itself (posterior-stabilized arthroplasty or posterior cruciate ligamentretaining prosthesis). Questions/Purpose: We asked two questions: (1) Would a posterior-stabilized arthroplasty provide sufficient constrain and improve pain and function in patients with severe malalignment due to a previous HTO? (2) Will malalignment of the previous HTO jeopardize the long-term results of a total knee reconstruction with a posterior-stabilized implant? Patients and Methods: We retrospectively reviewed 25 posterior-stabilized TKAs in 25 patients with severe valgus deformity after HTO (ranging from 10°to 20°of valgus) and compared the results with a series of matched 25 posteriorstabilized TKAs in 25 patients with normocorrection after HTO ranging from 5°of valgus to 5°of varus. Clinical, operative, and radiographic data were reviewed. Minimum follow-up was 10 years after the arthroplasty (average, 15 years; range, 10-20 years). Results: All the knees had standard posterior-stabilized total knee arthroplasty implants. Patients with an overcorrected HTO were more likely to require a soft tissue release to balance the knee. However, Average Knee Society and Function Score improved, respectively, from 48 to 85 and from 50 to 90 points in the severely overcorrected group, versus, respectively, 50 to 89 and 52 to 97 in the normocorrected group, but the range of mobility was superior for patients with normal alignment. Fifteen-year survivorship after the arthroplasty comparison showed no significant difference between the two groups (one revision in each group). Conclusions: Patients with an overcorrected HTO are more likely to require a soft tissue release to balance the knee. However, both groups show improvements in function and pain. With a posterior-stabilized arthroplasty, the degree of deformity has no impact on the longevity of the TKA.

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Section: Discussionsupporting

confidence: 90%

Outcome of Total Knee Arthroplasty After High Tibial Osteotomy: Does Malalignment Jeopardize the Results when Using a Posterior-Stabilized Arthroplasty?

et al. 2013

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“…They also found a reduction in patellar height. In the CWO group the patellar lowering reported by some authors [8,11,12] does not agree with the study by Dohin et al [5]. He used a theoretical model to simulate the proximal shifting of the tibial tuberosity, which is produced by a valgus osteotomy.…”

Section: Discussionmentioning

confidence: 84%

“…However, any such relationship was not found in a clinical study made on 59 knees [8,11,12]. Other studies using the method described by Insall and Salvati [8] also revealed significant patellar lowering after tibial osteotomy [10,11]. In 1989 Scuderi et al [11] suggested that the use of a cylinder cast after osteotomy could cause fibrosis of the patellar tendon with subsequent development of a contracture.…”

Section: Discussionmentioning

confidence: 95%

“…Through a theoretical calculation Dohin noticed that with a correction of 10°there should be a displacement of 0.08 cm and a proximal patellar lift of 0.8 cm [5]. However, any such relationship was not found in a clinical study made on 59 knees [8,11,12]. Other studies using the method described by Insall and Salvati [8] also revealed significant patellar lowering after tibial osteotomy [10,11].…”

Section: Discussionmentioning

confidence: 99%

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Patellar height after high tibial osteotomy

Tigani

Ferrari

Trentani

et al. 2001

International Orthopaedics

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We analysed two series of patients affected by unicompartmental arthrosis or axial malalignment of the knee treated with two different techniques of high tibial osteotomy. Forty-seven knees were treated with a closing wedge osteotomy (CWO) and 40 with an opening wedge osteotomy (OWO). The two groups were comparable with respect to age, gender and deformity. For each patient the patellar height was measured by Caton's method before surgery, and at the latest assessment (at least 1 year after operation). The correction rate for the two series was analysed to assess any possible correlation between the variation of the patellar height and the degree of correction of the knee axis. We concluded that a high tibial osteotomy modifies the patellar height and that this depends on the technique employed. Patellar 'lowering' occurred more often with OWO than with CWO and the latter also produced a high degree of patellar elevation.

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“…Depending on the surgical technique and postoperative management, alterations in patellar height can be induced [2,3,6,11,14,16,21]. Open wedge osteotomy (OWO) proximal to the tibial tuberosity, which is gaining popularity in recent years, has been reported to cause patella baja [6,12,21].…”

Section: Introductionmentioning

confidence: 99%

The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study

Gaasbeek

Welsing

Barink

et al. 2007

Knee Surg Sports Traumatol Arthr

110

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High tibial osteotomy (HTO) can cause alterations in patellar height, depending on the surgical technique, the amount of correction and the postoperative management. Alterations in patella location after HTO may lead to postoperative complications. However, information on changes in dynamic patellar kinematics following HTO is very limited. We conducted a biomechanical study, to analyze the effect of open (OWO) and closed wedge osteotomy (CWO) on patellar tracking. Using an inventive experimental setup, we studied the 3D dynamic patellar tracking in ten cadaver knees before and after valgus HTO. In each specimen, corrections of 7°and 15°of valgus according to, both, the OWO and CWO technique, were performed. Patellar height significantly increased with CWO and decreased with OWO. Both, OWO and CWO led to significant changes in the patellar tracking parameters tilt and rotation. We also found significant differences between OWO and CWO. Valgus high tibial osteotomy increased the medial patellar tilt and reduced the medial patellar rotation. These effects were more profound after OWO. No significant differences were found for the effect on medial-lateral patellar translation. These observations can be taken into consideration in the decision whether to perform an OWO or a CWO in a patient with medial compartment osteoarthritis of the knee.

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Observations on patellar height after proximal tibial osteotomy.

Cited by 161 publications

References 0 publications

Outcome of Total Knee Arthroplasty After High Tibial Osteotomy: Does Malalignment Jeopardize the Results when Using a Posterior-Stabilized Arthroplasty?

Outcome of Total Knee Arthroplasty After High Tibial Osteotomy: Does Malalignment Jeopardize the Results when Using a Posterior-Stabilized Arthroplasty?

Patellar height after high tibial osteotomy

The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study

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