Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO

Krause, Matthias; Drenck, Tobias C.; Korthaus, Alexander; Preiß, Achim; Frosch, Karl‐Heinz; Akoto, Ralph

doi:10.1007/s00167-017-4548-0

Cited by 52 publications

(73 citation statements)

References 65 publications

(124 reference statements)

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“…16,19 Recently, OWHTO below the tibial tuberosity has aroused attention and shown significant improvements in radiographic parameters and knee function without changes in patellar height or PTS. [22][23][24][25][26] An early study reported that this technique could lead to the potential for fracture of the tibial tubercle fragment. 45 Park et al also observed two tibial tuberosity fractures with this technique, and they noted that this condition is easily preventable with caution (i.e., leaving at least a 1 cm thickness on the proximal tuberosity fragment).…”

Section: Discussionmentioning

confidence: 99%

“…17 Different surgical techniques also have different influences on patellar height, with some studies suggesting that OWHTO below the tibial tubercle does not affect patellar height. [22][23][24][25][26] Some studies also suggested that patellar height decreases significantly if the knee axis correction is greater than 15 degrees after OWHTO, and patellar tracking will also be seriously affected if the correction of knee axis exceeds 15 degrees. 14,27 Although many studies have reported a change in patellar position after OWHTO, most of these studies used the measurements based on tibial reference, and these measurements should not be relied upon in surgical procedure involving the proximal tibia.…”

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confidence: 99%

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Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

et al. 2019

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The objectives of our study were to evaluate (1) patellar height changes when the knee axis correction was < 15 degrees and (2) the clinical effect after open wedge high tibial osteotomy (OWHTO). Sixty-nine patients (69 knees) undergoing OWHTO between January 2016 and June 2017 were enrolled in this prospective study. All patients underwent OWHTO using a three-dimensional (3D)-printed patient-specific instrument. We used X-ray and lower-limb computed tomography scan to measure the osteotomy angle, patellar height, and other patellofemoral joint indices. We used the hospital for special surgery knee (HSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Kujala's scores to evaluate the clinical outcome. All knee axis corrections were less than 15 degrees. The change in posterior tibial slope (PTS) did not show a statistically significant difference. We observed that the patellar height was not altered when we used femur referenced measurement method. The change in modified Miura–Kawamura index (MKI) and Femoral patellar height index (FPHI) did not show a statistically significant difference. The differences in Blackburne–Peel index (BPI) and Caton–Deschamps index (CDI) were statistically significant, decreasing from 0.91 ± 0.12 and 1.06 ± 0.11 preoperatively to 0.79 ± 0.13 and 0.95 ± 0.11 postoperatively, respectively. In the axial plane, we did not observe a change in lateral patellar shift (LPS), but we found that lateral patellar tilt (LPT) showed a significant decrease from 8.67 ± 2.60 degrees preoperatively to 6.13 ± 2.30 postoperatively, respectively. The tuberositas tibae–trochlear groove (TT–TG) distance showed a significant decrease after OWHTO from 14.30 ± 4.10 mm preoperatively to 11.52 ± 3.63 mm postoperatively. The clinical score showed a significant increase after OWHTO, and all patients were satisfied with the outcome. After OWHTO, the patellar height was not altered when the knee axis correction was < 15 degrees. It was also found that there was still lateral displacement of the patella. Internal rotation of the distal tibia is an important cause of LPT reduction. After OWHTO, all patients achieved satisfactory clinical outcomes. At 1-year short-term follow-up, patients did not report discomfort in the patellofemoral joint. The Level of Evidence for this study was IV.

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Section: Discussionmentioning

confidence: 99%

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Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

et al. 2019

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“…To prevent patellar infera, some studies [10,11,20,21] have suggested that modified biplanar OWHTO is performed. In cases in which a separate descending osteotomy is performed by leaving the tuberosity attached to the proximal tibia, the patella height is not influenced, preventing the progression of patellofemoral joint OA.…”

Section: Discussionmentioning

confidence: 99%

The effect of distal tibial tuberosity high tibial osteotomy on postoperative patellar height and patellofemoral joint degeneration

Han

Tian

et al. 2020

J Orthop Surg Res

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Background Distal tibial tuberosity high tibial osteotomy (DTT-HTO) can prevent distalization of the tibial tuberosity and thus patellar infera. However, no studies on the clinical and radiological effects of DTT-HTO on the patellofemoral joint have been conducted. The purpose of the study was to evaluate the effect of DTT-HTO on patella height and patellofemoral joint congruity based on the severity of patellofemoral joint OA. Methods Twenty-nine patients (33 knees) who underwent DTT-HTO and second-look arthroscopy when implant was removed between January 2018 and May 2020 were eligible for the study. Among them, 6 were males, and 23 were females, with ages from 51 to 78 years old. The Caton-Deschamps index (CDI), congruence angle (CA), and lateral patellar tilt (LPT) were measured to evaluate the effect of surgery on patellar height and patellofemoral joint congruity. The weight-bearing line ratio (WBLR) was measured to assess lower limb alignment. The cartilage lesion in the patellofemoral joint was assessed arthroscopically during surgery and implant removal by the International Cartilage Repair Society (ICRS) grading system at 18–24 months after surgery. The Hospital for Special Surgery (HSS) scale was used to evaluate knee joint function. Results Twenty-nine patients were followed up for 18–28 months. The preoperative CDI, CA, and LPT changed from 0.92 ± 0.16 to 0.89 ± 0.14, from 5.52 ± 2.19 to 5.44 ± 2.27, and from 6.95 ± 2.88 to 6.54 ± 2.42, respectively, and the differences were not statistically significant (p > 0.05). The preoperative WBLR significantly increased from 16.72 ± 6.77 to 58.77 ± 7.69% (p < 0.001). The cartilage lesions in the patella and femoral trochlea did not progress significantly from the first- to the second-look arthroscopy, according to the ICRS grades (p > 0.05). The HSS score significantly improved from 50.64 ± 19.18 preoperatively to 67.33 ± 14.72, 81.63 ± 11.92, and 82.73 ± 8.05 at the 3-month, 12-month, and last follow-up after surgery (p < 0.001). Conclusion DTT-HTO can effectively prevent patellar infera, and its effects on postoperative patellofemoral joint congruity and patellofemoral joint OA progression are inconspicuous. It can be recommended as a treatment of varus knee combined with patellar infera or patellofemoral joint OA.

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“…To prevent patellar infra, some studies [10,11,20,21] have suggested that modi ed biplanar OWHTO is performed. In cases in which a separate descending osteotomy is performed by leaving the tuberosity attached to the proximal tibia, the patella height is not in uenced, preventing the progression of patellofemoral joint OA.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Distal Tibial Tuberosity High Tibial Osteotomy on Postoperative Patellar Height and Patellofemoral Joint Degeneration

Han

Tian³

et al. 2020

Preprint

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Background: Distal tibial tuberosity high tibial osteotomy (DTT-HTO) can prevent distalization of the tibial tuberosity and thus patella infra. However, no studies on the clinical and radiological effects of DTT-HTO on the patellofemoral joint have been conducted. The purpose of the study was to evaluate the effect of DTT-HTO on patella height and patellofemoral joint congruity based on the severity of patellofemoral joint OA.Methods: Twenty-nine patients (33 knees) who underwent DTT-HTO and second-look arthroscopy when implant removal between January 2018 and May 2020 were eligible for the study. Among them, 6 were males, and 23 were females, with ages from 51-78 years old. The Caton-Deschamps index (CDI), congruence angle (CA) and lateral patellar tilt (LPT) were measured to evaluate the effect of surgery on patellar height and patellofemoral joint congruity. The weightbearing line ratio (WBLR) was measured to assess lower limb alignment. The cartilage lesion in the patellofemoral joint was assessed arthroscopically during surgery and implant removal by the International Cartilage Repair Society (ICRS) grading system at 18-24 months after surgery. The Hospital for Special Surgery scale (HSS) was used to evaluate knee joint function.Results: Twenty-nine patients were followed up for 18-28 months. The preoperative CDI, CA and LPT changed from 0.92±0.16 to 0.89±0.14, from 5.52±2.19 to 5.44±2.27 and from 6.95±2.88 to 6.54±2.42, respectively, and the differences were not statistically significant (p＞0.05). The preoperative WBLR significantly increased from 16.72±6.77% to 58.77±7.69% (p < 0.001). The cartilage lesions in the patella and femoral trochlea did not progress significantly from the first- to the second-look arthroscopy, according to the ICRS grades (p＞0.05). The HSS score significantly improved from 50.64±19.18 preoperatively to 67.33±14.72, 81.63±11.92 and 82.73±8.05 at the 3-month, 12-month, and last follow-up after surgery (p < 0.001).Conclusion: DTT-HTO can effectively prevent patellar infra, and its effects on postoperative patellofemoral joint congruity and patellofemoral joint OA progression are inconspicuous. It can be recommended as a treatment of varus knee combined with patella infra or patellofemoral joint OA.

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Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO

Abstract: IV.

Cited by 52 publications

References 65 publications

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

The effect of distal tibial tuberosity high tibial osteotomy on postoperative patellar height and patellofemoral joint degeneration

The Effect of Distal Tibial Tuberosity High Tibial Osteotomy on Postoperative Patellar Height and Patellofemoral Joint Degeneration

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