Patella infera or patellar tendon adherence after high tibial osteotomy

Gokay, Nevzat Selim; Erginer, Rıfat; Dervışoğlu, Sergülen; Yalçın, Mehmet Burak; Gökçe, Alper

doi:10.1007/s00167-012-2293-y

Cited by 13 publications

(15 citation statements)

References 28 publications

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“…In terms of the change in the sagittal alignment of patella after HTO, it has variable chances to change the patella height, which was confirmed in previous studies. 2,4,9,[14][15][16][17]27,30 However, the extent of the change could be different between various indexes of patellar height. [31][32][33] To interpret the results of sagittal alignment of patella correctly, it is essential to consider whether the indexes are sufficiently representative of the patellar height before and after HTO.…”

Section: Discussionmentioning

confidence: 99%

“…Four comparative studies showed the patellar height after both OW and CW HTO. 5,10,14,20 A total of 11 studies [2][3][4]9,15,16,[21][22][23][24][25] reported postoperative changes in patellar height or patellofemoral alignment only after OW HTO and five studies [26][27][28][29][30] reported changes only after CW HTO. The measured indexes used for the evaluation of patellar indexes in each study are shown in ►Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Changes of Sagittal and Axial Alignments of Patella after Open- and Closed-Wedge High-Tibial Osteotomy: A Systematic Review and Meta-Analysis

2017

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The present systematic review and meta-analysis were aimed to verify the effect of open-wedge (OW) and closed-wedge (CW) high-tibial osteotomy (HTO) on sagittal and axial alignments of the patella. A vigorous search was performed for studies that compared the changes of sagittal and axial alignments of patella after OW and CW HTO. After evaluating publication bias and heterogeneity, we aggregated variables by using the random-effects model. The weighted mean differences in sagittal and axial alignment of patella were estimated with 95% confidence intervals. Also, we analyzed the changes in sagittal alignment of various OW HTO techniques, such as uniplanar, biplanar, and retrotubercle osteotomy. Overall, 20 studies that included 831 OW HTOs and 206 CW HTOs were included in this study. Patellar height decreased after OW HTO based on the Blackburne-Peel index (BPI, mean: -0.10), and Caton-Deschamps index (CDI, mean: -0.08). However, the patellar height after CW HTO showed no change after surgery (BPI [mean: -0.02], and CDI [mean: 0.02]). Among OW HTO techniques, the retrotubercle osteotomy showed the least change in patellar height after surgery. The lateral patellar tilt decreased by 1.74 degrees, and lateral patellar shift showed no change after OW HTO. However, there was a lack of evidence to conclude the change of axial alignment of patella after CW HTO. Our results supported that the sagittal alignment of patella lowered after OW HTO. However, CW HTO maintained the constant sagittal position of the patella. Among OW HTO techniques, the retrotubercle osteotomy had the least effect on the sagittal alignment of the patella. Regarding the axial alignment of the patella, OW HTO resulted in a little change of lateral patellar tilt; however, there was little evidence to confirm the change of the axial alignment of patella after CW HTO.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Changes of Sagittal and Axial Alignments of Patella after Open- and Closed-Wedge High-Tibial Osteotomy: A Systematic Review and Meta-Analysis

2017

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“…26 Tendon stiffness may affect future surgical planning for total knee arthroplasty and may necessitate proximal quadriceps-plasty or distal tendino-osseous release. 13 This study had several limitations. The sample size was too small for correlation analysis or validation of the SWE.…”

Section: Discussionmentioning

confidence: 93%

Length, Thickness, and Elasticity of the Patellar Tendon after Closed Wedge High Tibial Osteotomy: A Shear Wave Elastographic Study

Botanlıoğlu

Kaynak

Kantarcı

et al. 2016

J Orthop Surg (Hong Kong)

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“…In addition, the patellofemoral joint on the sagittal plane is also in uenced by the operation [2] . Several studies have shown that OWHTO causes patella infra, increases patellofemoral joint pressure pain, increases the risk of patellofemoral OA progression, and makes it more di cult for total knee arthroplasty to be performed in the future [3][4][5][6][7][8] . Kim et al [8] reported the prevalence of the progression of patellofemoral OA to be 41.2% in the femoral trochlea and 21.9% in the patella articular surface after more than 2 years in 114 patients who underwent OWHTO.…”

Section: Introductionmentioning

confidence: 99%

“…Patella infra and patellofemoral malalignment have been reported to result from tibial tuberosity distalization and patellar tendon adherence [7,9] . To prevent patella infera, several studies have reported that osteotomy in the distal tibial tuberosity or below the tuberosity should be performed [10][11][12][13] .…”

Section: Introductionmentioning

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 infera or patellar tendon adherence after high tibial osteotomy

Abstract: The shortening of the tendon occurs as a result of adherence in the distal part of the tendon. It would appear that it is this shortening that causes the difficulties encountered during arthroplasty surgery of osteotomy patients, and not patella infera.

Cited by 13 publications

References 28 publications

Changes of Sagittal and Axial Alignments of Patella after Open- and Closed-Wedge High-Tibial Osteotomy: A Systematic Review and Meta-Analysis

Changes of Sagittal and Axial Alignments of Patella after Open- and Closed-Wedge High-Tibial Osteotomy: A Systematic Review and Meta-Analysis

Length, Thickness, and Elasticity of the Patellar Tendon after Closed Wedge High Tibial Osteotomy: A Shear Wave Elastographic Study

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

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