Patellofemoral Osteoarthritis Progresses After Medial Open-Wedge High Tibial Osteotomy: A Systematic Review

Kataoka, Kunio; Watanabe, Shu; Nagai, Kazuo; Kay, Jeffrey; Matsushita, Takehiko; Kuroda, Ryosuke; de, Darren

doi:10.1016/j.arthro.2021.04.015

Cited by 12 publications

(11 citation statements)

References 51 publications

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“…This valgus correction led to a significant distalisation of the patella, as measured by the CDI and BPI. These findings concur with the published evidence [ 8 , 26 – 29 ]. The mean CDI, BPI and ISI indices in all subgroups remained at or above the limit of a patella baja and did not significantly differ among subgroups.…”

Section: Discussionsupporting

confidence: 93%

“…Nonetheless, this study delivers the longest follow-up data and thorough analysis of the influence of patellofemoral cartilage lesions on final outcomes after OW-HTO. Furthermore, the present cohort was quite a bit younger than those in comparable studies, and male sex was predominant [ 8 ]. The natural aging of patients after a decade might also be associated with lower functional outcome scores and degenerative impairments.…”

Section: Discussionmentioning

confidence: 75%

“…A limitation of the present study is the lack of a control group, especially a control group of patients after distal tibial tuberosity osteotomy for medial varus OA with patellofemoral cartilage lesions. A large meta-analysis by Kataoka et al [ 8 ] published in 2021 could not prove a causal link of patellofemoral OA and clinical outcomes in patients after OW-HTO. In line with the literature available, cartilage lesions were not monitored by X-ray, MRI or arthroscopy at final follow-up in order to avoid an unnecessary examination and surgery, as well as higher drop-out rates of patients due to change of residence or higher age and reduced mobility.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, OW-HTO remains a demanding intervention with notable risk factors [ 3 ]. While risk factors were significantly reduced applying standard surgical techniques [ 4 – 6 ] patellofemoral joint anomalies remain a serious postoperative problem [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Patellofemoral cartilage defects are acceptable in patients undergoing high tibial osteotomy for medial osteoarthritis of the knee

Bode

Kühle

Brenner

et al. 2022

BMC Musculoskelet Disord

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Background Patients suffering cartilage defects of the medial compartment with underlying varus deformity do benefit from high tibial osteotomy (HTO) even in the long term. Nonetheless, kinematic and geometric changes especially in the patellofemoral joint have been described. Purpose of the present study was to evaluate the influence of patellofemoral cartilage defects detected during the diagnostic arthroscopy and their influence on HTO’s postoperative outcome. Methods Ninety patients with a mean follow-up of 10.08 ± 2.33 years after surgery were included. Patients were divided into four groups according to their cartilage status in the patellofemoral joint (A = no defects, B = isolated lesions of the patella, C = isolated lesions of the trochlea, D = kissing lesions). Functional outcome was evaluated before surgery and about ten years thereafter by relying on the IKDC, Lysholm, and KOOS scores. Radiological parameters were assessed pre- and six weeks postoperatively. Results In groups A to D, the HTO led to significant patellar distalisation in the sagittal view, with the mean indices remaining at or above the limit to a patella baja. All patients in all groups profited significantly from HTO (higher Lysholm score, lower VAS p < 0.001), patients in group D had the lowest outcome scores. Patella height negatively influenced outcome scores in group C (Blackburne-Peel-Index—VAS p = 0.033) and D (Caton-Deschamps-Index—Tegner p = 0.018), a larger valgus correction was associated with lower outcome scores in group D (Lysholm p = 0.044, KOOSpain 0.028, KOOSQOL p = 0.004). Conclusion Long-term results of HTO for varus medial compartment osteoarthritis remain good to excellent even in the presence of patellofemoral defects. Overcorrection should be avoided. Distal biplanar HTO should be considered for patients presenting trochlear or kissing lesions of the patellofemoral joint. Trial registration DRKS00015733 in the German Registry of Clinical Studies.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patellofemoral cartilage defects are acceptable in patients undergoing high tibial osteotomy for medial osteoarthritis of the knee

Bode

Kühle

Brenner

et al. 2022

BMC Musculoskelet Disord

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“…10,15,35 Recent clinical studies have supported the findings of biomechanical studies by reporting macroscopic cartilage degeneration of the patellofemoral joint after MOWHTO. 12,16,18,25,31,43 Most of these studies evaluated the cartilage status of the patellofemoral joint using arthroscopy with only a short-term follow-up of 19 to 26 months. Some studies reported that deterioration of the patellofemoral joint had a negative effect on patient-reported outcome measures such as the Kujala score, 22 Knee injury and Osteoarthritis Outcome Score (KOOS), 33 Lysholm knee score, 27 and Shelbourne and Trumper score, 25,34,43 whereas other studies reported the opposite.…”

mentioning

confidence: 99%

Does Degeneration of the Patellofemoral Joint After Medial Open-Wedge High Tibial Osteotomy Affect Clinical Outcomes?

Yoon

Kim

et al. 2022

Am J Sports Med

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Background: Although biomechanical and clinical studies have reported adverse effects on the patellofemoral joint after medial open-wedge high tibial osteotomy (MOWHTO), there is a paucity of literature that describes outcomes longer than midterm follow-up. Purpose: We aimed to evaluate the mid- to long-term radiologic and clinical outcomes of the patellofemoral joint after MOWHTO and to assess whether radiologic deterioration of the patellofemoral joint affected clinical outcomes or survivorship after MOWHTO. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed 170 knees that underwent MOWHTO and had a minimum 5-year follow-up. In radiologic evaluation, serial postoperative changes in the patellofemoral joint compared with the preoperative status were evaluated on the Merchant view according to the Kellgren-Lawrence grade. The American Knee Society (AKS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Kujala score, incidence of anterior knee pain, and survivorship were used to assess clinical outcomes. Using radiologic assessment of the patellofemoral joint, we divided the patients into a radiologic progression group and a radiologic nonprogression group to evaluate whether radiologic progression of patellofemoral arthritis affected long-term clinical outcomes and survivorship after MOWHTO. Results: The mean follow-up period was 96.3 months (range, 60-163 months). Arthritic progression of the patellofemoral joint on the Merchant view was observed in 44.9%, 56.3%, 66.0%, and 84.0% of the cases at 5, 7, 9, and 11 years, respectively. Clinical outcomes such as AKS scores and KOOS significantly improved after MOWHTO ( P < .001) at the latest follow-up. The incidence of anterior knee pain was 5.3% (9/170 knees). One knee (0.6%) underwent conversion to TKA due to progressive medial osteoarthritis, so the survival rate was 99.4% at a mean follow-up of 96.3 months. Despite patellofemoral degeneration over time, there were no significant differences in clinical outcomes or survivorship between patients with and without radiologic progression at the latest follow-up. Conclusion: Although degeneration of the patellofemoral joint was observed with time after MOWHTO, the related symptoms were minimal and arthritic changes in the patellofemoral joint did not affect the clinical outcomes or survivorship after MOWHTO over a mid- to long-term follow-up.

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Open wedge high tibial osteotomy alters patellofemoral joint kinematics: A multibody simulation study

Schroeder,

Grothues,

Brunner

et al. 2024

Journal Orthopaedic Research

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Changes in lower limb alignment after open‐wedge high tibial osteotomy (owHTO) influence joint kinematics. The aim of this study was to investigate the morphological and kinematic changes of the knee joint, in particular the patellofemoral joint, using a multibody simulation model. OwHTO with an open tibial wedge of 6–12 mm (1 mm intervals) was virtually performed on each of 13 three‐dimensional (3D) computer‐aided design models (CAD models) derived from computer tomography scans of full‐leg cadaver specimens. For each owHTO, an individual biomechanical simulation model was built and knee flexion from 5° to 100° was simulated using a multibody simulation model of the native knee. Morphologic and alignment parameters as well as tibiofemoral and patellofemoral kinematic parameters were evaluated. Almost linear changes in tibial tuberosity trochlea groove (TT‐TG) (0.42 mm/1 mm wedge height) were observed which led to pathological values (TT‐TG > 20 mm) in 3 out of 13 knees. Furthermore, a 6 mm increase in osteotomy wedge height increased lateral patellofemoral rotation by 0.8° (range: 0.39° to 1.11°) and led to a lateral patellar translation of 0.8 mm (range: 0.37–3.11 mm) on average. Additionally, valgisation led to a medial translation of the tibia and a decrease in the degree of tibial internal rotation during knee flexion of approximately 0.3°/1 mm increase in osteotomy wedge height. The increase in TT‐TG and the biomechanical effects observed influence patellofemoral tracking, which may increase retropatellar pressure and are potential risk factors for the development of anterior knee pain.

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Patellofemoral Osteoarthritis Progresses After Medial Open-Wedge High Tibial Osteotomy: A Systematic Review

Cited by 12 publications

References 51 publications

Patellofemoral cartilage defects are acceptable in patients undergoing high tibial osteotomy for medial osteoarthritis of the knee

Patellofemoral cartilage defects are acceptable in patients undergoing high tibial osteotomy for medial osteoarthritis of the knee

Does Degeneration of the Patellofemoral Joint After Medial Open-Wedge High Tibial Osteotomy Affect Clinical Outcomes?

Open wedge high tibial osteotomy alters patellofemoral joint kinematics: A multibody simulation study

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