Predictive Factors for Patellofemoral Degenerative Progression After Opening-Wedge High Tibial Osteotomy

Lee, Sung-Sahn; S, So; Jung, Eui-Yub; Kim, Hyun-Jun; Lee, Byung‐Hoon; Wang, Joon Ho

doi:10.1016/j.arthro.2019.01.032

Cited by 30 publications

(42 citation statements)

References 37 publications

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“…Prior studies have shown that cartilage degeneration in the patellofemoral joint progressed in 33%e45% of patients at the time of second-look arthroscopy after OWHTO (the mean interval between initial high tibial osteotomy and second-look arthroscopy was 14e26 months). 3,6,7 Likewise, the study of Lee et al 8 reported that 30% of patients exhibited patellofemoral degenerative progression after OWHTO, which could be elucidated by a marked elevation of patellofemoral contact pressure after OWHTO reported in prior biomechanical studies. 4,5 Moreover, Lee et al 8 suggested that overcorrection, which indicated a higher correction angle, could induce patellofemoral degenerative progression.…”

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confidence: 88%

“…3,6,7 Likewise, the study of Lee et al 8 reported that 30% of patients exhibited patellofemoral degenerative progression after OWHTO, which could be elucidated by a marked elevation of patellofemoral contact pressure after OWHTO reported in prior biomechanical studies. 4,5 Moreover, Lee et al 8 suggested that overcorrection, which indicated a higher correction angle, could induce patellofemoral degenerative progression. Similarly, Tanaka et al 7 reported that cartilage injuries in the patellofemoral joints tended to progress after OWHTO in the knees, with medial open gap 13 mm, or with a change in the medial proximal tibial angle 9 .…”

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confidence: 88%

“…However, whether this patellofemoral degenerative progression after OWHTO adversely affects the clinical outcomes remains unclear. In the study by Lee et al, 8 patients with patellofemoral degenerative progression exhibited inferior patient-reported outcomes. Likewise, Kim et al 6 reported postoperative anterior knee pain in 11.4% of patients, which correlated with patellofemoral arthrosis.…”

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confidence: 94%

“…3,7,9 In my experience, despite the progression of patellofemoral OA after OWHTO, there are few cases of anterior knee pain. 3 I have two reservations about the study of Lee et al, 8 and the conclusions must be interpreted with caution. First, whether only the deterioration of patellofemoral cartilage adversely affects clinical outcomes remains debatable.…”

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confidence: 97%

“…Based on the current literature, 3,[6][7][8] it could be concluded that OWHTO causes the progression of the patellofemoral cartilage degeneration; however, the impact of these changes on clinical outcomes remains debatable. In the future, a large-scale long-term followup study is warranted to elucidate this topic.…”

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confidence: 99%

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Editorial Commentary: Does Patellofemoral Degenerative Progression After Open-Wedge High Tibial Osteotomy Adversely Affect Clinical Outcomes?

Goshima¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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confidence: 88%

Section: See Related Article On Page 1703mentioning

confidence: 88%

Section: See Related Article On Page 1703mentioning

confidence: 94%

Section: See Related Article On Page 1703mentioning

confidence: 97%

Section: See Related Article On Page 1703mentioning

confidence: 99%

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Editorial Commentary: Does Patellofemoral Degenerative Progression After Open-Wedge High Tibial Osteotomy Adversely Affect Clinical Outcomes?

Goshima¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Good clinical outcomes and return to sports after hybrid closed-wedge high tibial osteotomy

Nakashima

Takahara

Itani

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose This study aimed to investigate preoperative sports participation and postoperative clinical outcomes including a return to sports (RTS) after hybrid closed-wedge high tibial osteotomy (CWHTO) for medial compartment osteoarthritis of the knee. Characteristic of Hybrid CWHTO was deined as extra-articular lateral closed and medial open wedge osteotomy. Methods The patients who underwent hybrid CWHTO from January 2016 to December 2018 were retrospectively reviewed and divided them into sports and non-sports groups. The preoperative demographic and radiographic characteristics were compared in both groups. And the clinical outcomes including the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), Lysholm score, University of California at Los Angeles (UCLA) activity score, and RTS in the sports group were also investigated. Statistical analysis was performed for comparisons among the preoperative factors between the two groups. Inluence of sports impact and bone union of ibular osteotomy was also statistically investigated for RTS. Results Of the 161 knees (129 patients; 46 males, 83 females), 20 knees (16 patients; 13 males, 3 females; 12.3%) belonged to sports group. Although there were no signiicant diferences regarding the age and radiographic parameters, there were signiicant diferences in the body mass index and proportion of males between both groups. The JOA, VAS, Lysholm, and UCLA activity scores signiicantly improved after surgery. RTS was 80% at a mean duration of 7.2 ± 3.1 months. RTS in the high-impact sports group was signiicantly lower than that in the low-impact sports group (high-impact 60% vs. low-impact 100%, p = 0.043). There was no signiicant diference in RTS regarding bone union after ibular osteotomy. ConclusionThe clinical outcomes including RTS were satisfactory in patients with hybrid CWHTO. Level of evidence IV.

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Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome

Schelker

Moret

Doğan

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to investigate whether specific bone tracer uptake (BTU) patterns on preoperative SPECT/CT could predict which patients with varus alignment and medial overload would particularly benefit from medial opening-wedge high tibial osteotomy (MOWHTO). It was the hypothesis that an increased preoperative BTU relative to the reference BTU of the femur on SPECT/CT in the lateral and patellar compartments of the knee are predictive factors for inferior clinical outcome and that the clinical outcome correlates with the extent of alignment correction. Methods Twenty-three knees from 22 patients who underwent MOWHTO for medial compartment overload were investigated preoperatively using Tc-99m-SPECT/CT. BTU was quantified and localised to specific joint areas according to a previously validated scheme. Pre- and postoperative mechanical alignment was measured. Clinical outcome was assessed at a median of 24 months (range 11–30) after MOWHTO by collecting the WOMAC score. Results Significant correlations between BTU in the patellar area and the total WOMAC score and its subcategories pain and stiffness were found. Thus, BTU in the 1sPat area (superior lateral patellar compartment) correlated with total WOMAC (rho = 0.43, p = 0.04), pain subcategory (rho = 0.43, p = 0.04), and stiffness subcategory (rho = 0.59, p = 0.003). No significant correlations were found between alignment correction, age, gender and WOMAC. Conclusion This study highlights the role of preoperative SPECT in modern knee surgery to obtain information about the loading pattern on different compartments of the knee. Despite the limited number of participants, the present study shows that a preoperative SPECT/CT scan can help the treating surgeons to identify patients who may be at risk of inferior clinical outcome if an MOWHTO is considered, as an elevated BTU in the patellar region on preoperative SPECT/CT appears to be a potential risk factor for postoperative pain and stiffness. Level of evidence Level III.

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Predictive Factors for Patellofemoral Degenerative Progression After Opening-Wedge High Tibial Osteotomy

Cited by 30 publications

References 37 publications

Editorial Commentary: Does Patellofemoral Degenerative Progression After Open-Wedge High Tibial Osteotomy Adversely Affect Clinical Outcomes?

Editorial Commentary: Does Patellofemoral Degenerative Progression After Open-Wedge High Tibial Osteotomy Adversely Affect Clinical Outcomes?

Good clinical outcomes and return to sports after hybrid closed-wedge high tibial osteotomy

Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome

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