Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach

Abstract

Background: High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty. Purpose: To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results: We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (± 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range [IQR], 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up ( P < .001). The mean Lysholm score at follow-up was 68 (SD, ± 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76). Conclusion: More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors.

Return to Sport and Work after Randomization for Knee Distraction versus High Tibial Osteotomy: Is There a Difference?

“…20 Also, rates of return to sport (RTS) of 82 to 85% and return to work (RTW) of 85 to 95% have been reported after HTO. [21][22][23] Knee joint distraction (KJD) is a less well known but promising alternative joint-sparing treatment option in relatively young OA patients with severe complaints. With KJD, an external distraction device creates a temporary load reduction between focal areas of cartilage surfaces in the knee.…”

Preoperative Medial Meniscal Extrusion Is Associated With Patient-Reported Outcomes After Medial Opening Wedge High Tibial Osteotomy

“…Sports activity level is an important factor in determining MOWHTO. 14 It is also a factor that could be closely associated with MME. Furthermore, there might be other factors that were not identified in the current study that influence PROM after HTO.…”

The difficulty of continuing sports activities after open-wedge high tibial osteotomy in patient with medial knee osteoarthritis: a retrospective case series at 2-year-minimum follow-up

“…Hoorntje et al have reported that among 294 patients who underwent HTO, the rate at which patients returned to sporting activities was 82%, with a rate of returning to sports within 6 months post-operatively of 75% and a rate of returning to sports within 1 year post-operatively of 92%. In a logistic regression analysis, the significant prognostic factor for returning to sports activity was continued sports participation during the year before surgery [ 6 ]. In a recent study of the Japanese population, Kanto has reported that among 77 patients who underwent OW-HTO, the rate of patients who returned to sports was 89.6% (69 patients), with a mean return time of 8.7 ± 2.7 months.…”