Risk Factors Affecting Return to Sports and Patient-Reported Outcomes After Opening-Wedge High Tibial Osteotomy in Active Patients

Abstract

Background: Although opening-wedge high tibial osteotomy (OWHTO) is favored for active patients who expect to return to sports, there is still a lack of robust evidence for factors affecting their recovery. Purpose: To identify (1) risk factors leading to a decreased level of return to preoperative sports after OWHTO and (2) patient characteristics and intraoperative factors influencing patient-reported outcomes after return to sports. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 69 patients who underwent OWHTO and who expected to return to their preoperative level of sports, measured as a Tegner activity level ≥2. All included patients had a minimum of 1 year of follow-up data. Logistic regression analyses were performed to assess the effect of independent variables on the level of return to preoperative sports after surgery; the independent variables were age, sex, body mass index, preoperative Tegner score, preoperative Kellgren-Lawrence grade, preoperative percentage of mechanical axis (%MA), opening gap width, concomitant meniscal treatment, postoperative %MA, postoperative medial proximal tibial angle (MPTA), and postoperative posterior tibial slope. Univariate and multiple regression analyses were performed to assess for influencing factors on postoperative International Knee Documentation Committee (IKDC) subjective scores in patients who were able to return to sports. Results: Of the 69 patients, 51 (73.9%) returned to sports after OWHTO. High preoperative Tegner scores were statistically associated with a decrease in return to sports (odds ratio, 1.494; P = .033). Multiple regression analysis (n = 46 patients) identified that a higher postoperative MPTA was associated with a decreased IKDC subjective score after return to sports ( r = –0.345; P = .019). Conclusion: Higher postoperative MPTA was associated with the worsening of patient-reported outcomes among those patients who did return to their preoperative sports after OWHTO. Also, participation in high-activity sports was confirmed to be a significant risk factor for a decreased rate of return to preoperative sports. These findings can support preoperative planning and intraoperative decision making, particularly for active patients.

Muti-factor analysis of sport activity level after high tibial osteotomy

“…Under the same postoperative Lysholm knee score, patients with lower preoperative Lysholm knee score are better relieved from knee joint pain symptoms after surgery compared to those with higher preoperative Lysholm knee score, and have more confidence in returning to sports, thus enjoying a better chance promoting activity level. Katagiri et al[ 28 ] also discovered that high preoperative Tegner scores were a prognostic risk factor for not returning to preoperative sports levels after open-wedge high tibial osteotomy (OWHTO).…”

“…Besides, the results of this study suggest that preoperative and postoperative MPTA does not affect the improvement of postoperative sport activity level. A previous study suggested that a high postoperative MPTA was a prognostic risk factor for unsatisfactory outcomes in terms of returning to sports after OWHTO [ 28 ].…”

“…HTO, as a valid treatment method for KOA, is commonly deemed more applicable for younger, active patients [ 7 , 11 , 28 , 30 ]. Some research has suggested that there’s no difference in the domain of returning to recreational activity and short-term clinical outcomes when comparing the postoperative outcomes of HTO and UKA in treating medial unicompartmental osteoarthritis [ 31 ], while other studies suggest that patients who underwent HTO were more physically active and more quicker to return to physical activity [ 7 , 32 ].…”

Influence of Previous Arthroscopic Meniscectomy on Midterm to Long-term Outcomes After Medial Open-Wedge High Tibial Osteotomy

“…9,23,24,27,31,40 Although satisfactory results have been reported in most patients undergoing MOWHTO, dissatisfactory results unexpectedly occur in a few patients. 5,14 Various factors have been reported to be associated with inferior outcomes after MOWHTO, including advanced age, greater body mass index, lower preoperative range of motion, and high-grade OA. 5,21,[28][29][30] A history of arthroscopic meniscectomy has been rarely reported in patients with OA knees undergoing MOWHTO.…”