Changes in the Contact Stress Distribution Pattern of the Patellofemoral Joint After Medial Open-Wedge High Tibial Osteotomy: An Evaluation Using Computed Tomography Osteoabsorptiometry

Kameda, Toshiaki; Kondo, Eiji; Onodera, Tomohiro; Iwasaki, Koji; Onodera, Jun; Yasuda, Kazunori; Iwasaki, Norimasa

doi:10.1177/2325967121998050

Cited by 9 publications

(11 citation statements)

References 38 publications

(52 reference statements)

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“…Some other radiologic and biomechanical studies indicated an increase of PF contact pressure and the progression of PF OA after OW-HTO. 10,19,39 Kameda et al 31 also cited a statistically significant decrease in patellar height and degradation of the PF cartilage after OW-HTO. Using the computed tomography–osteoabsorptiometry method, their study demonstrated that the OW-HTO procedure significantly increased the stress distribution patterns of the femoral lateral trochlea and the medial portion of the patellar lateral facet.…”

Section: Discussionmentioning

confidence: 97%

“…A systematic review and meta-analysis revealed that the tilting angle was significantly decreased but the lateral shift ratio did not differ significantly after OW-HTO. 38 Kameda et al 31 suggested that the medial tilt of the patella occurred because of lateral and distal shifts of the tibial tuberosity forcing up the lateral side of the femur and patella. In the present study, the tilting angle and lateral shift ratio after OW-HTO were similar to those in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…An a priori power analysis was performed. Based on our previous studies, 5,31,52,62 a sample size of 191 patients (220 knees) was calculated to have >85% power to test the hypothesis. All data are shown as means with a standard deviation.…”

Section: Methodsmentioning

confidence: 99%

“…46,72,74 Second, patellar height decreases after surgery. 10,23,31,32,43,73,74 Third, the length of the lower limb increases after surgery. 35,42,74 Fourth, the posterior tibial slope (PTS) angle of the tibial plateau increases after surgery.…”

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confidence: 99%

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Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy

Kondo

Yabuuchi²,

Joutoku

et al. 2022

Am J Sports Med

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Background: Recent studies have reported that medial opening wedge (OW) high tibial osteotomy (HTO) induces patella baja, resulting in degenerative changes in the patellofemoral joint. We have developed an inverted V-shaped (iV) HTO, which is classified as a neutral wedge osteotomy. Hypotheses: The study hypotheses were as follows: (1) patellar height, posterior tibial slope, and tibial length will not change between pre- and postoperative evaluations after iV-HTO; (2) the lateral shift ratio of the patella and the distance between the tibial tubercle and the trochlear groove may be significantly decreased after iV-HTO. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 191 patients (220 knees) who underwent HTO for medial osteoarthritis were enrolled retrospectively in this study: 107 knees underwent OW-HTO and 113 knees underwent iV-HTO. Clinical and radiological evaluations were performed before and at least 3 years after surgery. Results: Postoperatively, the mean Caton-Deschamps ratio was significantly decreased ( P < .0001) from 0.95 to 0.79 in the OW group, while there were no significant changes in the iV group. The mean posterior tibial slope was significantly increased ( P < .0001) from 8.5° to 10.5° in the OW group, while there were no significant differences in the iV group. Although the entire leg length was significantly increased ( P < .0003) in both groups after HTO, there were no significant differences in tibial length between the pre- and postoperative periods in the iV group. Regarding the congruity of the patellofemoral joint, the mean lateral shift ratio did not significantly change in the OW group, whereas it was significantly decreased ( P = .0012) from 11.5% to 8.8% in the iV group. The mean tibial tubercle–trochlear groove distance was significantly decreased ( P < .0001) from 12.8 to 9.7 mm in the iV group, while it was significantly increased in the OW group ( P < .0001). Concerning the clinical outcome, the Japanese Orthopaedic Association (JOA) and Lysholm knee scores at final follow-up (OW vs iV: JOA, 91.2 vs 90.1; Lysholm, 92.5 vs 89.0) were significantly increased ( P < .0001) as compared with the preoperative values (OW vs iV: JOA, 68.3 vs 66.8; Lysholm, 67.9 vs 61.0). Conclusion: Patellar height, posterior tibial slope, and tibial length did not change after the iV-HTO, while they were significantly changed after the OW-HTO. Although the preoperative degrees of varus knee and patellofemoral osteoarthritis were more severe in the iV group than the OW group, the iV-HTO led to altered patellofemoral joint congruity.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy

Kondo

Yabuuchi²,

Joutoku

et al. 2022

Am J Sports Med

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“…However, OWHTO still has its shortcomings. OWHTO has been reported to have a negative effect on the patellofemoral joint postoperatively due to a decrease in patellar height (PH) and an increase in patellofemoral contact pressure 5 , 6 , 7 . Biomechanical studies indicated that the alteration in sagittal patellar height can be attributed to distalization of the tibial tuberosity following OWHTO, which leads to the patella being pulled down toward the joint lines 8 .…”

Section: Introductionmentioning

confidence: 99%

Patellofemoral Joint after Opening Wedge High Tibial Osteotomy: A Comparative Study of Uniplane versus Biplane Osteotomies

Zheng

Wang

et al. 2022

Orthopaedic Surgery

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Objective To the best of our knowledge, there has been no comparative study of changes in radiographic parameters in the sagittal plane between biplane opening wedge high tibial osteotomy (OWHTO) with plate fixation and uniplane OWHTO with spacer implantation. The aim of the study was to compare sagittal radiographs between the procedures of biplane and uniplane OWHTOs in patients with genu varum and to investigate the impact on the patellofemoral joint. Methods A retrospective study of 71 patients (58.0 ± 5.0 years of age, 58 females and 13 males) with varus‐aligned medial compartment knee osteoarthritis treated with OWHTO was performed during the period from January 2016 to February 2019. Thirty‐three patients underwent biplane osteotomy with plate fixation (biplane group), and 38 patients underwent uniplane osteotomy with absorbable wedged spacer fixation (uniplane group). Independent t tests were used to compare the two groups according to the preoperative and postoperative radiographic parameters of hip‐knee‐ankle (HKA) angle, posterior tibial slope (PTS), tibial tubercle prominence (TTP), Caton–Deschamps (CD) index, and Blackburne–Peel (BP) index. During the last follow‐up assessment, patients were asked to rate their patellofemoral joint status using the Samsung Medical Center (SMC) patellofemoral (PF) scoring system. The visual analog scale (VAS) was also used to rate knee joint pain when walking. Results There was no significant difference between the two groups in any of the demographic, clinical, or radiological characteristics at baseline (p > 0.05). Comparisons of postoperative sagittal radiographic parameters between patients in the uniplane group and patients in the biplane group showed significant differences in the PTS (13.4° vs 16.6°, t = 4.465, p < 0.001), TTP (9.0 mm vs 4.2 mm, t = 7.950, p < 0.001), and CD index (0.81 vs 0.70, t = 4.035, p < 0.001). At the final follow‐up assessment (minimum, 2 years), the SMC PF function score was significantly lower in patients in the uniplane group than in patients in the biplane group (27.8 vs. 32.1, t = 2.458, p = 0.016), but there were no significant differences in the SMC PF pain score or VAS score (p > 0.05). Conclusion The essential difference in the postoperative sagittal radiographic changes between biplane and uniplane OWHTO was the tibial tubercle prominence, indicating the posterior displacement of the tibial tubercle. Uniplane OWHTO may yield better function of the patellofemoral joint compared to biplane OWHTO.

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Stress on the posteromedial region of the proximal tibia increased over time after anterior cruciate ligament injury

Miura

Iwasaki

Kondo

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Anterior cruciate ligament (ACL) injury induces anterior and rotatory instability of the knee. However, the efect of this instability on the stress distribution in the knee joint in living participants is not clear. The aim of this study was to compare the distribution pattern of subchondral bone density across the proximal tibia in the knees with and without ACL injury, and to investigate the correlation between the distribution patterns of the subchondral bone density and the duration of ACL-deiciency. Methods Radiographic and computed tomography (CT) data pertaining to 20 patients with unilateral ACL injury without combined injury (ACL-deicient group) and 19 nontraumatic subjects (control group) were collected retrospectively. Subchondral bone density of the proximal tibia was assessed using CT-osteoabsorptiometry. Both the medial and lateral compartments of the proximal tibia were divided into three subregions of equal width in the sagittal direction. The percentage of high subchondral bone density areas (HDA%) in each subregion was quantitatively analyzed. Results HDA% of the posteromedial region was signiicantly higher in the ACL-deicient group (mean: 21.6%) than in the control group (14.7%) (p = 0.002). In contrast, HDA% of the anteromedial region was signiicantly lower in the ACLdeicient group (9.4%) than in the control group (15.3%) (p = 0.048). The logarithm of the time elapsed from ACL injury to CT examination showed a signiicant correlation with HDA% in the posteromedial region (p = 0.032). Conclusions Subchondral bone density in the posteromedial region signiicantly increased after ACL injury and correlated with the duration of ACL-deiciency in semi-log manner in meniscus intact knees. The increase in stress on the posteromedial region after ACL injury, which induces a change in the subchondral bone density, justiies early ACL reconstruction after ACL injury.

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Changes in the Contact Stress Distribution Pattern of the Patellofemoral Joint After Medial Open-Wedge High Tibial Osteotomy: An Evaluation Using Computed Tomography Osteoabsorptiometry

Cited by 9 publications

References 38 publications

Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy

Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy

Patellofemoral Joint after Opening Wedge High Tibial Osteotomy: A Comparative Study of Uniplane versus Biplane Osteotomies

Stress on the posteromedial region of the proximal tibia increased over time after anterior cruciate ligament injury

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