Deterioration of patellofemoral cartilage status after medial open-wedge high tibial osteotomy

Abstract

Level IV, therapeutic case series.

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

“…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 . Javidan et al 5 investigated the impact of OWHTO on the patellofemoral joints in cadaveric knees and reported that the contact pressure of the patellofemoral joint significantly increased in the knees with a medial opening gap of 10 mm.…”

“…Conversely, several studies have highlighted that the patellofemoral OA progression after OWHTO did not affect clinical outcomes. 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.…”

“…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.…”

“…4,5 Some recent clinical studies have reported the progression of patellofemoral cartilage degeneration on second-look arthroscopy after OWHTO. 3,6,7 Nevertheless, whether patellofemoral degenerative progression adversely affects clinical outcomes remains unclear.…”

“…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.…”