Distal tuberosity osteotomy in open-wedge high tibial osteotomy does not exacerbate patellofemoral osteoarthritis on arthroscopic evaluation

Abstract

Purpose The purpose of the present study was to use arthroscopy to evaluate the effect of distal tuberosity osteotomy (DTO) in open‐wedge high tibial osteotomy (OW‐HTO) on patellofemoral (PF) cartilage degradation. Methods Between 2012 and 2017, 46 knees underwent DTO in OW‐HTO, and 65 knees underwent conventional OW‐HTO (cOW‐HTO). To assess changes in patellar height, the Blackburne–Peel (BP) ratio and the Caton–Deschamps (CD) index were measured. Arthroscopic evaluation on the PF joint was performed at the initial osteotomy and at the second‐look procedure 1 year later. Statistical analyses were performed to compare difference between the DTO and the cOW‐HTO group. Results In the cOW‐HTO group, the mean BP ratio and CD index decreased significantly from 0.81 and 0.89 preoperatively, respectively, to 0.69 and 0.76 postoperatively, respectively (p < 0.001). In contrast, the DTO group maintained a consistent patellar height; the mean BP ratio and CD index were 0.77 and 0.83 preoperatively, respectively, and 0.73 and 0.80 postoperatively, respectively. Upon arthroscopic evaluation, 39 of 46 patients (84.8%) in the DTO group showed no progression of PF cartilage degradation at the second look; indeed, five of 46 patients (10.9%) even demonstrated improvement. In contrast, 21 of 65 patients (32.3%) in the cOW‐HTO group exhibited increased PF cartilage degradation. There was a significant difference in progression of PF cartilage degradation between DTO and cOW‐HTO (p < 0.001). Conclusion DTO in OW‐HTO maintained the preoperative patellar height, which could help prevent progression of cartilage degeneration in the PF joint after surgery. In respect of the biplanar osteotomy direction in OW‐HTO, the DTO, rather than cOWHTO, is the preferred technique for the treatment of varus knee osteoarthritis to avoid progression of PF cartilage degradation. Level of evidence III.

How to achieve an optimal alignment in medial opening wedge high tibial osteotomy?

“…Using this method of maintaining patellar height, Horikawa et al. [ 63 ] reported that patellar height was almost the same preoperatively and postoperatively.…”

A Right Angle Guide for Distal Tuberosity Osteotomy With Medial Open Wedge High Tibial Osteotomy for Varus Knee Osteoarthritis

“…5,7 The superiority of Gaasbeek et al's technique with DTO, as compared with PTO, has been reported. [5][6][7][8][9][10][11][12][13] However, since it is sometimes difficult to set the DTO line perpendicular to the OWHTO line due to the triangular shape of the proximal tibia, we The main advantage of this guide is the ability to accurately set the second osteotomy line perpendicular to the first, thereby preventing gap formation at the second osteotomy site (Fig 9A). If the angle between the first and second osteotomy lines is obtuse, a gap will form ( Fig 9B).…”

“…Since the inception of this new technique, many authors have pointed out that patella height was not altered as compared with the conventional procedure. [5][6][7][8][9][10][11][12][13] In addition, Stoffel et al 14 experimentally revealed that OWHTO with DTO maintained normal patellofemoral joint biomechanics with no significant increase in patellofemoral cartilage pressure. However, setting the DTO (the second osteotomy) line perpendicular to the OWHTO (the first osteotomy) line, which prevents creating a gap at the DTO site, is quite difficult during the actual procedure due to the triangular shape of the proximal tibia.…”

Progression of pelvic retroversion is a critical factor for clinical outcome after Opening-wedge high tibial osteotomy among elderly patients

“…The effects of other factors on clinical outcomes should also be carefully considered in sagittal and axial view; Posterior tibial slope and patellofemoral OA might be associated with flexion contracture and poor clinical outcome after HTO [ 16 ]. Uni-compartment arthroplasty (UKA) and other types of HTO, such as hybrid HTO or opening-wedge distal tubercle osteotomy [ 6 , 17 ], might be considered for patients with symptoms of medial compartment OA who have a pelvic retroversion.…”