Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO
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The primary purpose of the study was to gain insight into geometric changes of the patellar height (PH) and posterior tibial slope (PTS) after a biplanar ascending medial open-wedge high tibial osteotomy (HTO) compared to biplanar descending medial open-wedge HTO in patients with genu varum.
Sixty-four patients (mean age 45.2 ± 8.7 years, females n = 24, males n = 40) with varus malalignment and medial gonarthrosis were retrospectively studied. Patients received either a biplanar ascending or descending medial open-wedge HTO. Radiographic analysis included the assessment of standing total leg axis, PH, and PTS prior to and after surgery.
In the ascending HTO group, PH decreased significantly by 4.0% (p = 0.037, Caton–Deschamps index) after an average leg axis valgus-producing correction of 7.1° ± 2.8°. In the descending HTO group, with an average leg axis correction of 7.0° ± 3.7°, there were no significant PH changes. There were no significant differences between the ascending and descending HTO groups regarding PTS or leg axis. The mean post-operative leg axis between ascending (1.6° ± 1.9°) and descending HTO (1.9° ± 2.4°) was not significantly different.
Compared to the biplanar ascending medial open-wedge HTO, the descending HTO did not influence patella height or increase the posterior tibial slope. In order to respect patellofemoral and slope-related knee kinematics, a biplanar descending medial open-wedge HTO has proven useful to control patella height and posterior tibial slope. These findings underscore the importance of the preoperative patella height assessment in the osteotomy planning and subsequent choice of the biplanar osteotomy direction.
Level of evidence
KeywordsVarus knee malalignment High tibial osteotomy Ascending biplanar retrotubercule osteotomy Descending biplanar retrotubercule osteotomy Tibial slope Patellar height
MK, RA, and KHF designed the study. MK and RA directed its implementation and wrote the manuscript. MK, AK, AP, and TCD performed the data collection. KHF reviewed the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standard
Conflict of interest
The authors declare that they have no conflict of interest.
This study was supported by Asklepios proresearch.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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