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Distal tibial tubercle osteotomy is superior to the proximal one for progression of patellofemoral osteoarthritis in medial opening wedge high tibial osteotomy

  • Hiroyasu Ogawa
  • Kazu MatsumotoEmail author
  • Hiroki Yoshioka
  • Masaya Sengoku
  • Haruhiko Akiyama
KNEE
  • 71 Downloads

Abstract

Purpose

To investigate the effect of proximal tibial tubercle osteotomy (PTO) and distal tibial tubercle osteotomy (DTO) in medial opening wedge high tibial osteotomy on patellofemoral alignment, patellofemoral osteoarthritis and clinical outcomes.

Methods

PTO (n = 41) and DTO (n = 43) for the same surgical indications were included. Radiographic measurements of the Caton-Deschamps index, patellar tilt and shift, and arthroscopic cartilage evaluation at the patellofemoral joint were performed at osteotomy and plate removal. The Knee Society Score (KSS) was evaluated preoperatively and at the latest follow-up.

Results

The follow-up period was longer in the PTO group (33.7 months; range 23–40 years) than in the DTO group (22.2 months; range 18–29 months) (p < 0.0001), whereas the period from osteotomy to plate removal was not different between the groups. The Caton-Deschamps index of the DTO group was unchanged from 0.9 (range 0.7–1.2) to 0.9 (range 0.6–1.4), whereas that of the PTO group changed from 0.9 (0.7–1.2) to 0.7 (0.5–1.0) (p < 0.0001). There were fewer deteriorated cases of cartilage status in the trochlear groove in the DTO group (20.9%) than in the PTO group (56.1%, p < 0.05). There were more improved cases in the DTO group (23.3%) than in the PTO group (4.9%, p < 0.05). Postoperative KSS was better in the DTO group than in the PTO group (p < 0.05).

Conclusion

DTO is associated not only with reduced deterioration but also with increased improvement of cartilage status in the trochlear groove and better KSS as compared with PTO.

Level of evidence

IV.

Keywords

Distal tibial tubercle osteotomy High tibial osteotomy Patellofemoral osteoarthritis Patella infera Patella baja Distal tuberosity osteotomy 

Notes

Funding

No funding has been received for this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

This retrospective study was approved by the institutional review board of Gifu University Graduate School of Medicine (approval no. 27-100).

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Hiroyasu Ogawa
    • 1
    • 2
  • Kazu Matsumoto
    • 1
    Email author
  • Hiroki Yoshioka
    • 3
  • Masaya Sengoku
    • 4
  • Haruhiko Akiyama
    • 1
  1. 1.Department of Orthopaedic SurgeryGifu University Graduate School of MedicineGifuJapan
  2. 2.Department of Advanced Joint Reconstructive SurgeryGifu University Graduate School of MedicineGifuJapan
  3. 3.Department of Orthopaedic SurgeryYamauchi HospitalGifuJapan
  4. 4.Department of Orthopaedic SurgeryOgaki Tokushukai HospitalOgakiJapan

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