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Assessment of return to sport and functional outcomes following distal femoral, double level and high tibial osteotomies for active patients with symptomatic varus malalignment

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study indicated the outcomes of three surgical techniques for the treatment of symptomatic unicompartmental knee osteoarthritis (UKOA) with varus malalignment in younger, active patients: distal femoral osteotomy (DFO), double-level osteotomy (DLO) and high tibial osteotomy (HTO). The outcomes measured included the return to sport, sport activity and functional scores.

Methods

A total of 103 patients (19 DFO, 43 DLO, 41 HTO) were enrolled in the study and were divided into three groups based on their oriented deformity, each undergoing one of the three surgical techniques. All patients underwent pre- and post-operative evaluations including X-rays, physical exams and functional assessments.

Results

All three surgical techniques were effective in treating UKOA with constitutional malalignment. The average time to return to sport was similar among the three groups (DFO: 6.4 ± 0.3 [5.8–7] months, DLO: 4.9 ± 0.2 [4.5–5.3] months, HTO: 5.6 ± 0.2 [5.2–6] months). The sport activity and functional scores improved significantly for all three groups, with no significant differences observed among the groups.

Conclusion

Various knee osteotomy procedures, DFO, DLO, and HTO, result in high RTS rates and quick RTS times with satisfactory functional scores. Despite pre- to post-operative improvements in sport activities following DFO and DLO, pre-symptom levels were not reached following all evaluated procedures.

Level of evidence

Retrospective case–control study, Level III.

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Fig. 1

Data availability

Data available upon request.

References

  1. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR (2022) Return to sport and work following distal femoral varus osteotomy: a systematic review. HSS J 18:297–306

    Article  PubMed  Google Scholar 

  2. Abs A, Micicoi G, Khakha R, Escudier JC, Jacquet C, Ollivier M (2023) Clinical and radiological outcomes of double-level osteotomy versus open-wedge high tibial osteotomy for bifocal varus deformity. Orthop J Sports Med 11:23259671221148456

    Article  PubMed  PubMed Central  Google Scholar 

  3. Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S (2022) Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 30:688–697

    Article  PubMed  Google Scholar 

  4. Bode G, Ogon P, Pestka J, Zwingmann J, Feucht M, Sudkamp N et al (2015) Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. Int Orthop 39:689–696

    Article  PubMed  Google Scholar 

  5. Bonnin MP, Laurent JR, Zadegan F, Badet R, Pooler Archbold HA, Servien E (2013) Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc 21:64–73

    Article  PubMed  Google Scholar 

  6. Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Jt Surg Br 90:1548–1557

    Article  Google Scholar 

  7. Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SM et al (2014) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004019.pub4CD004019

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cantin O, Magnussen RA, Corbi F, Servien E, Neyret P, Lustig S (2015) The role of high tibial osteotomy in the treatment of knee laxity: a comprehensive review. Knee Surg Sports Traumatol Arthrosc 23:3026–3037

    Article  CAS  PubMed  Google Scholar 

  9. Caubere A, Barbier O, Kley K, Hanak L, Jacquet C, Ollivier M (2022) Double level osteotomy for genu varum: is a return to sport possible? Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2022.103397103397

    Article  PubMed  Google Scholar 

  10. Ciolli G, Proietti L, Mercurio M, Corona K, Maccauro G, Schiavone Panni A et al (2022) Return to sport following distal femur osteotomy: a systematic review. Orthop Rev (Pavia) 14:33774

    Article  PubMed  Google Scholar 

  11. Dawson MJ, Ollivier M, Menetrey J, Beaufils P (2022) Osteotomy around the painful degenerative varus knee: a 2022 ESSKA formal consensus. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07024-0

    Article  PubMed  Google Scholar 

  12. Dean CS, Liechti DJ, Chahla J, Moatshe G, LaPrade RF (2016) Clinical outcomes of high tibial osteotomy for knee instability: a systematic review. Orthop J Sports Med 4:2325967116633419

    Article  PubMed  PubMed Central  Google Scholar 

  13. Diaz CC, Lavoie-Gagne OZ, Knapik DM, Korrapati A, Chahla J, Forsythe B (2022) Outcomes of distal femoral osteotomy for valgus malalignment: a systematic review and meta-analysis of closing wedge versus opening wedge techniques. Am J Sports Med. https://doi.org/10.1177/036354652110517403635465211051740

    Article  PubMed  Google Scholar 

  14. Ekhtiari S, Haldane CE, de Sa D, Simunovic N, Musahl V, Ayeni OR (2016) Return to work and sport following high tibial osteotomy: a systematic review. J Bone Jt Surg Am 98:1568–1577

    Article  Google Scholar 

  15. Grasso F, Martz P, Micicoi G, Khakha R, Kley K, Hanak L et al (2022) Double level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patients. Int Orthop 46:473–479

    Article  PubMed  Google Scholar 

  16. Hoorntje A, Kuijer P, Koenraadt KLM, Waterval-Witjes S, Kerkhoffs G, Mastbergen SC et al (2022) Return to sport and work after randomization for knee distraction versus high tibial osteotomy: is there a difference? J Knee Surg 35:949–958

    Article  PubMed  Google Scholar 

  17. Hoorntje A, Kuijer PPFM, van Ginneken BT, Koenraadt KLM, van Geenen RCI, Kerkhoffs GMMJ et al (2019) Prognostic factors for return to sport after high tibial osteotomy: a directed acyclic graph approach. Am J Sports Med 47:1854–1862

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hoorntje A, Witjes S, Kuijer P, Koenraadt KLM, van Geenen RCI, Daams JG et al (2017) High rates of return to sports activities and work after osteotomies around the knee: a systematic review and meta-analysis. Sports Med 47:2219–2244

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jacquet C, Gulagaci F, Schmidt A, Pendse A, Parratte S, Argenson JN et al (2020) Opening wedge high tibial osteotomy allows better outcomes than unicompartmental knee arthroplasty in patients expecting to return to impact sports. Knee Surg Sports Traumatol Arthrosc 28:3849–3857

    Article  PubMed  Google Scholar 

  20. Kley K, Bin Abd Razak HR, Khakha RS, Wilson AJ, van Heerwaarden R, Ollivier M (2021) Soft-tissue management and neurovascular protection during opening-wedge high tibial osteotomy. Arthrosc Tech 10:e419–e422

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kunze KN, Beletsky A, Hannon CP, LaPrade RF, Yanke AB, Cole BJ et al (2020) Return to work and sport after proximal tibial osteotomy and the effects of opening versus closing wedge techniques on adverse outcomes: a systematic review and meta-analysis. Am J Sports Med 48:2295–2304

    Article  PubMed  Google Scholar 

  22. Liu JN, Agarwalla A, Gomoll AH (2019) High tibial osteotomy and medial meniscus transplant. Clin Sports Med 38:401–416

    Article  CAS  PubMed  Google Scholar 

  23. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    Article  PubMed  Google Scholar 

  24. McNamara I, Birmingham TB, Fowler PJ, Giffin JR (2013) High tibial osteotomy: evolution of research and clinical applications—a Canadian experience. Knee Surg Sports Traumatol Arthrosc 21:23–31

    Article  CAS  PubMed  Google Scholar 

  25. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 246:250–259

    Article  Google Scholar 

  26. Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy. A subjective outcome study. J Bone Jt Surg Am 78:1353–1358

    Article  CAS  Google Scholar 

  27. Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43

    Article  PubMed  Google Scholar 

  28. Ollivier M, Fabre-Aubrespy M, Micicoi G, Ehlinger M, Hanak L, Kley K (2021) Lateral femoral closing wedge osteotomy in genu varum. Orthop Traumatol Surg Res 107:102989

    Article  PubMed  Google Scholar 

  29. Rupp MC, Muench LN, Ehmann YJ, Themessl A, Winkler PW, Mehl J et al (2022) Improved clinical outcome and high rate of return to low-impact sport and work after knee double level osteotomy for bifocal varus malalignment. Arthroscopy 38:1944–1953

    Article  PubMed  Google Scholar 

  30. Saier T, Minzlaff P, Feucht MJ, Lammle L, Burghoff M, Ihle C et al (2017) Health-related quality of life after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:934–942

    Article  PubMed  Google Scholar 

  31. Saragaglia D, Rouchy RC, Krayan A, Refaie R (2014) Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritis. Int Orthop 38:2109–2114

    Article  PubMed  Google Scholar 

  32. Sautet P, Kley K, Khakha R, Ollivier M (2022) Minimally invasive double level osteotomy in severe knee varus: pearls and pitfalls. Arthrosc Tech 11:e1105–e1109

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Favae F et al (2000) The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200012000-0000536-46

    Article  PubMed  Google Scholar 

  34. Schroter S, Nakayama H, Yoshiya S, Stockle U, Ateschrang A, Gruhn J (2019) Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg 139:519–527

    Article  CAS  PubMed  Google Scholar 

  35. Schröter S, Nakayama H, Yoshiya S, Stöckle U, Ateschrang A, Gruhn J (2019) Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg 139:519–527

    Article  PubMed  Google Scholar 

  36. Warme BA, Aalderink K, Amendola A (2011) Is there a role for high tibial osteotomies in the athlete? Sports Health 3:59–69

    Article  PubMed  PubMed Central  Google Scholar 

  37. Williams RJ 3rd, Kelly BT, Wickiewicz TL, Altchek DW, Warren RF (2003) The short-term outcome of surgical treatment for painful varus arthritis in association with chronic ACL deficiency. J Knee Surg 16:9–16

    PubMed  Google Scholar 

  38. Witjes S, Gouttebarge V, Kuijer PP, van Geenen RC, Poolman RW, Kerkhoffs GM (2016) Return to sports and physical activity after total and unicondylar knee arthroplasty: a systematic review and meta-analysis. Sports Med 46:269–292

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yim JH, Song EK, Seo HY, Kim MS, Seon JK (2013) Comparison of high tibial osteotomy and unicompartmental knee arthroplasty at a minimum follow-up of 3 years. J Arthroplasty 28:243–247

    Article  PubMed  Google Scholar 

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Funding

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Author information

Authors and Affiliations

  1. Tokyo Medical and Dental University, Tokyo, Japan

    Jae-Sung An & Hideyuki Koga

  2. Leeds Teaching Hospitals, Leeds, UK

    Ahmed Mabrouk

  3. Institut du Mouvement et de l’appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France

    Jae-Sung An, Ahmed Mabrouk, Raghbir Khakha, Kristian Kley, Christophe Jacquet & Matthieu Ollivier

  4. Guys and St. Thomas’ Hospitals, Great Maze Pond, London, UK

    Raghbir Khakha

  5. Harley Street Specialist Hospital, 18-22, Queen Anne Street, London, W1G8HU, UK

    Kristian Kley

  6. Orthopädie Maximilium, Donauwörth, Germany

    Kristian Kley

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  1. Jae-Sung An
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Contributions

MO, KK design the study protocol. MO operated all patients of the series. JA, AM wrote the initial manuscript. HK, CJ edited the manuscript. JA, CJ performed statistical analysis. AM, RK performed english editing (native english speakers).

Corresponding author

Correspondence to Matthieu Ollivier.

Ethics declarations

Conflict of interest

MO, KK, RK consultant for newclip technique.

Ethical approval

“Non interventional research”: waiver from the French national ethic regulation.

Informed consent

Acquired for all patients.

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An, JS., Mabrouk, A., Khakha, R. et al. Assessment of return to sport and functional outcomes following distal femoral, double level and high tibial osteotomies for active patients with symptomatic varus malalignment. Knee Surg Sports Traumatol Arthrosc 31, 4285–4291 (2023). https://doi.org/10.1007/s00167-023-07457-1

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