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Changes in patellofemoral alignment do not cause clinical impact after open-wedge high tibial osteotomy

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The objectives of this study were (1) to evaluate the clinical and radiologic outcomes of open-wedge high tibial osteotomy focusing on patellofemoral alignment and (2) to search for correlation between variables and patellofemoral malalignment.

Methods

A total of 46 knees (46 patients) from 32 females and 14 males who underwent open-wedge high tibial osteotomy were included in this retrospective case series. Outcomes were evaluated using clinical scales and radiologic parameters at the last follow-up. Pre-operative and final follow-up values were compared for the outcome analysis. For the focused analysis of the patellofemoral joint, correlation analyses between patellofemoral variables and pre- and post-operative weight-bearing line (WBL), clinical score, posterior slope, Blackburn Peel ratio, lateral patellar tilt, lateral patellar shift, and congruence angle were performed.

Results

The minimum follow-up period was 2 years and median follow-up period was 44 months (range 24–88 months). The percentage of weight-bearing line was shifted from 17.2 ± 11.1 to 56.7 ± 12.7 %, and it was statistically significant (p < 0.01). Regarding the clinical results, statistical significance was observed using all scores (p < 0.01). In the radiologic evaluation, patellar descent was observed with statistical significance (p < 0.01). Last follow-up lateral patellar tilt was decreased with statistical significance (p < 0.01). In correlation analysis between variables of patellofemoral malalignment, the pre-operative weight-bearing line showed an association with the change in lateral patellar tilt and lateral patellar shift (correlation coefficient: 0.3).

Conclusion

After open-wedge high tibial osteotomy, clinical results showed improvement, compared to pre-operative values. The patellar tilt and lateral patellar shift were not changed; however, descent of the patella was observed. Therefore, mild patellofemoral problems should not be a contraindication of the open-wedge high tibial osteotomy.

Level of evidence

Case series, Level IV.

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References

  1. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861

    Article  PubMed  Google Scholar 

  2. Backstein D, Meisami B, Gross AE (2003) Patella baja after the modified Coventry–Maquet high tibial osteotomy. J Knee Surg 16:203–208

    PubMed  Google Scholar 

  3. Bito H, Takeuchi R, Kumagai K, Aratake M, Saito I, Hayashi R, Sasaki Y, Saito T (2010) Opening wedge high tibial osteotomy affects both the lateral patellar tilt and patellar height. Knee Surg Sports Traumatol Arthrosc 18:955–960

    Article  PubMed  Google Scholar 

  4. Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238

    PubMed  Google Scholar 

  5. Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, Birmingham TB, Litchfield RB (2012) A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc 21:152–160

    Article  PubMed  Google Scholar 

  6. Fan JC (2012) Open wedge high tibial osteotomy: cause of patellar descent. J Orthop Surg Res 7:3

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gaasbeek R, Welsing R, Barink M, Verdonschot N, van Kampen A (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15:978–984

    Article  PubMed  Google Scholar 

  8. Gokay NS, Erginer R, Dervisoglu S, Yalcin MB, Gokce A (2012) Patella infera or patellar tendon adherence after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 22:1591–1598

    Article  PubMed  Google Scholar 

  9. Hinterwimmer S, Beitzel K, Paul J, Kirchhoff C, Sauerschnig M, von Eisenhart-Rothe R, Imhoff AB (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39:851–856

    Article  PubMed  Google Scholar 

  10. Lee YS, Lee BK, Kim WS, Choi JS, Baek JR, Moon CW (2013) Sagittal and coronal plane location of the popliteal artery in the open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc [Epub ahead of print]

  11. Lee YS, Lee BK, Lee SH, Park HG, Jun DS, Moon do H (2013) Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs. Knee Surg Sports Traumatol Arthrosc 21:2542–2547

    Article  PubMed  Google Scholar 

  12. Lind M, McClelland J, Wittwer JE, Whitehead TS, Feller JA, Webster KE (2011) Gait analysis of walking before and after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:74–81

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  14. Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25:639–646

    Article  PubMed  Google Scholar 

  15. Nha KW, Lee YS, Hwang DH, Kwon JH, Chae DJ, Park YJ, Kim JI (2013) Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy 29:226–231

    Article  PubMed  Google Scholar 

  16. Song IH, Song EK, Seo HY, Lee KB, Yim JH, Seon JK (2012) Patellofemoral alignment and anterior knee pain after closing- and opening-wedge valgus high tibial osteotomy. Arthroscopy 28:1087–1093

    Article  PubMed  Google Scholar 

  17. Stoffel K, Willers C, Korshid O, Kuster M (2007) Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 15:1094–1100

    Article  PubMed  Google Scholar 

  18. van Raaij TM, Bakker W, Reijman M, Verhaar JA (2007) The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord 8:74–80

    Article  PubMed  PubMed Central  Google Scholar 

  19. van Raaij TM, Reijman M, Furlan AD, Verhaar JA (2009) Total knee arthroplasty after high tibial osteotomy. A systematic review. BMC Musculoskelet Disord 10:88–97

    Article  PubMed  PubMed Central  Google Scholar 

  20. Yang JH, Lee SH, Nathawat KS, Jeon SH, Oh KJ (2012) The effect of biplane medial opening wedge high tibial osteotomy on patellofemoral joint indices. Knee 20:128–132

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea

    Yong Seuk Lee & Yong Eok Kwon

  2. Department of Orthopaedic Surgery, Gil Medical Center, Gil Hospital, Gachon University School of Medicine, 1198 Guwol-dong, Namdong-Gu, Incheon, 405-760, Korea

    Sang Bok Lee, Won Seok Oh & Beom Koo Lee

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  1. Yong Seuk Lee
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  2. Sang Bok Lee
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  3. Won Seok Oh
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Correspondence to Beom Koo Lee.

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Lee, Y.S., Lee, S.B., Oh, W.S. et al. Changes in patellofemoral alignment do not cause clinical impact after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 24, 129–133 (2016). https://doi.org/10.1007/s00167-014-3349-y

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  • DOI: https://doi.org/10.1007/s00167-014-3349-y

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