Opening wedge high tibial osteotomy affects both the lateral patellar tilt and patellar height

ObjectivesTo assess the impact of a biplanar ascending opening-wedge high tibial osteotomy (OWHTO) on the alignment of the knee extensor mechanism and patellar height using preoperative and postoperative MRI.MethodsMedical records of all patients submitted to ascending biplanar OWHTO between July 2008 and March 2017 were retrospectively assessed. Five parameters of the patellofemoral joint—tibial tubercle–trochlear groove distance (TT-TG), patellofemoral (PF) axial engagement index, lateral patellar tilt, Blackburne-Peel index (BPI) and Caton-Deschamps index (CDI)—were measured by two blinded independent observers on both preoperative and postoperative MRIs. Interobserver reliability was assessed with the intraclass correlation coefficient (ICC). Paired t-test was performed to compare preoperative and postoperative measurements. The association of the amount of HTO opening and the assessed PF joint parameters was also investigated with Pearson correlation coefficient.Results26 patients who underwent ascending biplanar OWHTO were enrolled in this imaging analysis (63.4%) with a mean follow-up of 16.3 months (SD, 16.9). ICC for all measurements ranged between 73.3% and 89.3%. Postoperatively, TT-TG distance significantly increased by 2.0 mm±2.3 mm (p<0.001). Patellar height significantly decreased when evaluated by the BPI (p<0.001) and CDI (p=0.001). The amount of osteotomy opening significantly correlates with the postoperative BPI (p=0.023) and CDI (p=0.013).ConclusionThis study comprehensively reports significant increase on TT-TG distance after an ascending biplanar OWHTO using MRI. Small but significant decreases in patellar height were also observed and are correlated to the amount of axis correction.Level of evidenceLevel IV, retrospective case study.

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Patellar height relevance in opening-wedge high tibial osteotomy

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2009.10.009 ◽

2010 ◽

Vol 96 (1) ◽

pp. 37-43 ◽

Cited By ~ 29

Author(s):

M.H. El Amrani ◽

B. Lévy ◽

S. Scharycki ◽

A. Asselineau

Keyword(s):

High Tibial Osteotomy ◽

Patellar Height ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Wedge High Tibial Osteotomy

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Open Wedge High Tibial Osteotomy with Distal Tubercle Osteotomy Lessens Change in Patellar Position

BioMed Research International ◽

10.1155/2017/4636809 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Hoon Park ◽

Hyun Woo Kim ◽

Jin Hwa Kam ◽

Dong Hoon Lee

Keyword(s):

High Tibial Osteotomy ◽

Proximal Tibia ◽

Young Patients ◽

Patellar Height ◽

Tibial Osteotomy ◽

Open Wedge ◽

Patellar Tilt ◽

Mean Values ◽

Patellar Position ◽

Wedge High Tibial Osteotomy

The purpose of this study was to investigate the change in patellar position after open wedge high tibial osteotomy (OWHTO) with distal tubercle osteotomy (DTO), comparing outcomes of conventional OWHTO in young adults with proximal tibia varus deformity but no arthritic manifestations. Thirty-three patients (mean age, 31.8 years) subjected to OWHTO/DTO were matched with 30 patients (mean age, 33.5 years) undergoing conventional OWHTO. Patellar position, as measured in pre- and postoperative standing lateral radiographs, was compared. Patellar height was assessed via Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel (BP) index, Caton-Deschamps (CD) index, and modified Miura-Kawamura index. Computed tomography was used to measure lateral patellar tilt and shift. In the OWHTO group, all patellar height indices decreased significantly following surgery. Although mean values of BP and CD indices decreased significantly in the OWHTO/DTO group, other determinants of patellar height showed no significant postoperative differences. Significant postoperative declines in average lateral patellar tilt were also evident in both groups, but pre- and postoperative lateral patellar shift did not differ significantly. OWHTO/DTO can be performed without significant changes in patellar height. The results obtained support that OWHTO/DTO is suitable for relatively young patients with proximal tibia vara but no arthritic change.

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