522 Measurement of Contact Pressure Distribution in Patellofemoral Joint before and after Open Wedge High Tibial Osteotomy

Background: No study has yet assessed the effect of medial open-wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint according to postoperative alignment. Purpose: To evaluate the effect of MOWHTO on the patellofemoral joint according to postoperative alignment by comparing the cartilage status before and after surgery and assessing the clinical and radiological outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 135 patients who underwent MOWHTO were retrospectively investigated. The patients were divided into 3 groups according to the postoperative weightbearing line ratio (WBLR): undercorrection (WBLR <58.3%, lowest quartile), acceptable correction (WBLR of 58.3%-66.3%, middle 2 quartiles), and overcorrection (WBLR >66.3%, highest quartile). The postoperative change in the cartilage status was assessed arthroscopically during implant removal at 2 years after MOWHTO. The clinical and radiological outcomes were evaluated at a mean follow-up of 52.1 months. A regression analysis was performed to identify the factors affecting the deterioration of the patellofemoral joint cartilage status. A receiver operating characteristic curve was employed to identify the cutoff point for the postoperative WBLR associated with the deterioration of the cartilage status in the patellofemoral joint. Results: Of all patients, progression of cartilage degeneration was noted in 39.3% for femoral trochlea and 23.7% for patella. The incidence of cartilage progression was significantly higher in the overcorrection group than in the undercorrection and acceptable correction groups (femoral trochlea: undercorrection group = 30.3%, acceptable correction group = 32.4%, and overcorrection group = 61.8% [ P = .008]; patella: undercorrection group = 15.2%, acceptable correction group = 17.7%, and overcorrection group = 44.1% [ P = .005]). The functional outcomes, including Lysholm knee score, Knee injury and Osteoarthritis Outcome Score (Pain, Symptoms, and Activities of Daily Living subscales), and Shelbourne and Trumper score, were significantly worse in the overcorrection group. The regression analysis showed that only the postoperative WBLR had a significant effect on cartilage deterioration. The cutoff point for the postoperative WBLR associated with progression of the International Cartilage Repair Society grade was 62.1% for the femoral trochlea (sensitivity = 61.5%, specificity = 62.7%, accuracy = 66.2%) and 62.2% for the patella (sensitivity = 59.4%, specificity = 60.2%, accuracy = 67.8%). Conclusion: The patellofemoral joint was adversely affected by MOWHTO. Overcorrection causing excessive valgus alignment led to further progression of degenerative changes in the patellofemoral joint and inferior clinical outcomes. The postoperative WBLR can be used as a predictive factor for deterioration of the cartilage status in the patellofemoral joint after MOWHTO.

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Preoperative flexion contracture is a predisposing factor for cartilage degeneration at the patellofemoral joint after open wedge high tibial osteotomy

Knee Surgery and Related Research ◽

10.1186/s43019-020-00063-2 ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Shuhei Otsuki ◽

Kuniaki Ikeda ◽

Hitoshi Wakama ◽

Nobuhiro Okuno ◽

Yoshinori Okamoto ◽

...

Keyword(s):

Clinical Outcomes ◽

High Tibial Osteotomy ◽

Patellofemoral Joint ◽

Cartilage Degeneration ◽

Flexion Contracture ◽

Tibial Osteotomy ◽

Open Wedge ◽

Progressive Degeneration ◽

Radiographic Parameters ◽

Wedge High Tibial Osteotomy

Abstract Purpose The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.

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Medial Open-Wedge High Tibial Osteotomy May Adversely Affect the Patellofemoral Joint

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2016.09.034 ◽

2017 ◽

Vol 33 (4) ◽

pp. 811-816 ◽

Cited By ~ 36

Author(s):

Kang-Il Kim ◽

Dong-Kyoon Kim ◽

Sang-Jun Song ◽

Sang-Hak Lee ◽

Dae-Kyung Bae

Keyword(s):

High Tibial Osteotomy ◽

Patellofemoral Joint ◽

Tibial Osteotomy ◽

Open Wedge ◽

Wedge High Tibial Osteotomy

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Relationship between the correction angle in medial open wedge high tibial osteotomy and the postoperative state of patellofemoral cartilage

10.21203/rs.2.20950/v1 ◽

2020 ◽

Author(s):

Chong-Hyuk Choi ◽

Min Jung ◽

Sung-Hwan Kim ◽

Sang-Hee Kim ◽

Tae-Hwan Yoon

Keyword(s):

High Tibial Osteotomy ◽

Patellofemoral Joint ◽

Group Versus ◽

International Knee Documentation Committee ◽

Cartilage Degeneration ◽

Tibial Osteotomy ◽

Open Wedge ◽

Correction Angle ◽

Significant Difference ◽

Wedge High Tibial Osteotomy

Abstract Background: To investigate clinical and radiologic effects of medial open wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint in relation to the correction angle by comparing changes in cartilage from before to after the surgery. Methods: A total of 124 MOWHTO cases were divided into the three groups of small, moderate, and large, depending on the correction angle. Clinical and radiologic outcomes were compared at the mean follow-up time of 38.8 months. Postoperative cartilage changes were assessed during implant removal completed at two years after MOWHTO. Results: There was no significant difference evident in most clinical outcomes measured, including Lysholm score and the Knee Injury and Osteoarthritis Outcome score subscales, with the exception of postoperative Shelbourne and Trumper score between the groups (P< 0.001). International Knee Documentation Committee scale value on radiologic evaluation did not significantly differ among the groups. A progression of cartilage degeneration was noted in 40.3% of femoral trochleas and 22.6% of patellas. Cartilage degeneration was significantly progressed in the large correction angle group versus in the other two groups. Regression analysis showed that the correction angle had a significant effect on cartilage deterioration (Trochela, P=0.009; Patella, P=0.034). Conclusion: Patellofemoral joint was more adversely affected by MOWHTO in conjunction with the requirement of a larger correction angle. Thus, cases necessitating considerable correction should be forewarned of patellofemoral joint symptoms within a relatively short time after the procedure. Keywords: medial open wedge high tibial osteotomy, osteoarthritis, patellofemoral arthritis, correction angle

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The effect of medial open wedge high tibial osteotomy on the patellofemoral joint: comparative analysis according to the preexisting cartilage status

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2989-y ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Hyun-Soo Moon ◽

Chong-Hyuk Choi ◽

Min Jung ◽

Sang-Hoon Park ◽

Dae-Young Lee ◽

...

Keyword(s):

Comparative Analysis ◽

Clinical Outcomes ◽

High Tibial Osteotomy ◽

Patellofemoral Joint ◽

Cartilage Lesion ◽

Tibial Osteotomy ◽

Open Wedge ◽

Radiographic Parameters ◽

Significant Difference ◽

Wedge High Tibial Osteotomy

Abstract Background Although it has been known that medial open wedge high tibial osteotomy (MOWHTO) would adversely affect the patellofemoral joint, no previous study examined the surgical outcome of MOWHTO according to the preexisting cartilage status of the patellofemoral joint. The aim of this study was to investigate the effect of MOWHTO on the patellofemoral joint with regard to objective and subjective aspects according to the preexisting cartilage status. Methods Ninety-two patients who underwent MOWHTO and a following second-look arthroscopic assessment were included in this study. The patients were divided into two groups according to the preexisting cartilage status of the patellofemoral joint: group 1 (International Cartilage Repair Society [ICRS] grade 2 or 3) and group 2 (ICRS grade 0 or 1). Comparative analysis was performed regarding clinical scores, radiographic parameters, and arthroscopic measurements between the two groups. Results Clinical outcomes showed overall improvement from baseline to the time of second-look operation, with no significant difference between the two groups at each time point. There were no significant differences in radiographic parameters between the two groups. Radiographic grade of patellofemoral osteoarthritis in both groups showed a tendency to progress, without statistical significance. In arthroscopic assessment, the size of the cartilage lesion on the patellofemoral joint increased with time in both groups (P = 0.003), but the degree of change over time between the two groups was not statistically significant. Consistently, there was no significant difference in the frequency of progression of cartilage lesion grade in the patellofemoral joint between the two groups. Conclusions MOWHTO would contribute to osteoarthritis progression of the patellofemoral joint regardless of the preexisting cartilage status, without an association with clinical outcomes in short-term follow-up.

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