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Veränderung der Patellahöhe nach „open“- und „closed wedge high tibial osteotomy“

Review der Literatur

Changes of patella position after closed and open wedge high tibial osteotomy

Review of the literature

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Zusammenfassung

Hintergrund

Die „high tibial osteotomy“ (HTO) ist eine etablierte Methode bei Varusgonarthrose. Die schließende („closed wedge HTO“) als auch die öffnende Technik („open wedge HTO“) kann die Patellahöhe verändern. Eine Veränderung der Patellahöhe kann das patellofemorale Alignement kompromittieren. Ziel der Arbeit war, die Veränderung der Patellahöhe nach „closed wedge HTO“ und „open wedge HTO“ anhand der verfügbaren Literatur festzustellen.

Material und Methode

Es erfolgte eine Literaturrecherche in Pubmed, wobei insgesamt 15 relevante Arbeiten identifiziert werden konnten. Die Arbeiten wurden nach „closed wedge HTO“ und „open wedge HTO“ aufgearbeitet und nach den verwendeten Indizes (Insall-Salvati-Index, Blackburne-Peel-Index, Caton-Deschamp-Index) unterteilt.

Ergebnisse

Der Insall-Salvati-Index nach „open wedge HTO“ nahm in 2 Arbeiten zu und in 5 Arbeiten ab. Nach „closed wedge HTO“ zeigte sich in 3 Arbeiten eine Zunahme, in 7 eine Abnahme und in einer Arbeit blieb die Patellahöhe unverändert. Im Blackburne-Peel- und Caton-Deschamp-Index zeigte sich in 7 und 5 Arbeiten jeweils eine Verminderung nach „open wedge HTO“. Eine Zunahme konnte in diesen Indices nicht festgestellt werden. Nach „closed wedge HTO“ ergab sich anhand des Blackburne-Peel-Index in 2 Arbeiten eine Abnahme und in 5 eine Zunahme. Der Caton-Deschamp-Index stieg in 2 Arbeiten an und nahm in 4 Arbeiten nach „closed wedge HTO“ ab. Nach „open wedge HTO“ zeigte sich hingegen in 4 Arbeiten eine Zunahme und in einer eine Abnahme. Der „tibial slope“ hat auf den Caton-Deschamps- und Blackburne-Peel-Index Einfluss. Die dargestellten Ergebnisse der unterschiedlichen Arbeitsgruppen zeigen divergente Ergebnisse. Sowohl bei der „closed wedge HTO“ wie auch bei der „open wedge HTO“ ist ein Tiefertreten der Patella zu beobachten. Ob eine Veränderung der Patellahöhe einen Einfluss auf das klinische Ergebnis hat, ist unklar.

Schlussfolgerung

Die Patellahöhe wird durch die „open wedge HTO“ und „closed wedge HTO“ beeinflusst. Ob es zu einem Höher- oder Tiefertreten nach HTO kommt, scheint u. a. vom verwendeten Index abzuhängen. Es sind prospektive Arbeiten mit weniger Einflussfaktoren und Berücksichtigung der Nachbehandlung erforderlich, um die Patellahöhe und den Einfluss auf das klinische Ergebnis beurteilen zu können.

Abstract

Aim

High tibial osteotomy (HTO) is an established treatment for varus osteoarthritis of the knee. The correction can be achieved by lateral closed wedge HTO or medial open wedge HTO techniques. Both techniques can change the patella position which influences alignment of the patella. Patella infera may compromise the result of secondary total knee prosthesis. An analysis of the current literature was carried out focusing on changes of patella position after HTO.

Method

A literature search was performed in PubMed which identified 15 relevant publications and the Insall-Salvati-index, the Blackburne-Peel-index and the Caton-Deschamps-index were analyzed.

Results

Results after closed wedge HTO: the Insall-Salvati-index decreased in 7 papers, increased in 3 papers and was unchanged in 1 paper. The Blackburne-Peel-index increased in 5 papers and decreased in 2. The Caton-Deschamps-index decreased in 4 papers and increased in 2 papers. Results after open wedge HTO: the InsalI-Salvati-index decreased in 5 papers and increased in 2. The Blackburne-Peel-index decreased in all 7 papers and the Caton-Deschamps-index decreased in all 5 papers. The results of these studies vary significantly and there was a tendency to patella infera in both techniques. The Blackburne-Peel-index and the Caton-Deschamps-index may be biased by slope changes but the exact effect is not yet known. The Insall-Salvati-index seems to be independent of slope changes. The effect of different rehabilitation concepts on patella height is not known.

Conclusion

The clinical relevance of the observed changes in patella position must be clarified by prospective studies with strict criteria.

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  1. Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland

    S. Schröter, J. Mueller, C. Ihle, U. Stöckle & D. Albrecht

  2. Sportsclinic Germany, Hannover, Deutschland

    P. Lobenhoffer

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  1. S. Schröter
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Correspondence to S. Schröter.

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Schröter, S., Lobenhoffer, P., Mueller, J. et al. Veränderung der Patellahöhe nach „open“- und „closed wedge high tibial osteotomy“. Orthopäde 41, 186–194 (2012). https://doi.org/10.1007/s00132-011-1872-9

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