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Distal tuberosity osteotomy in open-wedge high tibial osteotomy does not exacerbate patellofemoral osteoarthritis on arthroscopic evaluation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the present study was to use arthroscopy to evaluate the effect of distal tuberosity osteotomy (DTO) in open-wedge high tibial osteotomy (OW-HTO) on patellofemoral (PF) cartilage degradation.

Methods

Between 2012 and 2017, 46 knees underwent DTO in OW-HTO, and 65 knees underwent conventional OW-HTO (cOW-HTO). To assess changes in patellar height, the Blackburne–Peel (BP) ratio and the Caton–Deschamps (CD) index were measured. Arthroscopic evaluation on the PF joint was performed at the initial osteotomy and at the second-look procedure 1 year later. Statistical analyses were performed to compare difference between the DTO and the cOW-HTO group.

Results

In the cOW-HTO group, the mean BP ratio and CD index decreased significantly from 0.81 and 0.89 preoperatively, respectively, to 0.69 and 0.76 postoperatively, respectively (p < 0.001). In contrast, the DTO group maintained a consistent patellar height; the mean BP ratio and CD index were 0.77 and 0.83 preoperatively, respectively, and 0.73 and 0.80 postoperatively, respectively. Upon arthroscopic evaluation, 39 of 46 patients (84.8%) in the DTO group showed no progression of PF cartilage degradation at the second look; indeed, five of 46 patients (10.9%) even demonstrated improvement. In contrast, 21 of 65 patients (32.3%) in the cOW-HTO group exhibited increased PF cartilage degradation. There was a significant difference in progression of PF cartilage degradation between DTO and cOW-HTO (p < 0.001).

Conclusion

DTO in OW-HTO maintained the preoperative patellar height, which could help prevent progression of cartilage degeneration in the PF joint after surgery. In respect of the biplanar osteotomy direction in OW-HTO, the DTO, rather than cOWHTO, is the preferred technique for the treatment of varus knee osteoarthritis to avoid progression of PF cartilage degradation.

Level of evidence

III.

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Abbreviations

HTO:

High tibial osteotomy

OA:

Osteoarthritis

OW:

Open-wedge

cOW-HTO:

Conventional open-wedge high tibial osteotomy

PF:

Patellofemoral

DTO:

Distal tuberosity osteotomy

CD:

Caton–Deschamps

BMI:

Body mass index

BP:

Blackburne–Peel

FTA:

Femoro-tibial angle

JOA:

Japanese Orthopaedic Association

ICRS:

International Cartilage Repair Society

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Omuta Tenryo Hospital, 1-100, Tenryomachi, Omuta, 836-8566, Japan

    Tomohiro Horikawa, Kenji Kubota & Shintaro Hara

  2. Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yukio Akasaki

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  1. Tomohiro Horikawa
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  2. Kenji Kubota
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Correspondence to Yukio Akasaki.

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Horikawa, T., Kubota, K., Hara, S. et al. Distal tuberosity osteotomy in open-wedge high tibial osteotomy does not exacerbate patellofemoral osteoarthritis on arthroscopic evaluation. Knee Surg Sports Traumatol Arthrosc 28, 1750–1756 (2020). https://doi.org/10.1007/s00167-019-05596-y

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