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Arthroscopy. 2017 Apr;33(4):811-816. doi: 10.1016/j.arthro.2016.09.034. Epub 2016 Dec 30.

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

Author information

1
Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
2
Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea. Electronic address: coco9713@naver.com.
3
Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.

Abstract

PURPOSE:

To evaluate 2-stage arthroscopic findings of the patellofemoral joint before and after medial open-wedge high tibial osteotomy (HTO) and verify whether the patellofemoral joint would be influenced by medial open-wedge HTO.

METHODS:

We prospectively reviewed 114 cases of medial open-wedge HTO for the treatment of osteoarthritis with a varus knee. First-look arthroscopy was performed during HTO. The mean age at the time of HTO was 56.34 ± 5.4 years (range, 40-69 years). Second-look arthroscopy was performed concomitantly with plate removal at an average of 26.1 ± 6.0 months (range, 21.6-32.0 months) after HTO. We assessed the patellofemoral joint using the International Cartilage Repair Society (ICRS) grading system by first- and second-look arthroscopy and compared it before and after HTO. Postoperative anterior knee pain was also evaluated.

RESULTS:

Compared with first-look findings, second-look arthroscopic ICRS grading was changed as follows: In terms of the patella, 89 cases (78.1%) were not progressed whereas 25 cases (21.9%) were progressed. In terms of the femoral trochlea, 67 cases (58.8%) were not progressed whereas 47 cases (41.2%) were progressed. There was significant progression of the ICRS grade of the patella (P = .001) and femoral trochlea (P < .001) compared with first-look arthroscopic findings. The incidence of postoperative anterior knee pain was 11.4% (13 cases), and it was related to the ICRS grade of the patellofemoral joint at the time of second-look arthroscopy (P < .001 for patella and P < .001 for trochlea).

CONCLUSIONS:

This study showed that the patellofemoral joint might be adversely affected by medial open-wedge HTO. Although the incidence of postoperative anterior knee pain was low, it was clinically correlated with patellofemoral arthritis.

LEVEL OF EVIDENCE:

Level IV, therapeutic case series.

PMID:
28043753
DOI:
10.1016/j.arthro.2016.09.034
[Indexed for MEDLINE]

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