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Patellofemoral joint may be negatively impacted by medial open-wedge high tibial osteotomy
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Investigators found medial open-wedge high tibial osteotomy may adversely impact the patellofemoral joint.
Researchers prospectively reviewed 114 knees in 95 patients who underwent medial open-wedge high tibial osteotomy (HTO) for treatment of osteoarthritis in a varus knee. Investigators noted the first-look arthroscopy was performed at the time of the HTO. At an average of 26.1 months after HTO, a second-look arthroscopy was performed concomitantly with plate removal. At first- and second-look arthroscopy, the patellofemoral joint was assessed with the International Cartilage Repair Society (ICRS) grading system and was compared before and after HTO. Investigators also evaluated patients’ postoperative anterior knee pain.
A comparison of first- and second-look arthroscopy showed 89 knees showed no evidence of OA progression in the patella, while 25 knees did. Progression in the femoral trochlea was not found in 67 knees, but 47 knees showed evidence of this. Compared with first-look arthroscopy, the patella and femoral trochlea showed significant progression of the ICRS grading. There was an 11.4% incidence of postoperative anterior knee pain, which correlated with the ICRS grading of the patellofemoral joint at second-look arthroscopy. – by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Miho J. Tanaka, MD
In their study, Kim and colleagues performed second-look arthroscopy at the time of hardware removal in patients 26.1+/-6 months after performing opening-wedge HTO with arthroscopic debridement for the treatment of OA with varus deformity. They reported on 114 knees, of which 103 were female, in an average age of 56.3+/-5.4 years and found the International Cartilage Repair Society grade based on arthroscopic findings progressed on the patella in 21.9% and in 41.2% on the trochlea by one to two grades. However, only 13 patients (11.4%) were clinically symptomatic with complaints of anterior knee pain.
While this study is unique in that the authors arthroscopically document changes in the patellofemoral joint after opening-wedge HTO, the question lies in whether this rate is greater (and if so, by how much) than the expected rate of progression of patellofemoral OA over the same time period in a normal population. While HTO has been shown to change patellar height and potentially affect patellar kinematics, further studies are needed to fully understand its role in the progression or development of symptomatic patellofemoral OA.
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