Patellofemoral Update
Patellofemoral Update
September 09, 2019
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Medial open-wedge high tibial osteotomy impacts patellofemoral joint alignment, cartilage

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According to recently published results, medial open-wedge high tibial osteotomy adversely affected the patellofemoral joint.

“Overcorrection causing excessive valgus alignment led to further progression of degenerative changes in the patellofemoral joint and inferior clinical outcomes,” the authors wrote. “The postoperative weight-bearing ratio can be used as a predictive factor for deterioration of the cartilage status in the patellofemoral joint after [medial open-wedge high tibial osteotomy].”

Researchers retrospectively investigated 135 patients who underwent medial open-wedge high tibial osteotomy. Patients were grouped as having undercorrection, acceptable correction or overcorrection based on the postoperative weight-bearing line ratio. During implant removal at 2 years after surgery, the postoperative change in cartilage status was arthroscopically evaluated. At the mean follow-up of 52.1 months, clinical and radiological outcomes were assessed. Factors that impacted deterioration of the patellofemoral joint cartilage status were determined with regression analysis. A receiver-operating characteristic curve was used to identify the cutoff point of where the postoperative weight-bearing ratio correlated with the deterioration of cartilage status in the patellofemoral joint.

Results showed progression of cartilage degeneration in 39.3% of patients in the femoral trochlea and in 23.7% of patients in the patella. The overcorrection group had a significantly higher incidence of cartilage progression compared with the undercorrection and acceptable correction groups. Patients in the overcorrection group had significantly worse function scores, which included the Lysholm knee score, KOOS and the Shelbourne and Trumper score.

The postoperative weight-bearing ratio had a significant impact on cartilage deterioration, according to results of a regression analysis. The cutoff point for correlation of the postoperative weight-bearing ratio with International Cartilage Repair Society grade progression was 62.1% and 62.2% for the femoral trochlea and patella, respectively. – by Monica Jaramillo

 

Disclosures: The authors report no relevant financial disclosures.