High tibial osteotomy with anterior advancement of distal fragment for medial and patellofemoral compartmental osteoarthritis of the knee.

High tibial osteotomy was performed in 73 knees of 50 patients with medial and patellofemoral compartmental osteoarthritis of the knee, which was combined with anterior advancement of the distal fragment. At the operation, parapatellar release of the retinaculum and subperiosteal elevation of contracted medial soft tissue were also adjoined. The average age of the patients at the time of surgery was 64 years. The follow-up period was an average of 58 months. On overall clinical results assessed with the Knee Society score, the average total knee score was improved from preoperative 50 points to postoperative 94, and the preoperative average functional score of 47 points increased to 92 postoperatively. At follow-up, pain from a grinding patella was not found in 68 of 73 knees and pain from grinding and deviating of the patella was relieved in more than 96% of all cases. The mean femorotibial angle was reduced from preoperative 185 degrees to postoperative 167 degrees. On skyline view, the width of the lateral facet joint space was widely opened postoperatively, particularly on the flexion angle of 90 degrees. This operative procedure successfully relieved patellofemoral symptoms of the patients with medial and patellofemoral compartmental osteoarthritis of the knee.