P David Longino1, Trevor B Birmingham, William J Schultz, Rebecca F Moyer, J Robert Giffin. 1. Trevor B. Birmingham, and J. Robert Giffin, FRCS(C Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario N6A 3K7, Canada. rgiffin@uwo.ca / tbirming@uwo.ca).
Abstract
BACKGROUND: Medial opening wedge high tibial osteotomy (HTO) for the treatment of varus gonarthrosis can be associated with inadvertent decreases in patellar height. HYPOTHESIS: Decreases in patellar height observed after medial opening wedge HTO can be minimized with the addition of a tibial tubercle osteotomy (TTO). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Twenty-nine patients undergoing medial opening wedge HTO with a concurrent TTO were matched with 29 controls who previously underwent medial opening wedge HTO without a TTO. Both groups had substantial varus malalignment (mean mechanical axis angle, -10° ± 3°) requiring large corrections. Measurements of patellar height and posterior tibial slope were calculated from standing lateral radiographs and compared preoperatively and 6 months postoperatively. Patellar height measures included the Blackburne-Peel index, Caton-Deschamps index, Miura-Kawamura index, Insall-Salvati ratio, and modified Insall-Salvati ratio. RESULTS: The changes in the Blackburne-Peel, Caton-Deschamps, and Miura-Kawamura indices were significantly less in the HTO/TTO group versus the HTO group. There were 3 of 29 (10%) new cases that met the radiographic criteria for patella infera in the HTO/TTO group versus 11 of 29 (38%) new cases of patella infera found postoperatively in the HTO group, suggesting an absolute risk reduction of 28% with TTO. The changes in the Blackburne-Peel and Caton-Deschamps indices were correlated to a larger preoperative varus deformity in the coronal plane (r = 0.52 and r = 0.41, respectively). CONCLUSION: The addition of a TTO when performing a medial opening wedge HTO minimizes the decreases in patellar height associated with the procedure.
BACKGROUND: Medial opening wedge high tibial osteotomy (HTO) for the treatment of varus gonarthrosis can be associated with inadvertent decreases in patellar height. HYPOTHESIS: Decreases in patellar height observed after medial opening wedge HTO can be minimized with the addition of a tibial tubercle osteotomy (TTO). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Twenty-nine patients undergoing medial opening wedge HTO with a concurrent TTO were matched with 29 controls who previously underwent medial opening wedge HTO without a TTO. Both groups had substantial varus malalignment (mean mechanical axis angle, -10° ± 3°) requiring large corrections. Measurements of patellar height and posterior tibial slope were calculated from standing lateral radiographs and compared preoperatively and 6 months postoperatively. Patellar height measures included the Blackburne-Peel index, Caton-Deschamps index, Miura-Kawamura index, Insall-Salvati ratio, and modified Insall-Salvati ratio. RESULTS: The changes in the Blackburne-Peel, Caton-Deschamps, and Miura-Kawamura indices were significantly less in the HTO/TTO group versus the HTO group. There were 3 of 29 (10%) new cases that met the radiographic criteria for patella infera in the HTO/TTO group versus 11 of 29 (38%) new cases of patella infera found postoperatively in the HTO group, suggesting an absolute risk reduction of 28% with TTO. The changes in the Blackburne-Peel and Caton-Deschamps indices were correlated to a larger preoperative varus deformity in the coronal plane (r = 0.52 and r = 0.41, respectively). CONCLUSION: The addition of a TTO when performing a medial opening wedge HTO minimizes the decreases in patellar height associated with the procedure.
Authors: Matthias Cotic; Stephan Vogt; Matthias J Feucht; Tim Saier; Philipp Minzlaff; Stefan Hinterwimmer; Andreas B Imhoff Journal: Knee Surg Sports Traumatol Arthrosc Date: 2014-09-11 Impact factor: 4.342
Authors: Hayden F Atkinson; Trevor B Birmingham; Jenna M Schulz; Codie A Primeau; Kristyn M Leitch; Stephany L Pritchett; D W Holdsworth; J R Giffin Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-03-16 Impact factor: 4.342