Five years of clinical and radiological results with biplanar tibial open-wedge osteotomy: feasible option to prevent patella infera?

Eur J Orthop Surg Traumatol. 2020 Jul 26. doi: 10.1007/s00590-020-02747-7. Online ahead of print.

Abstract

Introduction: High tibial osteotomy (HTO) was a treatment option for relatively young active patients with isolated medial compartment arthritis of the knee. This report showed clinical and radiological results of a new HTO technique, that uses a particular open-wedge high tibial osteotomy by incorporating the tibial tubercle into osteotomy line (TT-OWHTO) to preserve patella height.

Materials and methods: Preoperative and postoperative function was recorded on the IKDC score, Kujala PF score, EQ-VAS and Tegner activity scale. Radiological patella height was measured with Insall-Salvati index. All this clinical and radiological recorded data on 45 active patients, with an average age of 40.2 years who underwent this procedure, allowed to do a retrospective analysis.

Results: All the patients reported improvement in symptoms with an average preoperative IKDC score from preoperative value 49.7-92.3 at last follow-up. Kujala PF score improves from 67.2 preoperative value to 91.4. EQ-VAS self-assessment of quality of life reported a preoperative value of 41.2-92.2 at last follow-up. There was 2.5 point average improvement in Tegner activity scale. Patella height was not altered with median preoperative value of 0.84 ± 0.1 and final follow-up value of 0.81 ± 0.2 on Insall-Salvati index.

Conclusions: TT-OWHTO showed to be able to achieve good clinical and radiological results maintaining patella height unchanged and ensuring safety and reproducibility as much as the traditional technique.

Keywords: Biplanar tibial open-wedge osteotomy; Knee; Patella height; Patello-femoral joint; Tibial osteotomy.