High tibial osteotomy combined with tibial tuberosity limited rotation in the treatment of disorder of patellofemoral joint with knee varus

Abstract

Objective To investigate the mid-term outcome of high tibia osteotomy (HTO) combined with tibial tuberosity limited rotation in the treatment of disorder of patellofemoral joint with knee varus. Methods HTO was performed in all 42 patients. The lower limb alignment, lateral femoral tibial angle, medial proximal tibial angle, Q angle and TT-TG were measured before and after operation. All the patients with disorder of patellofemoral joint were divided into three types based on preoperative patellar trajectory and TT-TG. According to different types we chose the limided rotation of distal tibia through adjustment of tibial tubercle location to improve patellar track. Type I in 10 cases and type II in 12 cases only accepted HTO, type III in 20 cases accepted HTO and tibial tubercle rotation. The rotation angle was determined according to preoperative imaging results and foot forward angle. Before and after operation patellar tilt angle, patellofemoral angle and lateral patellar angle were measured. Results 42 patients were followed up for more than 5 years, an average of 72.20±12.60 months (60-88 months). No nerve damage, infection and bone nonunion occurred. The patellar tilt angle was improved from 12.45°±3.76° to 6.98°±1.78° 5 years after operation. The patellofemoral angle was improved from 12.51°±4.71° to -4.70°±2.57° 5 years after operation, and the lateral patellar angle was improved from 1.50°±4.90° to 7.80°±3.10°. Preoperative lateral femoral tibial angle was improved from 182.45°±2.20° to postoperative 174.60°±3.50°, medial proximal tibial angle was improved from preoperative 78.75°±3.50° to postoperative 93.25°±1.95°. The Lysholm score was improved from preoperative 53.10±5.60 to 92.70±5.50. The preoperative IKDC subjective score was improved from 47.50±6.40 to 91.30±6.90. The Kujala score was 62.40±8.70 before operation and 87.30±4.10 5 years after operation. Visual analogue score (VAS) was 7.50±2.45 before operation and 1.50±0.90 5 years after operation. The short and mid-term follow-up, knee patellar trajectory and lower limb alignment was good, postoperative symptoms was satisfactory and acceptable. Conclusion HTO combined with limited rotation of the tibial tubercle could improve patellar trajectory and lower limb alignment to relieve pain, and has satisfactory mid-term outcome in the disorder of patellofemoral joint with knee varus patients. Key words: Tibia; Genu varum; Patellofemoral joint; Osteotomy