Abstract
PurposeThe purpose of this study was to quantify the influence of medial open wedge high tibial osteotomy on patellar kinematics using optical computer navigation, as anterior knee pain infrequently occurs postoperatively and the reason is still being unknown.MethodsTen medial open wedge high tibial osteotomies at supratuberosity level in 5 full body specimens were performed. The effect of the surgical procedure on patellar kinematics, measured at 5 and 10 degrees of leg alignment correction angle, was analyzed and compared to native patellar kinematics during passive motion—regarding patella shift, tilt, epicondylar distance and rotation. Linear mixed models were used for statistical analysis, a two‐sided p value of ≤ 0.05 was considered statistically significant.ResultsTilt behavior, medial shift and epicondylar distance did not show a significant difference regarding natural patellar kinematics at both osteotomy levels. Both osteotomy correction angles showed a significant less external rotation of the patella (p < 0.001, respectively) compared to natural kinematics.ConclusionsExcept less external rotation of the patella, medial open wedge high tibial osteotomy does not seem to relevantly alter patellar alignment during passive motion. Future clinical studies have to prove the effect of MOWHTO on patellar kinematics measured in this experimental setup, especially regarding its influence on anterior knee pain.
Highlights
High tibial osteotomy (HTO) is a widespread used, successful and continuously improving procedure in joint preserving orthopedic knee surgery [1]
The most important finding of this study is that patellar kinematics do not seem to be relevantly altered by medial open wedge high tibial osteotomy regarding medial shift, lateral patellar tilt and epicondylar distance in a cadaveric setup
The success of the surgical procedure at the medium and long term and the possibility of development of patellofemoral osteoarthritis might be affected by patellar kinematics, the question in dispute is of potentially great importance [9, 10, 15]
Summary
High tibial osteotomy (HTO) is a widespread used, successful and continuously improving procedure in joint preserving orthopedic knee surgery [1]. It is recognized to be a successful joint preserving procedure for unilateral knee osteoarthritis [1, 2]. HTO with a descending cut at the tibial tuberosity has been recently developed, as this procedure does not alter patellar height [8]. If and how classical open wedge HTO affects patellar kinematics remains unclear so far [6]. It is discussed if possible alterations might lead to a premature occurrence of patellofemoral osteoarthritis, the topic is, of great importance regarding the long-term clinical outcome [9, 10]
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