Medial Open-Wedge High Tibial Osteotomy May Adversely Affect the Patellofemoral Joint

Abstract

To evaluate 2-stage arthroscopic findings of the patellofemoral joint before and after medial open-wedge high tibial osteotomy (HTO) and verify whether the patellofemoral joint would be influenced by medial open-wedge HTO. We prospectively reviewed 114 cases of medial open-wedge HTO for the treatment of osteoarthritis with a varus knee. First-look arthroscopy was performed during HTO. The mean age at the time of HTO was 56.34 ± 5.4years (range, 40-69years). Second-look arthroscopy was performed concomitantly with plate removal at an average of 26.1 ± 6.0months (range, 21.6-32.0months) after HTO. We assessed the patellofemoral joint using the International Cartilage Repair Society (ICRS) grading system by first- and second-look arthroscopy and compared it before and afterHTO. Postoperative anterior knee pain was also evaluated. Compared with first-look findings, second-look arthroscopic ICRS grading was changed as follows: In terms of the patella, 89 cases (78.1%) were not progressed whereas 25 cases (21.9%) were progressed. In terms of the femoral trochlea, 67 cases (58.8%) were not progressed whereas 47 cases (41.2%) were progressed. There was significant progression of the ICRS grade of the patella (P= .001) and femoraltrochlea (P < .001) compared with first-look arthroscopic findings. The incidence of postoperative anterior kneepain was 11.4% (13 cases), and it was related to the ICRS grade of the patellofemoral joint at the time of second-look arthroscopy (P < .001 for patella and P < .001 for trochlea). This study showed that the patellofemoral joint might be adversely affected by medial open-wedge HTO. Although the incidence of postoperative anterior knee pain was low, it was clinically correlated with patellofemoral arthritis. Level IV, therapeutic case series.