Patellofemoral Osteoarthritis Progresses After Medial Open-Wedge High Tibial Osteotomy: A Systematic Review

Abstract

To investigate the progression of patellofemoral (PF) osteoarthritis (OA) after medial open-wedge high tibial osteotomy (OWHTO) and whether PF OA progression has an influence on clinical outcomes. According to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA), EMBASE, PubMed, and Cochrane Library were searched in June 2020 for English-language studies that presented data on PF OA or cartilage degeneration before and after OWHTO. Descriptive statistics are presented. Twenty studies comprising 1,173 patients were included. The mean age was 57.1 years (range 18-84) with 826 (70.4%) female. The mean follow-up was 27.1 months (range 7-144). Ten studies reported the trochlear International Cartilage Research Society (ICRS) scores, with each of these studies reporting a greater proportion of patients with grades 2-4 OA postoperatively compared with preoperatively (relative risk= 1.19-2.76, I2= 1.9%). Similarly, 7 studies reported patellar ICRS scores and found a greater proportion with grades 2-4 OA postoperatively (relative risk= 1.08-2.44, I2= 0%). Four studies assessed PF Kellgren-Lawrence grade, each of which reported a greater proportion of patients with grades 2-4 OA postoperatively (relative risk=1.25-21.0, I2= 31%). The PF OA assessments were heterogenous, and studies using classifications except the ICRS score or Kellgren-Lawrence grade were not included in statistical analysis. Fifteen studies assessed patellar height; 10 studies reported significant decrease in patellar height after OWHTO. Only 3 studies reported clinical outcomes for patients with and without PF OA progression. Outcome reporting was variable across these studies, and a relationship between PF OA progression and clinical outcome could not be definitively determined. Patients appear to have progression of PF OA after medial OWHTO. However, there are currently insufficient studies with inconsistent measurements of outcomes to make meaningful conclusions regarding the impact of PF OA on clinical outcomes. Level IV, systematic review of Level III-IV studies.