DOI: 10.1177/23259671261467542 ISSN: 2325-9671

Comparison of Patellofemoral Degeneration After Three Types of High Tibial Osteotomy: Retrotuberosity Biplane Open-Wedge, Supratuberosity Biplane Open-Wedge, and Closed-Wedge Techniques

Sang Jun Song, Kyoung Ho Yoon, Min Sung Kim, Cheol Hee Park
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Background:

Retrotuberosity biplane open-wedge high tibial osteotomy (RTOWHTO) may reduce negative patellofemoral joint outcomes. However, no studies have compared patellofemoral cartilage degeneration between RTOWHTO and supratuberosity biplane open-wedge high tibial osteotomy (STOWHTO) using arthroscopic assessment nor compared patellofemoral cartilage degeneration or radiographic patellofemoral-specific parameters between RTOWHTO and closed-wedge high tibial osteotomy (CWHTO).

Purpose:

To compare the arthroscopically assessed femoral trochlear cartilage degeneration and radiographic patellofemoral-specific parameters after RTOWHTO, STOWHTO, and CWHTO.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 58 RTOWHTOs, 59 STOWHTOs, and 88 CWHTOs were examined using first-look arthroscopy between 2013 and 2022. The demographics did not differ significantly between the groups. Hardware removal and second-look arthroscopy were performed, on average, 29.7, 26.9, and 26.7 months after the RTOWHTOs, STOWHTOs, and CWHTOs, respectively ( P = .30). Degeneration of the femoral trochlear cartilage was arthroscopically evaluated using the International Cartilage Regeneration & Joint Preservation Society grading system. Patellar translation and height were evaluated radiographically, and patellar height was assessed using the modified Blackburne-Peel ratio.

Results:

The prevalence rates of femoral trochlear cartilage degeneration were 17.2% (10/58), 39% (23/59), and 19.3% (17/88) in the RTOWHTO, STOWHTO, and CWHTO groups, respectively ( P = .008). The prevalence was significantly higher in STOWHTOs than in both RTOWHTOs and CWHTOs (both P = .01), but not significantly different between RTOWHTOs and CWHTOs ( P = .83). The increase in lateral patellar translation was significantly greater in the STOWHTOs (1.1 ± 1.5 mm) than in both the RTOWHTOs (–0.1 ± 2.0 mm) and the CWHTOs (0.5 ± 1.2 mm) ( P = .001 and .04, respectively). There was no significant difference between the RTOWHTOs and CWHTOs with respect to the increases in lateral translation ( P = .10). The lowering in patellar height was significantly greater after the STOWHTOs (–0.2 ± 0.1) than after both the RTOWHTOs (0.0 ± 0.1) and the CWHTOs (–0.1 ± 0.2) ( P < .001 and .002, respectively). The lowering was significantly smaller in the RTOWHTOs than in the CWHTOs ( P = .02).

Conclusion:

RTOWHTO may provide favorable patellofemoral joint outcomes, with a lower prevalence of trochlear cartilage degeneration and less lateral patellar translation than STOWHTO, as well as less patellar height lowering than both STOWHTO and CWHTO.

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