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Archives of Orthopaedic and Trauma Surgery

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09-07-2022 | Osteoarthrosis | Arthroscopy and Sports Medicine

Can double-level osteotomy prevent patellofemoral osteoarthritis progression compared with open wedge high tibial osteotomy?

Authors: Yasushi Akamatsu, Hideo Kobayashi, Shuntaro Nejima, Steffen Schröter

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2023

Abstract

Purpose

To compare radiographic, clinical, and arthroscopic findings in patellofemoral (PF) osteoarthritis (OA) between open wedge high tibial osteotomy (OWHTO) and double-level osteotomy (DLO) with the same operative indication.

Methods

After adjustment for patient age, and coronal alignment, 36 knees with OWHTO alone and 36 knees with DLO were compared. Radiographic, clinical, and arthroscopic findings were documented before osteotomy. Arthroscopic findings were observed 1 year after osteotomy, and clinical and radiographic findings were observed 2 years after osteotomy. Patellar height was evaluated using the Insall-Salvati (IS) ratio, Carton-Deschamps (CD) index, and Blackburne-Peel (BP) index. Lateral patellar tilt and patellar shift were measured. A power analysis was performed.

Results

The postoperative CD and BP indices in the OWHTO group were lower than those in the DLO group (p < 0.001 and p = 0.001, respectively). The CD and BP indices in both groups significantly decreased postoperatively (all p < 0.001). Tilting angles in the OWHTO and DLO groups significantly decreased postoperatively (p < 0.001 and p = 0.002, respectively). There were no significant differences in American Knee Society scores, Kujala score, and the Knee Injury and Osteoarthritis Outcome Scores between both groups. The PF OA progression of the trochlear in the OWHTO group was higher than that in the DLO group (p = 0.002), and the PF OA progression of the patellar facet in the DLO group and anterior femoral condyle in both groups on the lateral side were higher than those on the medial side (p = 0.006, 0.032, and 0.041, respectively).

Conclusions

DLO decreased the rate of low patellar height compared with OWHTO. DLO decreased the rate of PF OA progression in the trochlea compared with OWHTO. There were no significant differences in clinical outcomes in both groups.

Level of evidence

Level III, case–control study.

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Title: Can double-level osteotomy prevent patellofemoral osteoarthritis progression compared with open wedge high tibial osteotomy?
Authors: Yasushi Akamatsu
Hideo Kobayashi
Shuntaro Nejima
Steffen Schröter
Publication date: 09-07-2022
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Osteoarthrosis
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 4/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-022-04523-0

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Can double-level osteotomy prevent patellofemoral osteoarthritis progression compared with open wedge high tibial osteotomy?

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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