Cartilage Imaging and Functional Testing

P192 - Opening wedge distal tuberosity osteotomy decreases the incidence of cartilage lesion in the patellofemoral joint

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Presentation Topic
Cartilage Imaging and Functional Testing
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Abstract

Purpose

Purpose

To evaluate a post-operative patellofemoral joint cartilage lesion after opening wedge high tibial osteotomy (OWHTO) and opening wedge distal tuberosity osteotomy (OWDTO).

Methods and Materials

Methods

From 2016 to 2018, 25 patients who underwent OWHTO and 20 patients who underwent OWDTO were evaluated in this study.

Radiological outcomes including hip-knee-ankle angle(HKA), the Caton-Deschamps index(CDI),patella tilt angle(TA) and congruence angle (C-angle) were measured.

All participants underwent a second-look arthroscopic evaluation of the articular cartilage of patellofemoral joint at the time of removal of the plate, an average of 1.2 year after the initial osteotomy.

For evaluation of cartilage regeneration of patellofemoral joint, cartilage status of initial arthroscopy and second arthroscopy were evaluated using the International Cartilage repair society (ICRS) grading system.

Clinical evaluations were performed by use of Knee Injury and Osteoarthritis Outcomes Scores (KOOS) preoperatively and at 1 year postoperatively.

Results

Results

The CDI decreased significantly from 0.93±0.12 to 0.71±0.15 after OWHTO (p=0.03), whereas no difference was seen after OWDTO (n.s.).

There was no significant difference in the correction angles (HKA),TA,C-angle and clinical outcomes (KOOS score) between the OWHTO and OWDTO (n.s.). Of the 16 (80%) knee with grade 3 at initial operation, 4(25 %) improved to grade 1, 9 (56%) improved to grade 2 and 3 (19%) showed no regenerative change in OWDTO.On the contrary, Of the 17 (68%) knee with grade 0-1 at initial operation, 6(35%) progressed grade 2 cartilage degeneration and 11(65 %) got worse to grade 3 in OWHTO.Compared with first-look arthroscopy, the patella and femoral trochlea showed significant progression of the ICRS grading in OWHTO (p=0.01) but no significant change OWDTO (n.s.).

Conclusion

Conclusions

OWDTO decreases the incidence of cartilage lesion in the patellofemoral joint compared with OWHTO.OWDTO is the preferred technique for the treatment of varus knee combined with patellofemoral osteoarthritis.

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