Distal tibial tubercle osteotomy is superior to the proximal one for progression of patellofemoral osteoarthritis in medial opening wedge high tibial osteotomy.,Knee Surgery, Sports Traumatology, Arthroscopy

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Distal tibial tubercle osteotomy is superior to the proximal one for progression of patellofemoral osteoarthritis in medial opening wedge high tibial osteotomy.
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.3 ) Pub Date : 2019-12-24 , DOI: 10.1007/s00167-019-05836-1
Hiroyasu Ogawa _{1,

2} , Kazu Matsumoto ₁ , Hiroki Yoshioka ₃ , Masaya Sengoku ₄ , Haruhiko Akiyama ₁

Affiliation

Purpose

To investigate the effect of proximal tibial tubercle osteotomy (PTO) and distal tibial tubercle osteotomy (DTO) in medial opening wedge high tibial osteotomy on patellofemoral alignment, patellofemoral osteoarthritis and clinical outcomes.

Methods

PTO (n = 41) and DTO (n = 43) for the same surgical indications were included. Radiographic measurements of the Caton-Deschamps index, patellar tilt and shift, and arthroscopic cartilage evaluation at the patellofemoral joint were performed at osteotomy and plate removal. The Knee Society Score (KSS) was evaluated preoperatively and at the latest follow-up.

Results

The follow-up period was longer in the PTO group (33.7 months; range 23–40 years) than in the DTO group (22.2 months; range 18–29 months) (p < 0.0001), whereas the period from osteotomy to plate removal was not different between the groups. The Caton-Deschamps index of the DTO group was unchanged from 0.9 (range 0.7–1.2) to 0.9 (range 0.6–1.4), whereas that of the PTO group changed from 0.9 (0.7–1.2) to 0.7 (0.5–1.0) (p < 0.0001). There were fewer deteriorated cases of cartilage status in the trochlear groove in the DTO group (20.9%) than in the PTO group (56.1%, p < 0.05). There were more improved cases in the DTO group (23.3%) than in the PTO group (4.9%, p < 0.05). Postoperative KSS was better in the DTO group than in the PTO group (p < 0.05).

Conclusion

DTO is associated not only with reduced deterioration but also with increased improvement of cartilage status in the trochlear groove and better KSS as compared with PTO.

Level of evidence

IV.

中文翻译：

在内侧开口楔形高位胫骨截骨术中，of股远端骨截骨术优于to骨近端截骨术。

目的

目的探讨内侧开口楔形高位胫骨高位截骨术中胫骨近端结核截骨术（PTO）和胫骨远端截骨术（DTO）对pa股对齐，pa股骨关节炎和临床结局的影响。

方法

包括相同手术适应症的PTO（n = 41）和DTO（n = 43）。在截骨术和钢板切除术中进行the骨指数、,骨倾斜和移位的放射照相测量，以及measurements股关节的关节镜软骨评估。术前和最近一次随访中评估了膝关节社会评分（KSS）。

结果

PTO组的随访时间（33.7个月；范围23-40岁）比DTO组的随访时间（22.2个月；范围18-29个月）长（p <0.0001），而从截骨术到钢板切除的时间更长两组之间没有什么不同。DTO组的Caton-Deschamps指数从0.9（0.7-1.2的范围）变化到0.9（0.6-1.4的范围），而PTO组的Caton-Deschamps指数从0.9（0.7-1.2）变化到0.7（0.5-1.0）（p <0.0001）。DTO组（20.9％）的滑车沟软骨恶化情况比PTO组（56.1％，p <0.05）少。DTO组（23.3％）比PTO组（4.9％，p <0.05）。DTO组的术后KSS优于PTO组（p <0.05）。