Background:

Although biomechanical and clinical studies have reported adverse effects on the patellofemoral joint after medial open-wedge high tibial osteotomy (MOWHTO), there is a paucity of literature that describes outcomes longer than midterm follow-up.

Purpose:

We aimed to evaluate the mid- to long-term radiologic and clinical outcomes of the patellofemoral joint after MOWHTO and to assess whether radiologic deterioration of the patellofemoral joint affected clinical outcomes or survivorship after MOWHTO.

Study Design:

Case series; Level of evidence, 4.

Methods:

We retrospectively reviewed 170 knees that underwent MOWHTO and had a minimum 5-year follow-up. In radiologic evaluation, serial postoperative changes in the patellofemoral joint compared with the preoperative status were evaluated on the Merchant view according to the Kellgren-Lawrence grade. The American Knee Society (AKS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Kujala score, incidence of anterior knee pain, and survivorship were used to assess clinical outcomes. Using radiologic assessment of the patellofemoral joint, we divided the patients into a radiologic progression group and a radiologic nonprogression group to evaluate whether radiologic progression of patellofemoral arthritis affected long-term clinical outcomes and survivorship after MOWHTO.

Results:

The mean follow-up period was 96.3 months (range, 60-163 months). Arthritic progression of the patellofemoral joint on the Merchant view was observed in 44.9%, 56.3%, 66.0%, and 84.0% of the cases at 5, 7, 9, and 11 years, respectively. Clinical outcomes such as AKS scores and KOOS significantly improved after MOWHTO (P < .001) at the latest follow-up. The incidence of anterior knee pain was 5.3% (9/170 knees). One knee (0.6%) underwent conversion to TKA due to progressive medial osteoarthritis, so the survival rate was 99.4% at a mean follow-up of 96.3 months. Despite patellofemoral degeneration over time, there were no significant differences in clinical outcomes or survivorship between patients with and without radiologic progression at the latest follow-up.

Conclusion:

Although degeneration of the patellofemoral joint was observed with time after MOWHTO, the related symptoms were minimal and arthritic changes in the patellofemoral joint did not affect the clinical outcomes or survivorship after MOWHTO over a mid- to long-term follow-up.

中文翻译：

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内侧开放楔形胫骨高位截骨术后髌股关节退变会影响临床结果吗？

背景：

尽管生物力学和临床研究报告了内侧开放楔形高位胫骨截骨术（MOWHTO）对髌股关节的不良影响，但很少有文献描述超过中期随访的结果。

目的：

我们旨在评估 MOWHTO 后髌股关节的中长期放射学和临床结果，并评估髌股关节的放射学恶化是否影响 MOWHTO 后的临床结果或生存率。

学习规划：

案例系列；证据水平，4。

方法：

我们回顾性分析了 170 例接受 MOWHTO 并进行了至少 5 年随访的膝关节。在放射学评估中，根据 Kellgren-Lawrence 分级，在 Merchant 视图上评估与术前状态相比，髌股关节的一系列术后变化。美国膝关节协会 (AKS) 评分、膝关节损伤和骨关节炎结果评分 (KOOS)、Kujala 评分、膝关节前部疼痛发生率和生存率用于评估临床结果。通过对髌股关节的放射学评估，我们将患者分为放射学进展组和放射学非进展组，以评估髌股关节炎的放射学进展是否影响 MOWHTO 后的长期临床结果和生存率。

结果：

平均随访时间为 96.3 个月（范围 60-163 个月）。在 5、7、9 和 11 年，分别有 44.9%、56.3%、66.0% 和 84.0% 的病例在 Merchant 视图中观察到髌股关节的关节炎进展。在最近一次随访中， MOWHTO ( P < .001)后，AKS 评分和 KOOS 等临床结果显着改善。膝关节前部疼痛的发生率为 5.3%（9/170 膝）。1 个膝关节（0.6%）因进行性内侧骨关节炎而转为 TKA，因此在平均 96.3 个月的平均随访时间中，存活率为 99.4%。尽管随着时间的推移髌股关节退行性变，但在最近一次随访中，有和没有放射学进展的患者之间的临床结果或生存率没有显着差异。

结论：

尽管在 MOWHTO 后随着时间的推移观察到髌股关节的退化，但相关症状很少，并且在中长期随访中，髌股关节的关节炎变化不影响 MOWHTO 后的临床结果或生存率。