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Patella Height Changes Post High Tibial Osteotomy.

Siew Ghim Gooi¹, Chloe Xiao Yun Chan², Melvin Kian Loong Tan¹

¹Department of Orthopaedic Surgery, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore.

Indian Journal of Orthopaedics

|October 3, 2017

Summary

Medial opening wedge high tibial osteotomy (HTO) can cause patella baja. Performing HTO above the tibial tubercle significantly lowers patella height, suggesting infra-tubercle osteotomy to prevent this complication.

Keywords:

High tibial medial osteotomy Osteotomy knee mechanical osteoarthritis patella height posterior tibial slope

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Area of Science:

Orthopedic surgery
Knee osteoarthritis treatment
Biomechanical analysis

Background:

Medial opening wedge high tibial osteotomy (HTO) is a common treatment for medial knee osteoarthritis.
Potential complications include patella baja (lowered patella) and altered posterior tibial slope (TS).

Purpose of the Study:

To investigate the relationship between the osteotomy level and postoperative patella height changes after medial opening wedge HTO.
To identify risk factors for patella baja following HTO.

Main Methods:

Retrospective study of 106 patients undergoing HTO between 2009 and 2017.
Analysis of preoperative and postoperative weight-bearing long-leg and lateral knee radiographs.
Radiological measurements included Caton-Deschamps Index (CDI), mechanical axis deviation (MAD), and posterior TS.

Main Results:

A supra-tubercle osteotomy was significantly associated with a decrease in patella height (lowered CDI).
No significant correlation was found between patella height changes and correction angle or posterior TS change.
The association between osteotomy level (supra- vs. infra-tubercle) and patella height change was statistically significant (P < 0.001).

Conclusions:

Medial opening wedge HTO performed above the tibial tubercle is linked to a significant reduction in patella height.
Infra-tubercle osteotomy is recommended to mitigate the risk of developing patella baja after HTO.