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Open wedge high tibial osteotomy does not decrease patellar height relative to femur: A three-dimensional computer

Yuzo Yamada1, Yukiyoshi Toritsuka2, Norimasa Nakamura3

  • 1Department of Orthopaedic Surgery, Yao Municipal Hospital, 1-3-1, Ryugecho, Yao, Osaka, 581-0069, Japan.

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Summary

Patellar height measured using 3D femur-referenced models remained stable after open wedge high tibial osteotomy (OWHTO). Conventional tibia-referenced measurements, however, showed a significant decrease, highlighting the importance of considering measurement characteristics.

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Area of Science:

  • Orthopedic surgery
  • Biomedical engineering
  • Radiology

Background:

  • Patellar height conventionally assessed using tibial references may be affected by proximal tibia shape changes after open wedge high tibial osteotomy (OWHTO).
  • Previous methods relied on lateral knee radiographs, potentially introducing inaccuracies.
  • A novel approach using three-dimensional (3D) computer models is proposed to assess patellar height relative to the femur.

Purpose of the Study:

  • To evaluate changes in patellar height position relative to the transepicondylar axis of the femur after OWHTO.
  • To compare femur-referenced 3D model measurements with traditional tibia-referenced radiographic indices.
  • To determine the reliability of patellar height assessment post-OWHTO.

Main Methods:

  • Three-dimensional (3D) computer models were created from MRI scans of 14 patients before and after OWHTO.
  • Voxel-based registration was used to superimpose models at 30° and 50° knee flexion.
  • Patellar height was evaluated using the patellar center angle, defined by femoral condylar planes and a patellar reference point.

Main Results:

  • The patellar center angle, a femur-referenced measurement, showed no significant decrease at 30° and 50° knee flexion post-OWHTO.
  • Tibia-referenced indices, including the Caton-Deschamps and Blackburne-Peel indices, significantly decreased after OWHTO.
  • This indicates a discrepancy between femur-based and tibia-based patellar height measurements following the procedure.

Conclusions:

  • Patellar height relative to the femur, assessed via 3D models, remains stable after OWHTO.
  • Conventional tibia-referenced radiographic measurements underestimate patellar height post-OWHTO.
  • The choice of reference points (femur vs. tibia) is critical for accurate patellar height evaluation after OWHTO.