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Related Concept Videos

Bones of the Lower Limb: Femur and Patella01:16

Bones of the Lower Limb: Femur and Patella

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The femur is the body's longest and strongest bone spanning the thigh region. Its head articulates with the acetabulum of the hip bone to form the hip joint. A minor indentation on the medial side of the femoral head, called the fovea capitis, serves as the site of attachment for the ligament of the head of the femur. This weak ligament spans the femur and acetabulum and supports the hip joint. The narrowed region below the head is the neck of the femur. The inclination angle between the...
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Osteotomy Correction Angle Cut-off Points Can Guide the Operation to Prevent a Significant Decrease in Patella

Renjie Chen1,2,3,4, Chenghao Yu1,2,3, Haining Peng1,2,3

  • 1Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China.

Orthopaedic Surgery
|February 7, 2024
PubMed
Summary

Excessive correction during open-wedge high tibial osteotomy can lead to patellar position changes and knee pain. A correction angle between 12.5° and 13.4° is identified as a critical threshold to avoid these issues.

Keywords:
Hip-Knee-Ankle AngleMedial Open-Wedge High Tibial OsteotomyPatellar HeightPatellar TiltPatellofemoral Index

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Area of Science:

  • Orthopedic surgery
  • Biomechanics
  • Osteoarthritis research

Background:

  • Open-wedge high tibial osteotomy (OWHTO) is a common procedure for knee osteoarthritis.
  • Excessive correction during OWHTO can result in patella infera and postoperative knee pain.
  • Identifying optimal correction angles is crucial for successful surgical outcomes.

Purpose of the Study:

  • To determine the cut-off points for knee varus correction during OWHTO associated with symptomatic patellar position changes.
  • To establish a safe range of correction to minimize postoperative complications.

Main Methods:

  • Retrospective study of 124 patients undergoing biplanar medial OWHTO for knee osteoarthritis.
  • Radiographic and CT imaging pre- and post-surgery (18 months).
  • Assessment of patellar height (Caton-Deschamps, Insall-Salvati, Blackburne-Peel indices), patellofemoral index, patellar tilt, and WOMAC scores.

Main Results:

  • Significant changes in patellar indices observed with increasing correction angles.
  • Patellar height, tilt, and patellofemoral index showed significant alterations beyond a certain correction threshold.
  • Groups with greater correction angles (G, H, I) exhibited significantly worse patellar index changes and lower WOMAC score improvements compared to Groups A-F.

Conclusions:

  • Patellar height, tilt, and patellofemoral index are significantly affected by the degree of osteotomy correction.
  • The critical cut-off points for correction angle are identified as 12.5° to 13.4°.
  • Correction angles exceeding this range can significantly alter patellar position, potentially leading to postoperative patellofemoral joint pain.