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Related Concept Videos

Bones of the Lower Limb: Femur and Patella01:16

Bones of the Lower Limb: Femur and Patella

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 neck...

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Femur-referenced 3D-CT detects patellar height decrease and its correlation with correction magnitude after

Shinya Dobashi1, Koji Iwasaki2, Taku Ebata1

  • 1Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of, Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.

Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association
|July 11, 2026
PubMed
Summary

Three-dimensional computed tomography (3D-CT) revealed decreased patellar height after high tibial osteotomy (HTO). This advanced imaging is more sensitive than conventional methods for assessing patellofemoral changes post-HTO.

Keywords:
High tibial osteotomyKnee osteoarthritisPatellar heightPatellofemoral jointThree-dimensional computed tomography

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Area of Science:

  • Orthopedic surgery
  • Biomedical imaging
  • Knee biomechanics

Background:

  • Medial opening wedge high tibial osteotomy (OWHTO) is used to treat knee osteoarthritis.
  • Understanding changes in the patellofemoral joint after OWHTO is crucial for patient outcomes.
  • Conventional radiography may not fully capture subtle positional changes in the patella relative to the femur.

Purpose of the Study:

  • To evaluate changes in the femur-patella positional relationship before and after OWHTO using 3D-CT.
  • To compare the sensitivity of 3D-CT with conventional radiography in detecting postoperative patellar height changes.
  • To investigate the association between the magnitude of correction and patellar height changes.

Main Methods:

  • Retrospective analysis of 18 knees from 17 patients who underwent OWHTO.
  • Pre- and 1-year postoperative assessments included conventional radiography (Caton-Deschamps index [CDI], femoral-patellar height index [FPHI], patellar tilt) and 3D-CT.
  • 3D-CT used a femur-based coordinate system to measure patellar height and tilt; correlation with hip-knee-ankle (HKA) angle change was assessed.

Main Results:

  • CDI significantly decreased postoperatively (0.84 to 0.78), while FPHI showed no significant change.
  • 3D-CT demonstrated a significant decrease in patellar height (3.0 ± 1.5 mm) and a lateral shift in patellar tilt (1.5° ± 2.1°).
  • A significant correlation existed between HKA angle change and decreased 3D-patellar height (r = -0.50, p = 0.04), but not with CDI or FPHI.

Conclusions:

  • OWHTO leads to a significant decrease in patellar height and a lateral opening tilt, as detected by 3D-CT.
  • 3D-CT provides a more detailed and sensitive evaluation of the patellofemoral joint compared to conventional radiographic indices.
  • Femur-referenced 3D-CT is a valuable tool for assessing postoperative patellofemoral mechanics after OWHTO.