Distal High Tibial Osteotomy Allows Improved Patellofemoral Joint Preservation but Results in Increased Posterior Tibial Slope Compared to Proximal High Tibial Osteotomy.
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引用次数: 0
Abstract
Purpose: To compare the postoperative trajectory of posterior tibial slope (p-TS) after distal (DTO) versus proximal (PTO) biplanar open-wedge high tibial osteotomy performed with an identical, early weightbearing protocol.
Methods: All consecutive open-wedge high tibial osteotomies performed from May 2015 to December 2020 were reviewed. Eligible knees had complete lateral radiographs (preoperative, 1 week, 1 month, 3 months, 6 months, 12 months) and a ≥24-month follow-up. p-TS and Caton-Deschamps index were measured. International Cartilage Repair Society cartilage grade at routine plate removal was recorded.
Results: Thirty consecutive DTOs and 30 consecutive PTOs were retrospectively compared. The mean p-TS in the DTO group initially decreased after osteotomy but subsequently increased compared to the PTO group (P = .016). From 1 week to 12 months postoperatively, 9 of 30 knees (30%) that underwent DTO had a >2° increase in p-TS, compared with 2 of 30 knees (7%) that underwent PTO (P = .045). Of the 9 DTO knees with a >2° p-TS increase, 4 exhibited widening of the descending gap (the descending cut in the tibial tuberosity) and nonunion in the retrotubercle. The p-TS correction loss primarily occurred between 1 and 3 months postoperatively (P < .001). Arthroscopic assessment revealed patellofemoral cartilage deterioration in 8 of 28 knees (29%) in the PTO group, compared to only 1 of 28 knees (4%) in the DTO group (P = .024). A greater change in the Caton-Deschamps index was associated with patellofemoral cartilage deterioration at 12 months (P = .021).
Conclusions: The p-TS changes during the postoperative course occurred more frequently in DTO compared to PTO. In DTO, p-TS increased for up to 12 months postoperatively, with the most substantial changes occurring between 1 and 3 months. While DTO has the advantage of preserving the patellofemoral joint, the increase in p-TS may require careful attention, as it could adversely impact bone union in the retrotubercle.
Level of evidence: Level III, retrospective comparative case series.
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