Patellar height changes sequentially after medial open wedge high tibial osteotomy: Evaluation using shear wave elastography

Background: Medial opening wedge high tibial osteotomy (HTO) for the treatment of varus gonarthrosis can be associated with inadvertent decreases in patellar height. Hypothesis: Decreases in patellar height observed after medial opening wedge HTO can be minimized with the addition of a tibial tubercle osteotomy (TTO). Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-nine patients undergoing medial opening wedge HTO with a concurrent TTO were matched with 29 controls who previously underwent medial opening wedge HTO without a TTO. Both groups had substantial varus malalignment (mean mechanical axis angle, −10° ± 3°) requiring large corrections. Measurements of patellar height and posterior tibial slope were calculated from standing lateral radiographs and compared preoperatively and 6 months postoperatively. Patellar height measures included the Blackburne-Peel index, Caton-Deschamps index, Miura-Kawamura index, Insall-Salvati ratio, and modified Insall-Salvati ratio. Results: The changes in the Blackburne-Peel, Caton-Deschamps, and Miura-Kawamura indices were significantly less in the HTO/TTO group versus the HTO group. There were 3 of 29 (10%) new cases that met the radiographic criteria for patella infera in the HTO/TTO group versus 11 of 29 (38%) new cases of patella infera found postoperatively in the HTO group, suggesting an absolute risk reduction of 28% with TTO. The changes in the Blackburne-Peel and Caton-Deschamps indices were correlated to a larger preoperative varus deformity in the coronal plane (r = 0.52 and r = 0.41, respectively). Conclusion: The addition of a TTO when performing a medial opening wedge HTO minimizes the decreases in patellar height associated with the procedure.

Hybrid Lateral Closed-Wedge High Tibial Osteotomy Showed Similar Accuracy in Angular Correction and Reduction of Posterior Tibial Slope Compared to Opening-Wedge High Tibial Osteotomy: A Correction Angle Matched Cohort Study

BackgroundAn iatrogenic lateral hinge fracture is a common intraoperative problem that may occur during medial open wedge high tibial osteotomy (MOWHTO). This study aims to assess the significance of using additional crossing lateral K-wires and their advantage in protecting the lateral hinge during MOWHTO procedures.MethodsThe data of patients fulfilling the inclusion criteria who underwent MOWHTO between May 2021 and August 2022 were retrospectively evaluated. One group had additional lateral hinge crossing K-wires (+ MOWHTO group), while the other did not (-MOWHTO group). Both groups were assessed for rate of intraoperative lateral hinge fractures, knee injury and osteoarthritis outcome score − 12 (KOOS-12), medial proximal tibial angle (MPTA), time of union, and time to return to work. The outcomes were compared using the independent T-test for continuous variables and the Fisher Exact test for nominal variables. A p-value of < 0.05 was considered statistically significant for both tests.ResultsThe study included forty-eight patients; twenty-four in each treatment group. The mean follow-up durations were 30.5 ± 3.6 months for + MOWHTO and 31.6 ± 3.2 months for –MOWHTO (p = 0.26). There was no statistically significant difference regarding mean age, sex, KOOS-12, MPTA, and time of surgery between both groups. The + MOWHTO group had a faster time of union (p = 0.001), an earlier return to work (p = 0.002), and a lower rate of intraoperative lateral hinge fractures (p = 0.04).ConclusionThis study demonstrated that using additional crossing lateral K-wires during MOWHTO had a beneficial effect on reducing the rate of iatrogenic lateral hinge fractures, with a faster time of union, and an early return to work. The KOOS-12, MPTA, and mean operative time did not reveal significant differences between treatment groups.Level of evidenceretrospective cohort comparative study; level III.

PurposeAn observation was made by the senior author of this paper that patients reported changes in their hip function after a medial opening wedge high tibial osteotomy (MOHTO) for varus pattern osteoarthritis. Alignment changes at the hip after MOHTO have not been previously documented. This study assesses coronal alignment changes at the hip after MOHTO.MethodsWe retrospectively analysed pre- and post-operative lower limb alignment radiographs of patients who underwent MOHTO. The medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD) were measured to assess the alignment changes created by the MOHTO. The coronal alignment changes at the hip were evaluated using the mechanical greater trochanter angle (MGTA).Results29 osteotomies in 27 patients were included in this study. Results showed MOHTO created alignment changes at the hip. A positive correlation was found between the size of the correction at the knee and the subsequent changes at the hip. The change in the MGTA had a stronger correlation with the MAD than with the change in MPTA (r = 0.684 vs. 0.585). It was found that age, weight, height and BMI had no significant influence on these correlations.ConclusionsIncreased correction by the MOHTO lead to increased change in the coronal alignment of the hip. These changes are likely to result in an alteration in the weight bearing portion of the femoral head and the function of the abductors and we recommend assessing the hip joint as part of pre-operative planning.Level of evidencePrognostic level IV.

Patient-Specific Instrumentation in Medial Proximal Tibial Angle-Based Medial Open Wedge High Tibial Osteotomy: Improved Correction, Accuracy, and Cartilage Regeneration at Second-Look Arthroscopy.

To compare clinical and radiological outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using two different alignment methods: the alignment rod (AR) versus the gap measurement (GM) method. The primary outcome was to report the surgical accuracy of coronal plane corrections in each method. Patients who underwent MOWHTO with either AR or GM method between 2014 and 2022 at a single institution, with a minimum of 2 years of follow-up, were included. The opening gap was gradually spread with an AR under fluoroscopic control in the AR group, whereas the osteotomy site was opened to the value of the measured gap distance in addition to the thickness of the bone saw in the GM group. Radiological assessment of geometric characteristics included hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle and joint line convergence angle. Surgical accuracy, which is the deviation (Δ) between the intended and achieved correction, was compared between both methods. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Scores. A total of 110 patients (n = 110 knees) with a mean age of 54.1 ± 8.4 years were included in the study. Radiological parameters were significantly improved as reflected by HKA correction from 171.6° ± 2.0° to 181.1° ± 2.6° in the AR group and from 171.0° ± 2.3° to 181.1° ± 2.8° in the GM group at 2 years (Intergroup n.s). There was no significant intergroup difference for all radiological parameters and clinical outcomes. There was no intergroup difference in the surgical accuracy as evaluated by Δvalues and absolute Δvalues of both HKA and MPTA (n.s). Comparable correction accuracy was achieved in MOWHTO using either the AR or GM method. The GM method is simple and reliable in achieving the intended correction in MOWHTO. Ⅲ retrospective comparative study.

Background: Genu varum is a common deformity that leads to increased medial compartment loading and progressive osteoarthritis of the knee. High tibial osteotomy (HTO) is a well-established joint-preserving procedure that corrects malalignment and redistributes load. Among its variations, the uniplanar medial open-wedge method offers accurate correction with minimal complications. Aim: This research aimed to assess the short-term functional and radiological results of uniplanar medial open-wedge high tibial osteotomy in adult patients with genu varum. Methods: Prospective research has been performed on twenty adult cases had symptomatic genu varum who underwent uniplanar medial open-wedge HTO utilizing a T-buttress plate and autologous iliac crest bone graft. Patients were followed for at least twelve months. Clinical results have been evaluated utilizing the Visual Analogue Scale (VAS) and Lysholm Knee Scoring Scale (LKSS), while radiological parameters included varus angle, medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), tibial slope and patellar height (Insall–Salvati index). Results: The mean age of patients was 34.65 ± 9.92 years, with 11 males (55%) and 9 females (45%). Postoperatively, VAS significantly enhanced from 8.15 ± 0.67 to 3.45 ± 0.94 (p = 0.001), and LKSS increased from 53.65 ± 8.85 to 86.6 ± 7.08 (p = 0.001). Based on LKSS grading, 5 patients (25%) achieved excellent, 13 (65%) good, and 2 (10%) fair to poor outcomes. Radiologically, varus angle improved from 12.83 ± 3.96° to 0.76 ± 3.45° (p < 0.001) and MPTA from 80.31 ± 2.74° to 89.72 ± 2.04° (p < 0.001). The tibial slope and patellar height showed slight, non-significant changes. Complications occurred in 3 patients (15%): Infection (5%), delayed union (5%) and lateral hinge fracture (5%), all managed conservatively with complete recovery. Conclusion: Uniplanar medial open-wedge high tibial osteotomy resulted in significant functional improvement, pain relief and precise alignment correction in patients with genu varum with minimal complications. It remains an effective joint-preserving option for young and middle-aged adults with medial compartment overload.

To investigate the accuracy of split three-dimensional (3D) printing patient-specific instrumentation (PSI) in medial open-wedge high tibial osteotomy (MOWHTO) and its effectiveness in treating medial knee osteoarthritis. Clinical data of 14 patients with medial knee osteoarthritis and treated with split 3D printing PSI-assisted MOWHTO between August 2019 and August 2020 were retrospectively analyzed. There were 5 males and 9 females with an average age of 61 years (range, 43-68 years). The disease duration ranged from 1 to 16 years, with an average of 4.7 years. Preoperative Kellgren-Lawrence grading of knee osteoarthritis included grade Ⅰ in 2 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 6 cases. The Hospital for Special Surgery (HSS) score was 59.1±4.9. The weight bearing line ratio (WBL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), and actual correction angle of the lower limbs were measured on postoperative imaging data, and compared with the preoperative measurements and the designed target values to evaluate the accuracy of the PSI-assisted surgery. The patients' knee function were evaluated with the HSS score at 3 and 6 months postoperatively, and at last follow-up. One patient suffered from an incision exudation at 2 weeks postoperatively, and the incision healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 7-19 months (mean, 14.8 months). There was no neural injuries, hinge fracture, plate or screw fractures, loosening, or other complications. The WBL was maintained at the postoperative level according to the X-ray examination during the follow-up period. The WBL, HKA, MPTA, and PTSA were all within a satisfactory range after operation. The WBL, HKA, and MPTA were significantly improved when compared with the preoperative measurements ( P<0.05). There was no significant difference between preoperative and postoperative PTSA ( P>0.05). The differences in postoperative WBL, HKA, MPTA, and correction angle compared with the preoperative designed target values were not significant ( P>0.05). The HSS scores were 69.2±4.7, 77.7±4.3, and 88.1±5.4 at 3 and 6 months postoperatively, and last follow-up, respectively. The differences between time points were significant ( P<0.05). For patients with medial knee osteoarthritis, the split 3D printing PSI can assist the surgeon in MOWHTO with accurate osteotomy orthopedics and achieve favorable effectiveness.

Can pre-operative MRI estimate hamstring autograft diameter inanterior-cruciate ligament reconstruction? (110)

medial opening-wedge osteotomy is a widely performed procedure used to treat moderate isolated medial knee osteoarthritis. Historically, the literature has contained reports showing satisfactory mid-term results when accurate patient selection and precise surgical techniques were applied. This study was conducted to investigate the clinical and radiographic seven- to twelve-year results of opening-wedge high tibial osteotomy in a consecutive series of patients affected by varus knee malalignment with isolated medial compartment degenerative joint disease. we reviewed a case series of 147 medial opening-wedge high tibial osteotomies at an average follow-up of 9.5 years. Endpoints for evaluation included the reporting of adverse effects, radiographic evidence of bone union, radiographic changes in the correction angle during union, and clinical and functional final outcomes. good or excellent results were obtained in 94% of the cases: the patients reported no major complications related to the opening-wedge high tibial osteotomy surgical technique, bone graft resorption, implant choice or postoperative rehabilitation protocol. At final follow-up, the average hip-knee angle was 4° of valgus without major loss of correction during the healing process. A statistically significant change in the patellar height was detected postoperatively, with a trend towards patella infera. medial opening-wedge high tibial osteotomy is still a reliable method for correcting varus deformity while producing stable fixation, thus allowing satisfactory stability, adequate bone healing and satisfactory mid- to long-term results. Level IV, therapeutic cases series.

ABSTRACTPurposeKnee osteoarthritis (OA) is the most common degenerative joint disease in the world. It results in not only physical limitation and pain, but also negatively impacts quality of life and mental wellbeing. Treatment options such as medial opening wedge high tibial osteotomy (MOWHTO) help to relieve pain and improve functionality, but there is limited literature on the effect on mental health. This study aims to investigate the effect of MOWHTO on the mental health of patients with knee OA.MethodsIn this retrospective cohort study, data were collected from patients who underwent MOWHTO between 2019 and 2023 in a single tertiary institution. The main outcome score, short form‐36 mental component score (SF‐36 MCS), was recorded at baseline, 6 months and 2 years postprocedure. Secondary outcomes included the SF‐36 physical component score (PCS) and Oxford knee score (OKS).ResultsThere were a total of 108 MOWHTOs, comprising 51 men and 57 women. At surgery, the mean age was 55.4 ± 6.97. Twelve patients did not turn up at the 6‐month follow‐up. There was a significant improvement of SF‐36 MCS from a preoperative mean of 50.8 ± 12.6 to 57.1 ± 11.0 (p < 0.05) and 56.8 + 9.07 (p < 0.05) at 6 months and 2 years postoperation, respectively. There was also a significant increase in the scores of SF‐36 PCS and OKS (p < 0.05 for both) at 6‐month and 2‐year follow‐up. Higher preoperative SF‐36 MCS was significantly correlated with improved postoperation SF‐36 PCS (ρ = 0.184, p = 0.05) and OKS (ρ = −0.218, p = 0.02 < 0.05).ConclusionsAt 2‐year follow‐up, MOWHTO results in a significant improvement in the mental health of patients with knee OA. There is a correlation between preoperative mental health and postoperative outcomes, suggesting a role of mental health in affecting MOWHTO outcomes.Level of EvidenceLevel IV.

MRI findings change after medial opening-wedge high tibial osteotomy for medial knee osteoarthritis

Medial opening wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for joint preservation in active patients with medial knee osteoarthritis (KOA). However, older patients and those with prolonged preoperative sports cessation often struggle to resume high-impact activities, such as running, after MOWHTO. Remote rehabilitation tools may help overcome these challenges. We report the case of an older woman with prolonged cessation of sports activity who resumed sports activity after MOWHTO with the help of the mymobility® smartphone application. A 71-year-old woman with Kellgren-Lawrence grade 3 medial KOA and -5° varus alignment underwent MOWHTO. She discontinued daily 7 km runs for two years owing to knee pain. The preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were 53 for Symptoms, 50 for Pain, 61 for Activities of Daily Living, 25 for Sport and Recreation Function, and 6.25 for Quality of Life, and the Oxford Knee Score (OKS) was 31. Bone union was achieved on postoperative day (POD) 90. However, she maintained a low step count (approximately 2000 steps/day) and was unable to run owing to anxiety. We used mymobility® to provide chat-based guidance, step-count goals, and video assessments of jogging and running form. Activity progressively increased, and she achieved jogging ability on POD 150 and pain-free running ability on POD 180. Her Visual Analog Scale score improved to 0 mm, KOOS and OKS scores improved substantially, and step count increased to approximately 8000 steps/day. This case indicates that mymobility® can facilitate safe and timely return to sports after MOWHTO by improving motivation, providing remote supervision, and enabling individualized activity progression. mymobility® may be particularly effective for older patients or those who cannot access specialized postoperative rehabilitation services.

Bioabsorbable Magnesium-Based Bulk Metallic Glass Composite (BMGC) for Improved Medial Opening Wedge High Tibial Osteotomy in Knee Osteoarthritis

Closing the tendon defect does not affect tendon length and patellar height after bone-patellar tendon-bone ACL reconstruction. A retrospective study using radiographs.