Medial Open-Wedge High Tibial Osteotomy May Adversely Affect the Patellofemoral Joint
Medial Open-Wedge High Tibial Osteotomy May Adversely Affect the Patellofemoral Joint
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DOI：
10.1016/j.arthro.2016.09.034
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发表时间：
2017-04-01
影响因子：
4.7
通讯作者：
Bae, Dae-Kyung
中科院分区：
文献类型：
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作者：
Kim, Kang-Il;Kim, Dong-Kyoon;Bae, Dae-Kyung
目的：评价内侧开放楔形胫骨高位截骨术（HTO）前后髌股关节的2期关节镜检查结果，并验证内侧开放楔形HTO是否会影响髌股关节。方法：我们前瞻性回顾了114例内侧开放楔形HTO治疗膝内翻骨关节炎的病例。在HTO期间进行了关节镜首次检查。HTO时的平均年龄为56.34 ± 5.4岁（范围：40 - 69岁）。在HTO后平均26.1 +/-6.0个月（范围：21.6 - 32.0个月）时，在取出接骨板的同时进行关节镜二次探查。我们使用国际软骨修复学会（ICRS）分级系统通过关节镜第一次和第二次检查评估了髌股关节，并比较了HTO前后的情况。还对术后膝前疼痛进行了评价。结果如下：与第一次检查结果相比，第二次关节镜ICRS分级变化如下：髌骨方面，89例（78.1%）未进展，25例（21.9%）进展。在股骨颈骨折方面，67例（58.8%）未进展，47例（41.2%）进展。与初次关节镜检查结果相比，髌骨（P = 0.001）和股骨髁（P <0.001）的ICRS分级有显著进展。术后膝前疼痛的发生率为11.4%（13例），与二次关节镜检查时髌股关节的ICRS分级有关（髌骨P <0.001，髌骨P <0.001）。结论：本研究表明内侧开放楔形HTO可能会对髌股关节产生不利影响。虽然术后膝前疼痛的发生率较低，但临床上与髌股关节炎相关。
Purpose: To evaluate 2-stage arthroscopic findings of the patellofemoral joint before and after medial open-wedge high tibial osteotomy (HTO) and verify whether the patellofemoral joint would be influenced by medial open-wedge HTO. Methods: We prospectively reviewed 114 cases of medial open-wedge HTO for the treatment of osteoarthritis with a varus knee. First-look arthroscopy was performed during HTO. The mean age at the time of HTO was 56.34 +/- 5.4 years (range, 40-69 years). Second-look arthroscopy was performed concomitantly with plate removal at an average of 26.1 +/- 6.0 months (range, 21.6-32.0 months) after HTO. We assessed the patellofemoral joint using the International Cartilage Repair Society (ICRS) grading system by first-and second-look arthroscopy and compared it before and after HTO. Postoperative anterior knee pain was also evaluated. Results: Compared with first-look findings, second-look arthroscopic ICRS grading was changed as follows: In terms of the patella, 89 cases (78.1%) were not progressed whereas 25 cases (21.9%) were progressed. In terms of the femoral trochlea, 67 cases (58.8%) were not progressed whereas 47 cases (41.2%) were progressed. There was significant progression of the ICRS grade of the patella (P = .001) and femoral trochlea (P < .001) compared with first-look arthroscopic findings. The incidence of postoperative anterior knee pain was 11.4% (13 cases), and it was related to the ICRS grade of the patellofemoral joint at the time of second-look arthroscopy (P < .001 for patella and P < .001 for trochlea). Conclusions: This study showed that the patellofemoral joint might be adversely affected by medial open-wedge HTO. Although the incidence of postoperative anterior knee pain was low, it was clinically correlated with patellofemoral arthritis.