The effect of medial open wedge high tibial osteotomy on the patellofemoral joint: comparative analysis according to the preexisting cartilage status
The effect of medial open wedge high tibial osteotomy on the patellofemoral joint: comparative analysis according to the preexisting cartilage status
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DOI：
10.1186/s12891-019-2989-y
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发表时间：
2019-12-14
影响因子：
2.3
通讯作者：
Kim, Sung-Hwan
中科院分区：
文献类型：
--
作者：
Moon, Hyun-Soo;Choi, Chong-Hyuk;Kim, Sung-Hwan
背景虽然众所周知内侧胫骨高位楔形截骨术（MOWHTO）会对髌股关节产生不良影响，但以前没有研究根据髌股关节原有的软骨状态来检查MOWHTO的手术结果。本研究的目的是根据先前存在的软骨状态，从客观和主观方面研究MOWHTO对髌股关节的影响。方法对92例接受MOWHTO手术的患者进行关节镜下二次观察。根据髌股关节先前存在的软骨状态将患者分为两组：第1组（国际软骨修复学会[ICRS] 2级或3级）和第2组（ICRS 0级或1级）。对两组的临床评分、影像学参数和关节镜测量值进行比较分析。结果两组患者的临床疗效均较术前有明显改善，两组患者在各时间点的疗效比较差异无统计学意义。两组之间的放射学参数无显著差异。两组髌股骨关节炎影像学分级均呈进展趋势，但无统计学意义。在关节镜评估中，两组髌股关节软骨病变的大小均随时间增加（P = 0.003），但两组之间随时间变化的程度无统计学显著性。因此，两组之间髌股关节软骨病变分级进展的频率无显著差异。结论MOWHTO会促进髌股关节骨关节炎的进展，无论先前存在的软骨状态如何，与短期随访的临床结局无关。
Background Although it has been known that medial open wedge high tibial osteotomy (MOWHTO) would adversely affect the patellofemoral joint, no previous study examined the surgical outcome of MOWHTO according to the preexisting cartilage status of the patellofemoral joint. The aim of this study was to investigate the effect of MOWHTO on the patellofemoral joint with regard to objective and subjective aspects according to the preexisting cartilage status. Methods Ninety-two patients who underwent MOWHTO and a following second-look arthroscopic assessment were included in this study. The patients were divided into two groups according to the preexisting cartilage status of the patellofemoral joint: group 1 (International Cartilage Repair Society [ICRS] grade 2 or 3) and group 2 (ICRS grade 0 or 1). Comparative analysis was performed regarding clinical scores, radiographic parameters, and arthroscopic measurements between the two groups. Results Clinical outcomes showed overall improvement from baseline to the time of second-look operation, with no significant difference between the two groups at each time point. There were no significant differences in radiographic parameters between the two groups. Radiographic grade of patellofemoral osteoarthritis in both groups showed a tendency to progress, without statistical significance. In arthroscopic assessment, the size of the cartilage lesion on the patellofemoral joint increased with time in both groups (P = 0.003), but the degree of change over time between the two groups was not statistically significant. Consistently, there was no significant difference in the frequency of progression of cartilage lesion grade in the patellofemoral joint between the two groups. Conclusions MOWHTO would contribute to osteoarthritis progression of the patellofemoral joint regardless of the preexisting cartilage status, without an association with clinical outcomes in short-term follow-up.