Preoperative flexion contracture is a predisposing factor for cartilage degeneration at the patellofemoral joint after o
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(2020) 32:55
Knee Surgery & Related Research
RESEARCH ARTICLE
Open Access
Preoperative flexion contracture is a predisposing factor for cartilage degeneration at the patellofemoral joint after open wedge high tibial osteotomy Shuhei Otsuki* , Kuniaki Ikeda, Hitoshi Wakama, Nobuhiro Okuno, Yoshinori Okamoto, Tomohiro Okayoshi, Yuki Miyamoto and Masashi Neo
Abstract Purpose: The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods: Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results: Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions: Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy. Keywords: Knee, Open wedge high tibial osteotomy, Range of motion, Cartilage degeneration, Patellofemoral joint, Clinical outcome
Introduction Open wedge high tibial osteotomy (OWHTO) is a successful treatment option for osteoarthritis (OA) in the medial compartment of the knee [1, 2]. Despite the * Correspondence: [email protected] Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan
favorable clinical outcomes of OWHTO, complications have been reported, such as loss of correction, nonunion, plate irritation, device failures, hinge fracture, and patella baja [3–5]. Particularly, the progression of postoperative patellofemoral cartilage degeneration is an important clinical issue to consider [5–7]. The degree of correction angle [6], overcorrection [7], and sagittal
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution
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