HKA angle exceeding 5 degrees is strongly associated with lateral patellar translation beyond 2 mm: surgical recommendations for avoiding adverse effects on the patellofemoral joint after OWHTO.

Publisher: BioMed Central Country of Publication: England NLM ID: 101265112 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-799X (Electronic) Linking ISSN: 1749799X NLM ISO Abbreviation: J Orthop Surg Res Subsets: MEDLINE

Original Publication: London : BioMed Central, 2006-

Patellofemoral Joint*/diagnostic imaging ; Patellofemoral Joint*/surgery ; Patellofemoral Joint*/physiopathology ; Osteotomy*/methods ; Osteotomy*/adverse effects ; Tibia*/surgery ; Tibia*/diagnostic imaging; Humans ; Female ; Male ; Middle Aged ; Adult ; Biomechanical Phenomena ; Patella/diagnostic imaging ; Patella/surgery ; Stair Climbing/physiology ; Postoperative Complications/prevention & control ; Postoperative Complications/etiology

Purpose: Previous studies reported that anterior knee pain (AKP) occurs with an incidence of 32% after opening-wedge high tibial osteotomy (OWHTO). However, the biomechanical effects of this procedure on patellofemoral joints (PFJs) remain unclear. We aimed to quantify the changes in the kinematics and cartilage conditions of the PFJ during stair climbing before and after OWHTO.
Methods: We recruited 15 patients who underwent unilateral OWHTO. All patients performed continuous stair climbing under the surveillance of a dual fluoroscopic imaging system to determine accurate 6-degree-of-freedom (6-DOF) PFJs and 3D hip-knee-ankle (HKA) angles before and 6 months after OWHTO. The volume penetration centres between the patellar and femoral cartilage models were defined as contact centres. Eleven of these patients underwent quantitative T2 relaxation MRI to determine whether and how PFJ cartilage degeneration progressed.
Results: After OWHTO, patella valgus (mean - 3.73°, P = 0.02) and internal rotation (mean 3.14°, P = 0.03) increased compared with the preoperative conditions during the stair climbing motion. In addition, the patellae of OWTHO knees were located more laterally after surgery (1.56 ± 2.24 mm, P = 0.02) at knee flexion. Moreover, lateral shifts in the contact patterns of both the medial and lateral patellar facets together with increased T2 values (207.10 ± 21.84 ms, P = 0.04) of the lateral patella cartilage were found after surgery. Finally, the lateral patellar shift increased with decreasing varus 3D-HKA after surgery (R= -0.79, P < 0.001). Therefore, controlling 3D-HKA may be helpful in limiting lateral patellar shift.
Conclusion: OWHTO changed the patellofemoral kinematics and contact patterns during stair climbing, especially the lateral patellar shift, which may lead to degeneration of the PFJ cartilage. Avoiding overcorrection of the HKA angle beyond 5 degrees of valgus reduces lateral patellar translation, which may help prevent AKP. Additional clinical studies are necessary to validate these biomechanical findings and clarify their impacts on patient outcomes.
Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)

Knee Surg Sports Traumatol Arthrosc. 2020 Feb;28(2):454-462. (PMID: 31375878)
Orthop J Sports Med. 2020 Aug 13;8(8):2325967120943874. (PMID: 32851106)
J Biomech. 1994 Aug;27(8):1059-65. (PMID: 8089160)
J Biomech Eng. 2007 Dec;129(6):937-43. (PMID: 18067400)
J Orthop Surg (Hong Kong). 2023 Jan-Apr;31(1):10225536221151132. (PMID: 36757867)
Arthroscopy. 2012 Aug;28(8):1087-93. (PMID: 22520445)
Ann Biomed Eng. 2021 Apr;49(4):1183-1198. (PMID: 33094419)
Orthop J Sports Med. 2021 Dec 01;9(12):23259671211047904. (PMID: 34881345)
Arthritis Rheum. 2004 Jul;50(7):2184-90. (PMID: 15248216)
J Bone Joint Surg Am. 2006 Dec;88(12):2596-605. (PMID: 17142409)
Knee Surg Sports Traumatol Arthrosc. 2007 Aug;15(8):978-84. (PMID: 17483931)
J Orthop Surg Res. 2009 Mar 13;4:6. (PMID: 19284658)
J Knee Surg. 2017 Feb;30(2):158-165. (PMID: 27218480)
Bone Joint J. 2014 Sep;96-B(9):1214-21. (PMID: 25183593)
Orthop J Sports Med. 2023 Feb 21;11(2):23259671221150958. (PMID: 36846813)
J Exp Orthop. 2021 Nov 9;8(1):104. (PMID: 34750692)
Arch Orthop Trauma Surg. 2023 Apr;143(4):2073-2085. (PMID: 35809099)
Int Orthop. 2014 Aug;38(8):1577-83. (PMID: 24966079)
Arch Orthop Trauma Surg. 2022 Jan;142(1):13-21. (PMID: 32816055)
J Biomech Eng. 2006 Aug;128(4):588-95. (PMID: 16813450)
Arthroscopy. 2021 Oct;37(10):3177-3186. (PMID: 33895305)
J Bone Joint Surg Am. 2007 Aug;89(8):1749-55. (PMID: 17671014)
Med Eng Phys. 2013 May;35(5):591-600. (PMID: 22922096)
Ann Biomed Eng. 2004 Mar;32(3):447-57. (PMID: 15095819)
Am J Knee Surg. 2001 Summer;14(3):163-73. (PMID: 11491427)
J Biomech. 2012 Sep 21;45(14):2432-7. (PMID: 22840488)
Am J Sports Med. 2019 Jul;47(8):1863-1873. (PMID: 31157981)
J Bone Joint Surg Am. 1987 Mar;69(3):332-54. (PMID: 3818700)
BMC Musculoskelet Disord. 2019 Dec 14;20(1):607. (PMID: 31837699)
Arthritis Rheum. 2000 Aug;43(8):1874-80. (PMID: 10943879)
Ann Rheum Dis. 1957 Dec;16(4):494-502. (PMID: 13498604)
J Orthop Res. 2019 Mar;37(3):615-630. (PMID: 30680795)
Knee Surg Sports Traumatol Arthrosc. 2014 Jul;22(7):1591-8. (PMID: 23135414)
J Bone Joint Surg Am. 2012 Jun 6;94(11):1023-9. (PMID: 22637208)
Knee. 2015 Jun;22(3):156-62. (PMID: 25715920)
J Biomech. 2016 Jan 25;49(2):185-92. (PMID: 26708962)
J Knee Surg. 2022 Jan;35(1):54-60. (PMID: 32544971)
Curr Rev Musculoskelet Med. 2014 Dec;7(4):292-301. (PMID: 25129702)
J Orthop Translat. 2020 May 20;24:96-102. (PMID: 32775201)
Arthroscopy. 2017 Apr;33(4):811-816. (PMID: 28043753)
J Biomech. 2013 May 31;46(9):1576-82. (PMID: 23591448)
Eur J Orthop Surg Traumatol. 2014 May;24(4):567-70. (PMID: 23633086)
Springerplus. 2016 Feb 12;5:123. (PMID: 26904392)
BMC Musculoskelet Disord. 2015 Feb 21;16:35. (PMID: 25886863)
Arch Orthop Trauma Surg. 1999;119(1-2):46-9. (PMID: 10076944)

No. PW2023D-09 Shanghai Pudong New Area Health Commission; No. 21ZR1448900 Science and Technology Commission of Shanghai Municipality; ynhg1g202403 Shanghai Sixth People's Hospital; No. ynhglg202402 Shanghai Sixth People's Hospital

Keywords: Kinematics; Knee cartilage; Osteotomy; Patellofemoral joint

Date Created: 20250114 Date Completed: 20250115 Latest Revision: 20250129

20250129

PMC11734403

10.1186/s13018-024-05391-7

39810245