Low-profile fixation devices for medial opening wedge high tibial osteotomy (OWHTO) were developed in order to avoid skin irritation and additional invasion. However, the low-profile system is associated with additional risks. We report three cases of locking pin back out with the low-profile locking plate system for medial OWHTO.
Knee ; Osteotomy ; Skin

PURPOSE: The purpose of this study was to evaluate the effect of concomitant arthroscopic lateral release (LR) in open wedge high tibial osteotomy (OWHTO) by comparing the pre- and postoperative radiological parameters of patellar position and orientation. MATERIALS AND METHODS: The study was comprised of 19 knees undergoing OWHTO and concomitant LR and 18 knees undergoing OWHTO alone. Radiological parameters for patellar position and orientation included the Caton-Deschamps index (CDI), Blackburne-Peel index (BPI), patellar tilting angle (PTA), patellar lateral shift (PLS), and patellofemoral distance (PFD), which were evaluated in the preoperative period and at one year after surgery. RESULTS: Patellar height was significantly reduced after surgery as indicated by the decrease in BPI (p=0.03) in the OWHTO/LR group, and decrease in CDI (p=0.03) and BPI (p=0.04) in the OWHTO alone group. PTA and PLS were significantly reduced after the combined OWHTO/LR procedure (p=0.04 and p=0.04, respectively). By contrast, no significant changes were detected when isolated OWHTO was performed. CONCLUSIONS: OWHTO induced a postoperative decrease in patellar height in both groups. Regarding the change in patellofemoral alignment, concomitant LR in OWHTO significantly decreased lateral patellar tilt and shift, while no significant difference in those parameters were noted in the OWHTO alone knees.
Arthroscopy ; Knee ; Osteotomy ; Preoperative Period

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.

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.