Kurien Thomas, East Jamie, Mandalia Vipul
Exeter Knee Reconstruction Unit, Royal Devon and Exeter NHS Trust, Exeter, UK; Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK; NEOS, Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust; NIHR Biomedical Research Centre, Nottingham, UK.
Exeter Knee Reconstruction Unit, Royal Devon and Exeter NHS Trust, Exeter, UK.
Knee. 2023 Jan;40:201-219. doi: 10.1016/j.knee.2022.11.023. Epub 2022 Dec 10.
BACKGROUND (INCLUDING AIMS OF THE STUDY): To investigate the impact medial opening wedge high tibial osteotomy (MOWHTO) has on the progression of patellofemoral (PF) OA, patella height, contact pressure within the PF joint and clinical outcomes.
A systematic review was conducted in January 2022 according to PRISMA guidelines. The ICRS cartilage grade of the PF joint at the initial MOWHTO surgery and at second look surgery was compared and relative risk of progression of PF OA was calculated. Evaluation of patella height was assessed by Caton-Deschamps index, Blackburne-Peel index or Insall-Salvati index pre and post MOWHTO. Cadaveric studies assessing contact pressures in the PF after MOWHTO were included.
Forty-two studies comparing 2419 patients were included. The mean age was 53.1 years (16-84), 61.3% female. The risk of progression of PF OA was highest in the uniplanar and biplanar MOWHTO with proximal tubercle osteotomy groups (RR = 1.28-1.51) compared to biplanar MOHWTO with distal tubercle osteotomy (RR = 0.96-1.04). Patella height was not affected after biplanar MOWHTO with distal tubercle osteotomy (p < 0.001). Cadaveric studies demonstrate that PF contact pressures increase with more severe corrections (15°) but suggest biplanar MWOHTO and distal tubercle osteotomy induces lower contact pressures within the PF joint than other MOWHTO techniques. Significant over correction is associated with worse clinical outcomes and anterior knee pain.
Biplanar MOWHTO and distal tubercle osteotomy has minimal effect on the contact pressures in the PF joint resulting in less severe progression of PF OA and has minimal impact on patella height.
背景（包括研究目的）：探讨内侧开口楔形高位胫骨截骨术（MOWHTO）对髌股关节（PF）骨关节炎进展、髌骨高度、PF关节内接触压力及临床结局的影响。
2022年1月根据PRISMA指南进行系统评价。比较初次MOWHTO手术和二次探查手术时PF关节的ICRS软骨分级，并计算PF骨关节炎进展的相对风险。通过Caton-Deschamps指数、Blackburne-Peel指数或Insall-Salvati指数在MOWHTO前后评估髌骨高度。纳入评估MOWHTO后PF接触压力的尸体研究。
纳入42项比较2419例患者的研究。平均年龄53.1岁（16 - 84岁），女性占61.3%。与双平面远端结节截骨的MOHWTO（RR = 0.96 - 1.04）相比，单平面和双平面近端结节截骨的MOWHTO组PF骨关节炎进展风险最高（RR = 1.28 - 1.51）。双平面远端结节截骨的MOWHTO术后髌骨高度未受影响（p < 0.001）。尸体研究表明，PF接触压力随更严重的矫正（15°）而增加，但提示双平面MWOHTO和远端结节截骨比其他MOWHTO技术在PF关节内产生的接触压力更低。明显的过度矫正与更差的临床结局和膝前疼痛相关。
双平面MOWHTO和远端结节截骨对PF关节内接触压力影响最小，导致PF骨关节炎进展较轻，对髌骨高度影响最小。
