2025 ISAKOS Biennial Congress ePoster
Return to Sports after Inverted V-Shaped High Tibial Osteotomy for Medial Knee Osteoarthritis - Comparison with Medial Opening Wedge High Tibial Osteotomy -
Taku Ebata, MD, PhD, Sapporo JAPAN
Eiji Kondo, MD, PhD, Sapporo, Hokkaido JAPAN
Koji Iwasaki, MD, PhD, Sapporo, Hokkaido JAPAN
Dai Sato, MD, PhD, Sapporo, Hokkaido JAPAN
Masatake Matsuoka, PhD, Sapporo JAPAN
Tomohiro Onodera, MD, PhD, Sapporo, Hokkaido JAPAN
Kazunori Yasuda, MD, PhD, Prof., Sapporo, Hokkaido JAPAN
Tomonori Yagi, MD, PhD, Sapporo, Hokkaido JAPAN
Norimasa Iwasaki, MD, PhD, Sapporo, Hokkaido JAPAN
Hokkaido University, Sapporo, Hokkaido, JAPAN
FDA Status Not Applicable
Summary
Return to sports of the patients who underwent an inverted V-shaped high tibial osteotomy were comparable than those who underwent a medial opening wedge high tibial osteotomy.
ePosters will be available shortly before Congress
Abstract
Introduction
High tibial osteotomy (HTO) is increasingly performed in physically active patients with medial knee osteoarthritis (OA), who have high expectations for return to sports (RTS). While several studies have reported on RTS following medial opening wedge HTO (OW-HTO), there is limited information regarding RTS after closing or neutral wedge HTO. We have originally developed an inverted V-shaped HTO for severe varus deformity, which is classified as a neutral wedge (NW) osteotomy that combines hemi-closing and hemi-opening wedge osteotomy techniques. However, there were no reports on the details of RTS following NW-HTO. The aim of this study was to compare RTS following NW-HTO with those after OW-HTO.
Methods
A total of 59 knees who underwent HTO for a medial OA or a varus knee with spontaneous osteonecrosis of the knee (SONK) from 2015 to 2022 were enrolled retrospectively in this study. All patients participated in sports activity before surgery. HTO was performed using iV-HTO (NW group; 32 knees) or OW-HTO (OW group; 27 knees), according to the following indications. The NW-HTO was performed for knees requiring a valgus correction of more than 10° to shift the mechanical axis to 65% or with patellofemoral OA (PF-OA) of stage 3 or higher. The OW-HTO was performed for knees needing a valgus correction of 10° or less or with PF-OA of stage 2 or lower. RTS including Tegner activity scores, clinical outcomes, and radiographic parameters were assessed before and 2 years after surgery. Paired t-tests and Mann-Whitney U tests were used for statistical analysis, with significance set at p=0.05.
Results
The NW group had more severe OA grades in the femorotibial (FT) and PF joints than the OW group (p=0.02 and p<0.01, respectively). At 2 years postoperatively, 28/32 patients (87.5%) in NW group and 24/27 patients (88.9%) in OW group returned to sports. The RTS time after HTO averaged 8.7 months and 7.8 months in NW and OW groups, respectively, with no significant difference between the groups. The pre-symptomatic, preoperative, and postoperative Tegner activity scores averaged 4.8, 2.3, and 4.1 in NW group, and 5.0, 2.9, and 4.4 in OW group, respectively, with no significant differences between the pre-symptomatic and postoperative scores in either group. Japanese Orthopaedic Association score and Lysholm score significantly improved after both HTO surgery (p<0.01), with no significant differences between the groups. Regarding preoperative coronal lower leg alignment, the NW group had severe varus deformity. Knee alignment showed significant correction in the coronal plane after both HTO procedures (p<0.01).
Conclusion
In this study, 87.5% of the patients who underwent NW-HTO for severe medial OA returned to sports after surgery, with an average time to return of 8.7 months. Although the FT and PF-OA were more severe in the NW group than the OW group, RTS rates of the patients who underwent NW-HTO were comparable than those who underwent OW-HTO. Therefore, an inverted V-shaped HTO procedure may be one of the surgical options for the patients with severe varus knee combined PF and FT-OA who wish to RTS.