The correlation of sagittal osteotomy inclination and the anteroposterior translation in medial open-wedge high tibial osteotomy-one of the causes affecting the patellofemoral joint?

PURPOSE: For opening-wedge high tibial osteotomy, previous studies have shown that most osteotomies were anterior-inclined. The purpose of this study was to determine the effect of sagittal osteotomy inclination on the anteroposterior translation of osteomized fragments and discuss its possible impact on the patellofemoral joint.

METHODS: We retrospectively measured the angle between the joint line and the sagittal osteotomy line. We also evaluated the anteroposterior translation of osteomized fragments by measuring the distance from the most posterior point of the tibial plateau to the tibial tuberosity and the anterior cortical line. Correlation between the sagittal osteotomy inclination and the anteroposterior translation of fragments was analyzed.

RESULTS: The mean sagittal osteotomy inclination was 6.3 ± 8.4° anteriorly to the joint line and 82% of osteotomies were anterior-inclined. The anteroposterior translation of the osteomized fragments was moderately correlated to the sagittal inclination. Anterior-inclined osteotomy tends to result in the anterior translation of the proximal fragment.

CONCLUSION: High rates of anterior-inclined osteotomy have been described previously as well as in this study. Anterior-inclined osteotomy tends to result in the anterior translation of the proximal fragment. This may result in increased vertical vector force onto the patellofemoral joint, which further accelerates patellofemoral joint degeneration. Therefore, surgeons should attempt to perform parallel osteotomy or avoid anterior displacement of the proximal fragment if there is concern of anterior-inclined osteotomy.