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Patellar height and the inclination of the tibial plateau after high tibial osteotomy

THE OPEN VERSUS THE CLOSED-WEDGE TECHNIQUE

¹ Department of Orthopaedics, Martini Hospital, P. O. Box 30033, 9700 RM Groningen, The Netherlands.
² Department of General Practice, Erasmus Medical Centre, P. O. Box 1738, 3000 DR Rotterdam, The Netherlands.
³ Department of Orthopaedics, Erasmus Medical Centre, P. O. Box 2040, 3000 CA Rotterdam, The Netherlands.

Correspondence should be sent to Dr R. W. Brouwer; e-mail: r.w.brouwer{at}mzh.nl

Our aim was to compare the degree of patellar descent and alteration in angle of the inclination of the tibial plateau in lateral closing-wedge and medial opening-wedge high tibial osteotomy (HTO) in 51 consecutive patients with osteoarthritis of the medial compartment and varus malalignment. Patellar height was measured by the Insall-Salvati (IS) and the Blackburne-Peel (BP) ratios. The tibial inclination was determined by the Moore-Harvey (MH) method. Multivariate linear regression analysis was used to determine the influence of the type of HTO (closing vs opening wedge) on the post-operative patellar height or tibial inclination. The intra- and interobserver variability of these methods was determined before operation and at follow-up at one year.

After an opening-wedge HTO the patellar height was significantly more decreased (mean post-operative difference: IS = 0.15; 95% confidence interval (CI) 0.06 to 0.23; BP = 0.11; 95% CI 0.05 to 0.18) compared with a closing-wedge HTO.

The angle of tibial inclination differed significantly (mean post-operative difference MH = –6.40°; 95% CI –8.74 to –4.02) between the two HTO techniques, increasing after opening-wedge HTO and decreasing after closing-wedge HTO.

There was no clinically-relevant difference in the intra- and interobserver variability of measurements of patellar height either before or after HTO.

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