title: Changes in patellofemoral alignment do not cause clinical impact after open-wedge high tibial osteotomy.
abstract: OBJECTIVE
  The objectives of this study were (1) to evaluate the clinical and radiologic outcomes of open-wedge high tibial osteotomy focusing on patellofemoral alignment and (2) to search for correlation between variables and patellofemoral malalignment.
  
  
  METHODS
  A total of 46 knees (46 patients) from 32 females and 14 males who underwent open-wedge high tibial osteotomy were included in this retrospective case series. Outcomes were evaluated using clinical scales and radiologic parameters at the last follow-up. Pre-operative and final follow-up values were compared for the outcome analysis. For the focused analysis of the patellofemoral joint, correlation analyses between patellofemoral variables and pre- and post-operative weight-bearing line (WBL), clinical score, posterior slope, Blackburn Peel ratio, lateral patellar tilt, lateral patellar shift, and congruence angle were performed.
  
  
  RESULTS
  The minimum follow-up period was 2 years and median follow-up period was 44 months (range 24-88 months). The percentage of weight-bearing line was shifted from 17.2 ± 11.1 to 56.7 ± 12.7%, and it was statistically significant (p < 0.01). Regarding the clinical results, statistical significance was observed using all scores (p < 0.01). In the radiologic evaluation, patellar descent was observed with statistical significance (p < 0.01). Last follow-up lateral patellar tilt was decreased with statistical significance (p < 0.01). In correlation analysis between variables of patellofemoral malalignment, the pre-operative weight-bearing line showed an association with the change in lateral patellar tilt and lateral patellar shift (correlation coefficient: 0.3).
  
  
  CONCLUSIONS
  After open-wedge high tibial osteotomy, clinical results showed improvement, compared to pre-operative values. The patellar tilt and lateral patellar shift were not changed; however, descent of the patella was observed. Therefore, mild patellofemoral problems should not be a contraindication of the open-wedge high tibial osteotomy.
  
  
  METHODS
  Case series, Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea. smcos1@hanmail.net.
authors.forename: Yong Seuk
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Gil Medical Center, Gil Hospital, Gachon University School of Medicine, 1198 Guwol-dong, Namdong-Gu, Incheon, 405-760, Korea.
authors.forename: Sang Bok
authors.initials: SB
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Gil Medical Center, Gil Hospital, Gachon University School of Medicine, 1198 Guwol-dong, Namdong-Gu, Incheon, 405-760, Korea.
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yong Eok
authors.initials: YE
authors.lastname: Kwon
authors.affiliation: Department of Orthopaedic Surgery, Gil Medical Center, Gil Hospital, Gachon University School of Medicine, 1198 Guwol-dong, Namdong-Gu, Incheon, 405-760, Korea. bklee@gilhospital.com.
authors.forename: Beom Koo
authors.initials: BK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D017760:Bone Malalignment / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D057071:Patellofemoral Joint / Q000601:surgery*; D012189:Retrospective Studies; D013977:Tibia / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Knee; Open-wedge high tibial osteotomy; Osteoarthritis; Patellofemoral indices