Abstract
Purpose
Alterations in patellar height after high tibial osteotomy are found in many instances. Fibrosis of the tendon is implicated as the cause of the mechanism of patella lowering. This study aimed to determine the relationship between the position of the patella and the histopathological findings at the patellar tendon after high tibial osteotomy.
Methods
Nineteen knees in seventeen patients who were consecutively hospitalised for implant extraction are studied. All of the patients had previously undergone closing wedge osteotomy by the same surgeon at the same department. The median follow-up time is 15 months (range: 11–35). Five patients who all underwent high tibial osteotomy at the same time are also included in the study as a control group for histopathological evaluation. All of the patients are evaluated radiologically, patellar tendon biopsies are taken during the operation, and histopathological analyses are performed.
Results
The shortening of the patellar tendon is statistically significant (P < 0.05). The severity of the vascularisation, inflammation, and fibrotic change observed at the distal part of the tendon is evident. However, there is no statistically significant correlation between these findings and the degree of shortening.
Conclusions
The shortening of the tendon occurs as a result of adherence in the distal part of the tendon. It would appear that it is this shortening that causes the difficulties encountered during arthroplasty surgery of osteotomy patients, and not patella infera.
Level of evidence
Retrospective study, Level II.
Similar content being viewed by others
References
Amendola L, Fosco M, Cenni E, Tigani D (2010) Knee joint arthroplasty after tibial osteotomy. Int Orthop 34(2):289–295
Backstein D, Meisami B, Gross AE (2003) Patella baja after modified Coventry-Maquet high tibial osteotomy. J Knee Surg 16(4):203–208
Berg EE, Mason SL, Lucas MJ (1996) Patellar height ratios. A comparison of four measurement methods. Am J Sports Med 24(2):218–221
Berman AT, Bosacco SJ, Kirshner S, Avolio A (1991) Factors influencing long term results in high tibial osteotomy. Clin Orthop Relat Res 272:192–198
Billings A, Scott DF, Camargo MP, Hofmann AA (2000) High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg 82(1):70–79
Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59(2):241–242
Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 87(9):1227–1232
El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S (2010) Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38(2):323–329
Giagounidis EM, Sell S (1999) High tibial osteotomy: factors influencing the duration of satisfactory function. Arch Orthop Trauma Surg 119:445–449
Healy WL, Riley LH (1986) High tibial valgus osteotomy. A clinical review. Clin Orthop Relat Res 209:227–233
Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104
Kaper BP, Bourne RB, Rorabeck CH, Macdonald SJ (2001) Patellar infera after high tibial osteotomy. J Arthroplasty 16(2):168–173
Katz MM, Hungerford DS, Krackow KA, Lennox DW (1987) Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 69(2):225–233
Kesmezacar H, Erginer R, Öğüt T, Seyahi A, Babacan M, Tenekecioğlu Y (2005) Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13(7):539–544
Kitson J, Weale AE, Lee AS, MacEachern AG (2001) Patellar tendon length following opening wedge high tibial osteotomy using an external fixator with particular reference to later total knee replacement. Injury 32:140–143
Matar WY, Boscariol R, Dervin GF (2009) Open wedge high tibial osteotomy: a roentgenographic comparison of a horizontal and an oblique osteotomy on patellar height and sagittal tibial slope. Am J Sports Med 37(4):735–742
Mont MA, Alexander N, Krackow KA, Hungerford DS (1994) Total knee arthroplasty after failed high tibial osteotomy. Orthop Clin North Am 25(3):515–525
Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy. A subjective outcome study. J Bone Joint Surg Am 78(9):1353–1358
Nakamura E, Mizuta H, Kudo S, Takagi S, Sakamoto K (2001) Open wedge osteotomy of the proximal tibia with hemicallotasis. J Bone Joint Surg Br 83(8):1111–1115
Noda T, Yasuda S, Nagano K, Takahara Y, Namba Y (2000) Clinico radiological study of total knee arthroplasty after high tibial osteotomy. J Orthop Sci 5(1):25–36
Odenbring S, Tjornstrand B, Egund N, Hagstedt B, Hovelius L, Lindstrand A, Luxhoj T, Svanstrom A (1989) Function after tibial osteotomy for medial gonarthrosis below aged 50 years. Acta Orthop Scand 60(5):527–531
Okamoto R, Koshino T, Morii T (1993) Shortening of patellar ligament and patella baja with improvement of quadriceps muscle strength after high tibial osteotomy. Bull Hosp Jt Dis 53(3):21–24
Rudan JF, Simurda MA (1991) Valgus high tibial osteotomy: a long term follow-up study. Clin Orthop Relat Res 268:157–160
Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am 71(2):245–248
Seil R, Müller B, Georg T, Kohn D, Rupp S (2000) Reliability and intraobserver variability in radiological patellar height ratios. Knee Surg Sports Travmatol Arthrosc 8(4):231–236
Sen C, Kocaoğlu M, Eralp L (2003) The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow up). Knee Surg Sports Travmatol Arthrosc 11(3):139–144
Tigani D, Ferrari D, Trentani P, Barbanti-Brodano G, Trentani F (2001) Patellar height after high tibial osteotomy. Int Orthop 24(6):331–334
Westrich GH, Peters LE, Haas SB, Buly RL, Windsor RE (1998) Patella height after high tibial osteotomy with internal fixation and early motion. Clin Orthop Relat Res 354:169–174
Windsor E, İnsall JN, Vince KG (1988) Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg 70(4):547–555
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gokay, N.S., Erginer, R., Dervisoglu, S. et al. Patella infera or patellar tendon adherence after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 22, 1591–1598 (2014). https://doi.org/10.1007/s00167-012-2293-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-012-2293-y