Distal tibial tubercle osteotomy is superior to the proximal one for progression of patellofemoral osteoarthritis in medial opening wedge high tibial osteotomy.

Purpose: To investigate the effect of proximal tibial tubercle osteotomy (PTO) and distal tibial tubercle osteotomy (DTO) in medial opening wedge high tibial osteotomy on patellofemoral alignment, patellofemoral osteoarthritis and clinical outcomes.

Methods: PTO (n = 41) and DTO (n = 43) for the same surgical indications were included. Radiographic measurements of the Caton-Deschamps index, patellar tilt and shift, and arthroscopic cartilage evaluation at the patellofemoral joint were performed at osteotomy and plate removal. The Knee Society Score (KSS) was evaluated preoperatively and at the latest follow-up.

Results: The follow-up period was longer in the PTO group (33.7 months; range 23-40 years) than in the DTO group (22.2 months; range 18-29 months) (p < 0.0001), whereas the period from osteotomy to plate removal was not different between the groups. The Caton-Deschamps index of the DTO group was unchanged from 0.9 (range 0.7-1.2) to 0.9 (range 0.6-1.4), whereas that of the PTO group changed from 0.9 (0.7-1.2) to 0.7 (0.5-1.0) (p < 0.0001). There were fewer deteriorated cases of cartilage status in the trochlear groove in the DTO group (20.9%) than in the PTO group (56.1%, p < 0.05). There were more improved cases in the DTO group (23.3%) than in the PTO group (4.9%, p < 0.05). Postoperative KSS was better in the DTO group than in the PTO group (p < 0.05).

Conclusion: DTO is associated not only with reduced deterioration but also with increased improvement of cartilage status in the trochlear groove and better KSS as compared with PTO.

Level Of Evidence: IV.