Description
High tibial osteotomy (HTO) is increasingly used in physically active patients with medial knee osteoarthritis (OA). These patients have high expectations including return to sports (RTS). We have originally developed an inverted V-shaped high tibial osteotomy (iV-HTO) for severe medial OA which is classified as a neutral (hemi-closing and hemi-opening) wedge osteotomy. However, there were no reports about the details of RTS after iV-HTO. The purpose of this study was to clarify RTS and clinical outcome after iV-HTO. A total of 30 patients who underwent iV-HTO for a medial OA or a varus knee with spontaneous osteonecrosis of the knee (SONK) of the medial compartment from 2016 to 2021 were enrolled retrospectively in this study. All patients participated in sports activity before surgery. We evaluated the pre-symptomatic, preoperative, and postoperative Tegner activity score, sports activity level, clinical outcome, and radiographic parameters before and 2 years after surgery. 26/30 patients (87%) returned to sports activity at 2 years after surgery. The pre-symptomatic, preoperative, and postoperative Tegner activity score averaged 4.9, 2.3, and 4.2, respectively. In the 26 patients who returned to sports after surgery, 17 patients (65%) had equal or better Tegner activity score at 2 years after surgery than that at pre-symptomatic condition. Concerning to the clinical outcome, Japanese Orthopaedic Association (JOA) score, Lysholm score, Kujala score and Knee Injury and Osteoarthritis Outcome Score (KOOS) improved significantly after surgery compared to the preoperative values. In addition, the knee alignment was significantly changed after iV-HTO surgery in the coronal and axial views. Our results demonstrated that the RTS rates of the patients who underwent iV-HTO were comparable than those who underwent OW-HTO. When the patients who wish to RTS have severe varus OA, an iV-HTO procedure may be one of the surgical options.
