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389
390
26
FIGURE LEGENDS AND TABLES
391
392
393
Fig 1. PRISMA flow diagram of the screening process for literature on PF OA progression after
OWHTO
394
Fig 2. Relative risks of trochlea OA
395
Fig 3. Relative risks of patella OA
396
397
398
399
400
401
402
403
404
405
406
407
408
27
409
411
412
Fig 1.
28
414
Fig 2.
415
29
417
Fig 3.
418
30
419
Table 1. Study demographics
420
Values are shown as mean (range). MINORS, Methodological Index for Non-Randomized Studies; PF, patellofemoral; OWHTO, open
421
wedge high tibial osteotomy; K-L, Kellgren-Lawrence; KSS, Knee Scoring System; HSS, Hospital for Special Surgery; dGEMRIC,
422
delayed gadolinium-enhanced magnetic resonance imaging of cartilage; IKS, International Knee Society; ICRS, International
423
Cartilage Repair Society; JOA, Japanese Orthopedic Association; OKS, Oxford Knee Score; KOOS, Knee injury and Osteoarthritis
424
Outcome Score; WOMAC, Western Ontario and McMaster Universities Osteoarthritis; IKDC, International Knee Documentation
425
Committee; OA, osteoarthritis
Author
Year
Country
Study design
MINORS
Surgical
Number of
%Female
Age, years
(level of
score
technique
knees
19 of 24
OWHTO
20
60
58.4 (50-70)
13 of 16
OWHTO
10
12 of 16
OWHTO
40
36.1
Follow-up duration,
PF assessment
clinical outcome
48.4
K-L grade
KSS, HSS score
48.3
12
dGEMRIC score
55.0 (44-67)
50.4 (21.6-144)
modified Iwano
months
evidence)
Cho W et al.32
2018
Korea
case control
(III)
d'Entremont
2015
Canada
(IV)
A et al.38
El Amrani M
2010
France
al.18
case series
(IV)
et al.30
Gosima K et
case series
2017
Japan
case series
IKS scale
classification
15 of 16
OWHTO
60
71.7
(IV)
61.8 (38-84)
58.2 (25-106)
ICRS grade, K-L
grade
31
JOA score, OKS
Horikawa T et
2019
Japan
21 of 24
OWHTO
65
73.8
63.0 (49-78)
12
ICRS grade
JOA score
22 of 24
OWHTO
36
74.2
66.0 (46-79)
64.4 (60-77)
Iwano
KOOS, OKS
(III)
al.36
Ishimatsu T et
case control
2019
Japan
case control
(III)
al.27
classification,
PF joint space
Kim K et al.28
2017
Korea
case series
13 of 16
OWHTO
114
90.4
56.34 (40-69)
26.1 (21.6-32.0)
(IV)
ICRS grade,
KSS
Merchant stage
system
Kolb W et
2009
Germany
al.29
Lee O et al.35
case series
12 of 16
OWHTO
49
49.2 (18-66)
52.0 (30-66)
(IV)
2019
Korea
case control
22 of 24
OWHTO
87
49.4
57
23.4
Ahlback
Lysholm score,
classification
HSS score
ICRS grade
KSS, WOMAC
(III)
Lee S et al.20
2019
Korea
case series
index
14 of 16
OWHTO
94
72.3
51.7 (21-64)
21.4 (18-55)
ICRS grade
(IV)
Lee S et al.33
2020
Korea
case control
KOOS, Kujala
score
21 of 24
OWHTO
89
86.5
55.6 (40-71)
19.8 (12.3-46.5)
ICRS grade
(III)
IKDC subjective
score,
WOMAC index
Moon H et
2019
Korea
case control
23 of 24
OWHTO
92
71.7
54.9
21.5
(III)
al.26
ICRS grade,
IKDC subjective
Iwano
score, Kujala score
classification
Ogawa H et
2019
Japan
16 of 16
OWHTO
41
69.0
62.8 (48-75)
15.2 (12-25)
ICRS grade
KSS
23 of 24
OWHTO
42
71.4
58.6 (55-63)
65.3 (61-100)
modified OA
Samsung Medical
grading system
Center
(IV)
al.37
Oh K et al.17
case series
2016
Korea
case control
(III)
32
patellofemoral
scoring sysytem
Otakara E et
2019
Japan
2019
Japan
OWHTO
57
73.7
54.1
20.5
case control
2012
Korea
case control
ICRS grade, K-L
KSS
grade
23 of 24
OWHTO
24
45.8
66.6
31.0 (21-48)
(III)
al.34
Song I et al.8
15 of 16
(IV)
al.19
Otsuki S et
case series
K-L grade, PF
Kujala score
joint space
23 of 24
OWHTO
50
80.0
57.9 (49-65)
42.4 (36-48)
K-L grade
HSS score
15 of 16
OWHTO
52
40.4
56.0
16.3
ICRS grade
KSS
14 of 16
OWHTO
85
82.5
61.5 (40-78)
13.0 (7-30)
ICRS grade
KOOS, JOA score
19 of 24
OWHTO
135
75.6
56.2
23.6
ICRS grade,
KOOS, Shelbourne
IKDC radio-
and Trumper score
(III)
Tanaka T et
2019
Japan
(IV)
al.16
Yabuuchi K et
2020
Japan
al.15
case series
(IV)
al.31
Yoon T et
case series
2019
Korea
case control
(III)
graphic
assessment scale
426
427
33
428
Table 2. Rate of postoperative PF OA progression in ICRS grade
429
PF, patellofemoral; OA, osteoarthritis; ICRS, International Cartilage Repair Society; OWHTO, open wedge high tibial osteotomy;
430
DTO, distal tubercle osteotomy; posop, postoperative; AKP, anterior knee pain;
431
Osteoarthritis Outcom Score; HKA, hip-knee-ankle angle; MPTA, medial proximal tibial angle; KSS, Knee Society Score.
MA, mechanical axis; KOOS, Knee injury and
Author
Rate of postoperative PF OA progression (ICRS)
Note
Goshima et al.
27/60 knees (45%) in PF joint
No significant correlation with clinical outcome
Horikawa et al.
21/65 knees (32.3%) in PF joint
Significant higher progression in OWHTO than DTO
Kim et al.
25/114 knees (21.9%) in patella, 47/114 knees (41.2%) in trochlea
11.4% had postop AKP and was related to ICRS grade at 2nd look
Lee O et al.
39/87 knees (44.8%) in patella, 35/87 knees (51.7%) in trochlea
No significant difference in progression with or without microfracture
28/94 knees (30%) in PF joint [16/94 knees (17%) in patella, 26/94 knees
Postop MA (overcorrection) was the most related to PF OA progression
(28%) in trochlea]
Kujala and KOOS were lower in progression group
Lee S et al. 2019
Lee S et al. 2020
Ogawa et al.
Otakara et al.
Tanaka et al.
Yoon et al.
16/89 knees (18.0%) in PF joint
PF OA progression in OWHTO aiming at Fujisawa point was higher than
that aiming at lateral tibial spine (overcorrection led to PF OA progression)
24/41 knees (58.5%) in medial facet of patella, 24/41 knees (58.5%) in
OWHTO has higher PF OA progression than DTO
lateral facet of patella, 23/41 knees (56.1%) in trochlea
DTO has better clinical outcome
30/57 knees (52.6%) in PF joint
17/52 knees (32.7%) in PF joint, 12/52 knees (23.0%) in patella, 16/52
knees (30.8%) in trochlea
53/135 knees (39.3%) in trochlea, 32/135 knees (23.7%) in patella
Change in HKAA and MPTA were greater in PF OA progression group
No difference in postop KSS
Change in MPTA, medial opening gap was greater in progression group
PF OA progression is higher in overcorrection group and overcorrection
was related to worse clinical outcome
432
34
433
Table 3. Changes in ICRS grade of Trochlea
434
ICRS, International Cartilage Repair Society; HTO, high tibial osteotomy.
Number
of
ICRS grade (preoperative / postoperative)
Period between HTO and 2nd
look arthroscopy
(months)
19
6/5
16 / 7
24 / 24
14 / 24
0/0
65
12
0/0
36 / 24
19 / 20
9 / 18
1/3
114
26.1
7/3
45 / 27
25 / 32
17 / 32
20 / 20
microfracture
57
24
7/2
26 / 15
18 / 29
5/9
1/2
no microfracture
30
24
9/2
12 / 7
6 / 16
3/5
0/0
Author
Year
knees
Goshima et al.
2017
60
Horikawa et al.
2019
Kim et al.
2017
Lee O et al.
2019
Lee S et al.
2019
94
21.4
36 / 23
22 / 23
27 / 24
9 / 17
0/7
Lee S et al.
2020
89
19.8
29 / 26
29 / 26
13 / 15
16 / 19
2/3
Ogawa et al.
2019
41
15.2
9/2
11 / 8
16 / 7
5 / 21
0/3
Otakara et al.
2019
57
20.5
16 / 7
29 / 16
9 / 23
3/9
0/0
Tanaka et al.
2019
52
16.3
12 / 5
15 / 12
8 / 13
12 / 18
5/4
Yoon et al.
2019
undercorrection
33
23.3
3/2
12 / 8
9 / 11
6/8
3/4
acceptable correction
68
23.6
8/4
25 / 19
15 / 20
12 / 14
8 / 11
overcorrection
34
23.9
2/0
15 / 9
7/8
7 / 10
3/7
435
35
436
Table 4. Changes in ICRS grade of Patella
437
ICRS, International Cartilage Repair Society; HTO, high tibial osteotomy.
Number
of
ICRS grade (preoperative/postoperative)
Period between HTO and 2nd
look arthroscopy
(months)
26.1
9/6
67 / 60
25 / 28
7 / 11
6/9
57
24
15 / 1
29 / 29
9 / 22
2/4
2/1
30
24
9/4
16 / 14
4 / 11
1/1
0/0
Author
Year
knees
Kim et al.
2017
114
Lee O et al.
2019
microfracture
no microfracture
Lee S et al.
2019
94
21.4
36 / 29
25 / 23
26 / 26
7 / 14
0/2
Lee S et al.
2020
89
19.8
35 / 32
41 / 43
9 / 10
3/2
1/2
Otakara et al.
2019
57
20.5
16 / 9
36 / 35
5 / 10
0/2
0/0
Tanaka et al.
2019
52
16.3
14 / 8
20 / 17
12 / 18
6/7
0/2
Yoon et al.
2019
undercorrection
33
23.3
3/3
15 / 13
10 / 10
4/5
1/2
acceptable correction
68
23.6
6/4
35 / 33
17 / 17
7/9
3/5
overcorrection
34
23.9
4/2
15 / 10
9 / 12
4/6
2/4
438
36
...
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