Effect of Infratuberosity Anterior Closing Wedge Osteotomy for Posterior Tibial Slope Correction on Patellar Height in Patients Undergoing Revision ACL Reconstruction.

Abstract

An excessive posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) rupture or rerupture, and it can be managed by an anterior closing wedge high tibial osteotomy (ACW-HTO). The effect of slope-changing osteotomies on patellar height is poorly described after infratuberosity ACW-HTO. To assess the effect of ACW-HTO on patellar height using an infratuberosity approach. Case series; Level of evidence, 4. Patients who underwent ACW-HTO between January 2019 and March 2024 were assessed for eligibility. Among 98 cases, 94 knees were analyzed with a complete radiographic assessment for the patellar height evaluation. Patellar height was measured on lateral radiographs according to the Caton-Deschamps index (CDI), Insall-Salvati index (ISI), and Blackburne-Peel index (BPI). The change in patellar height was assessed postoperatively, as were the rates of cases with a postoperative difference <0.3, <0.5, or >0.5 points of the respective index. The change in patellar height category (baja, normal, or alta) after correction of the PTS was also evaluated. In univariate analysis, no significant difference was found between pre- and postoperative radiographs for the patellar height indices (differences for ISI: +0.1 ± 0.1, <i>P</i> = .18; CDI: +0.1 ± 0.1, <i>P</i> = .41; BPI: +0.1 ± 0.2, <i>P</i> = .52). The patellar height variation was +0.5 points in only 1 case for CDI, and it was <0.5 points in all other cases (98.9%). Five cases (5.3%) exhibited a postoperative change in patellar height category when measured by the ISI (3 moved up a category, 2 moved down a category; <i>P</i> = .65). Eight cases (8.5%) changed category according to the CDI (6 moved up a category, 2 moved down a category; <i>P</i> = .14). Twelve cases (12.7%) changed category according to the BPI (7 moved up a category, 5 moved down a category; <i>P</i> = .55). Infratuberosity ACW-HTO for tibial slope correction did not lead to significant changes in patellar height. However, slight variations in both directions were possible in a small portion of patients.