Distal Tibial Tubercle Osteotomy Using the Elmslie-Trillat Procedure-Like Technique May Provide Better Clinical Outcomes Than the Proximal One in Medial Opening Wedge High Tibial Osteotomy: A Minimum 5-Year Follow-Up.

Objective: To evaluate differences in clinical outcomes, including patient-reported outcomes and radiographic evaluation of lower limb alignment and the patellofemoral joint, between distal tibial tubercle osteotomy (DTO) and proximal tibial tubercle osteotomy (PTO) in medial opening wedge high tibial osteotomy with a minimum 5-year follow-up.

Methods: Patients with knee osteoarthritis or osteonecrosis/subchondral insufficiency fracture of the knee, who underwent PTO or DTO and were followed up for at least 5 years between 2015 and 2019, were retrospectively reviewed. DTO was performed using the Elmslie-Trillat procedure-like technique. Clinical assessments, including the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala score, as well as radiographic assessments of the lower limb alignment and the patellofemoral joint, were evaluated preoperatively and at the final follow-up. The preoperative and final results were compared between the PTO and DTO groups. Complications were also investigated.

Results: Overall, 36 and 41 patients who underwent PTO (PTO group) and DTO (DTO group), respectively, were included in this study. The mean follow-up period was 8.3 ± 0.6 and 5.8 ± 0.6 years in the PTO and DTO groups, respectively. Comparing the final results, the DTO group had a significantly better Knee Society Score knee score (99.2 ± 1.8 vs 94.6 ± 7.8, P = .002), Western Ontario and McMaster Universities Osteoarthritis Index pain score (1.6 ± 1.8 vs 2.6 ± 2.7, P = .046), function score (4.0 ± 5.2 vs 9.5 ± 15.0, P = .031), and total scores (6.3 ± 7.1 vs 13.2 ± 18.0, P = .028). In radiographic assessment, the postoperative Caton-Deschamps index was significantly smaller in the PTO group (0.66 ± 0.13) than in the DTO group (0.93 ± 0.18, P < .001). No severe complications occurred in either group.

Conclusions: DTO using the Elmslie-Trillat procedure-like technique may provide better clinical outcomes than PTO in opening wedge high tibial osteotomy at a minimum 5-year follow-up. Methods: Level III, retrospective comparative case series.