Does Arthroscopic Patellar Denervation With High Tibial Osteotomy Improve Anterior Knee Pain
Condition: Anterior Knee Pain Syndrome
MeSH terms: Patellofemoral Pain Syndrome
Study type: Interventional

Summary: 
      Arthroscopy will be done in all cases before osteotomy to assess lat. Comp and grade of
      patellofemoral O.A Arthroscopic patellar denervation with vaper or diathermy will be done
      plus open wedge high tibial osteotomy in one group and other group OWHTO only will be done
      comparing the rustles of two groups to assess the efficacy of this procedure

      followed by an average follow up to 12 months. And follow up( 6th weeks ,3rd month ,6th month
      , 12th month)

      By clinical examinationan and x-ray and knee scores

        1. Scoring of patellofemoral disorders( Kujala) score

        2. Knee Injury and Osteoarthritis Outcome Score (KOOS)
    

Detailed description: 
      -  Patellofemoral joint osteoarthritis (P.F.O.A) is a highly prevalent disease and an
           important source of anterior knee pain and Disability during daily activities (kneeling,
           squatting, climbing stairs, getting up from low chair.( 3,5)

        -  Coexisting Patellofemoral osteoarthritis (PFOA) and Tibiofemoral O.A disease is a common
           radiographic pattern of knee OA observed in older adults with knee pain. In addition,
           symptomatic disease and reduced function are more likely to be found if radiographic OA
           changes are present in both the TF and PF compartment also it demonstrates features
           distinctly different from those observed in Tibiofemoral O.A without presence of
           Patellofemoral osteoarthritis (PFOA) . More specifically, "Moderate/Severe PFOA" seems
           to be associated with lower limb impairments of lower knee extension strength and
           limitations of knee range of motion. (14)

             -  (14,6)

        -  High tibial osteotomy (HTO) with medial opening wedge has gained in popularity over
           recent years and is used for the treatment of medial compartmental osteoarthritis (OA)
           but not for anterior knee pain (P.F.O.A). This procedure is appealing because of the
           high preservation of the knee joint relative to total knee arthroplasty (TKA) or
           unicompartmental knee arthroplasty (9)

        -  High tibial osteotomy (HTO) can cause alterations in patellar height (Patella baja) and
           alignment which can increase contact stress and eventually lead to anterior Knee pain
           (13,17)

        -  The findings indicate that anterior knee pain might be due to OA progression in the
           patellofemoral joint after HTO (11,12)

        -  Patellofemoral OA and Cartilage injuries in PF joints tended to progress after Open
           Wedge HTO which proven by second lock arthroscopy. a significant proportion of patients
           (about 20%) had grade II OA of the patellofemoral joint at final follow-Up 2yrs. (7,8)

        -  Anterior knee pain also were quite high (28% and 32% in the opening- and closing-wedge
           groups) after surgery. Although there are several possible causes for anterior knee pain
           after HTO, such as surgery itself, alteration of patellar alignment, and OA change in
           the patellofemoral joint ,patients with severe anterior knee pain were found to have
           grade II patellofemoral OA. (7,8)

        -  In spite of its high prevalence, treatment of this painful disorder (PFOA) is
           challenging due to the diversity of causes of the disorder and the lack of knowledge on
           articular regeneration, little information is available in the literature about the best
           conservative or surgical treatment options.(3,5)

        -  Non-operative treatment options for patellofemoral osteoarthritis include patellar
           bracing, physical therapy intervention, corticosteroid injections, patellar taping, and
           strengthening of the quadriceps muscle, this is considered a potential short-term fix
           for many patients. Ultimately, surgical treatment is necessary to provide a long-term
           solutions. which include Patellofemoral arthroplasty, total knee replacement with
           patellar resurfacing,(5)

        -  Arthroscopic circumpatellar denervation, this joint-preserving, minimal invasive
           technique provides relief of anterior knee pain. Moreover, this technique provide a
           faster recovery period immediately after surgery and less morbidity (1,18,19)
           Arthroscopy will be done in all cases before osteotomy to assess lat. Comp and grade of
           patellofemoral O.A Arthroscopic patellar denervation with vaper or diathermy will be
           done plus open wedge high tibial osteotomy in one group and other group OWHTO only will
           be done comparing the rustles of two groups to assess the efficacy of this procedure

      followed by an average follow up to 12 months. And follow up( 6th weeks ,3rd month ,6th month
      , 12th month)

      By clinical examinationan and x-ray and knee scores

        1. Scoring of patellofemoral disorders( Kujala) score

        2. Knee Injury and Osteoarthritis Outcome Score (KOOS)
    

Intervention name(s): high tibial osteotomy with or without arthroscopic circumpatellar denervation with or without arthroscopic circumpatellar denervation
Intervention type(s): Procedure
Intervention description(s): Arthroscopy will be done in all cases before osteotomy to assess lat. Comp and grade of patellofemoral O.A Arthroscopic patellar denervation with vaper or diathermy will be done plus open wedge high tibial osteotomy in one group and other group OWHTO only will be done comparing the rustles of two groups to assess the efficacy of this procedure
followed by an average follow up to 12 months. And follow up( 6th weeks ,3rd month ,6th month , 12th month)
By clinical examinationan and x-ray and knee scores
Scoring of patellofemoral disorders( Kujala) score
Knee Injury and Osteoarthritis Outcome Score (KOOS)
Other intervention name(s): arthroscopic circumpatellar denervation
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: It is prospective case series study The aim is to evaluate the effect of arthroscopic denervation of patella In management of ant. Knee after High tibial osteotomy operation in pain reduction, improving knee joint function, quality of life, and deferring arthritic progression
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: arthroscopy; Patellofemoral Osteoarthritis