Paper 31: Patient Reported and Clinical Outcomes of High Tibial Osteotomy and Distal Femoral Osteotomy in High Level Athletes
Authors: Moore Michael , Montgomery Samuel , Chalem Isabel , Hoffmeister Thomas , Seidenberg Julian , Wolfe Isabel , Vidal Armando , Kanakamedala Ajay , Alaia Michael 
Published: August 2024

Objectives:

High Tibial Osteotomy (HTO) and Distal Femoral Osteotomy (DFO) have long been utilized in the treatment of symptomatic osteoarthritis as well as malalignment with instability, meniscal deficiency or chondral defects. There remains a paucity of literature on the clinical and patient reported outcomes following HTO and DFO procedures in high level athletes. The purpose of this study is to present the outcomes in high-level athletes following HTO and DFO surgery at a large academic institution.

Methods:

High-level athletic patients (defined as Tegner score over 5) undergoing HTO/DFO from January 2010 to August 2023 were eligible for inclusion. Patients were excluded if they were less than 18 years old, had a Tegner score below 5 prior to symptom onset or had less than 2 years of follow-up. Demographic data including sex, age at time of surgery, and body mass index (BMI) at time of surgery was obtained from the EMR. Outcomes were assessed using follow-up questionnaires that consisted of symptom resolution, patient satisfaction, Tegner Activity Scale, IKDC, KOOS, Lysholm, and return to sports. Patients with concomitant meniscus allograft transplantation, osteochondral allograft transplantation and anterior cruciate ligament reconstruction were included.

Results:

There were 52 patients that met inclusion criteria, with 39 (75.0%) of patients undergoing HTO and 13 (25.0%) patients undergoing DFO. The mean age at the time of surgery was 39.5 ± 11.1 years, mean follow-up was 5.6 ± 3.1 years (2.0-12.2 years). The cohort was 71.2% male with average BMI of 26.8 ±4.1 Complete symptomatic resolution was reported by 46.2% of patients. When asked about their overall physical ability after surgery, 41.2% patients said they were “much better”, with 27.5% patients saying they were “better”. The mean VAS satisfaction score at final follow-up was 73.7 and 64.7% patients would choose to undergo the operation again if given the option. There was a significant decrease in the value of VAS pain score from the patient’s pre-operative level after knee injury versus their current pain level (73.6 vs. 29.5, p<0.0001). Furthermore, 3/51 (5.9%) patients eventually underwent total knee arthroplasty with an average time of 2.9 ± 0.2 years form HTO/DFO procedure. The mean Tegner score before injury was 6.4, before surgery was 2.7 and a significant increase to 4.3 (p<0.0001) after the procedure at follow up. Following surgery 82.7% of patients met the threshold for patient acceptable symptom state (PASS) for IKDC. 44 percent returned to sports after surgery and only 12 (25.0%) were able to return to sport to the same level from before their injury. The average time to return to sport was 47.3 ±27.0 weeks. There was a significant difference between male and female patients undergoing HTO/DFO procedures with respect to IKDC (p=0.027), KOOS symptom (p=0.048), KOOS activities of daily living (p=0.050), KOOS pain (p=0.050), KOOS QoL (p=0.039) and KOOS sports (p=0.016). Additionally, there was no significant difference in any of the clinical or patient reported outcomes studied between patients who underwent HTO/DFO procedures for degenerative joint disease versus instability aside from IKDC (72.8 vs. 61.1, p=0.046) and KOOS ADL (92.1 vs. 81.0, p=0.037).

Conclusions:

In high level-athletes, HTO and DFO procedures lead to high satisfaction rates and significant increases in Tegner scores following surgery compared to their symptomatic baseline, with low conversion rates to total knee arthroplasty at mid-term follow up, with male patients having better outcomes. The majority of patients did not return to sport following these procedures and even fewer were able to return to sport at their pre-injury activity level. Surgeons can use the findings from this study to educate high-level athletes that HTO/DFO procedures provide reliable improvements in clinical and patient reported outcomes with high patient satisfaction but may not allow them to return to sport at their pre-injury level.