Abstract
Objectives:
High tibial osteotomies (HTOs) and distal femoral osteotomies (DFOs) are used to address lower limb malalignment in the setting of unicompartmental arthritis and/or soft tissue injuries. There is a paucity of research in regards the influence of preoperative bone marrow edema (BME) on outcomes after these procedures. The purpose of this study was to assess the association between preoperative BME on return to sport and patient reported outcomes following high tibial osteotomy and distal femoral osteotomy.
Methods:
We conducted a retrospective review of 153 knees undergoing primary HTO and DFOs with preoperative MRI’s available at our institution, from 2011 to 2021. BME was evaluated using magnetic resonance imaging (MRI). Preoperative subchondral BME on the tibia and femur was analyzed for the existence, position, extent, and volume of the BME. Associations between preoperative BME and postoperative outcomes at a mean follow-up of 5.36 ± 2.79 were evaluated. Outcomes asses were return to sport (RTS), IKDC, Lysholm, VAS pain, VAS, Tegner score, VAS sports, KOOS Symptoms, KOOS Pain, KOOS ADL,KOOS Sports, and KOOS QoL.
Results:
The final cohort size was 153 knees undergoing high tibial osteotomy (HTO) or distal femoral osteotomy (DFO). Of these, 108 patients (70.6%) completed patient-reported outcomes (PROs). Among the 153 knees analyzed, 112 knees (73.2%) showed evidence of bone marrow edema in the femur, tibia, or both. The average bone marrow edema volume was 4.2 ± 10.1 cm³ in the femur, 1.6 ± 4.1 cm³ in the tibia, and 5.7 ± 11.2 cm³ combined in the femur and tibia. There was no significant correlation with bone marrow edema and multiple PRO’s or return to sport in the HTO cohort. Nor was there any significant correlation with combined bone marrow edema and PRO’s or return to sport for the HTO cohort. There was no significant correlation with bone marrow edema and multiple PRO’s or return to sport in the DFO cohort. However with increasing bone marrow edema volume in the tibia in the DFO cohort, we found worsened IKDC (β=-1.685, p=0.020), VAS pain (β=1.808, p=0.037), VAS satisfaction (β=-1.685, p=0.020), VAS sports (β=2.297, p=0.015), KOOS Pain (β=- 2.390, p=0.009), and KOOS ADL (β=-2.523, p=0.008) at final follow-up.
Conclusions:
The present study demonstrated that increasing bone marrow edema volume in the tibia correlated very strongly with decreased PROs in DFO patients. However, preoperative subchondral BME did not influence return to sport in HTO or DFO patients. There was no correlation between patient reported outcomes with the existence, position, extent, and volume of BME in HTO patients. Our findings suggest increasing preoperative bone marrow edema in the tibia may be associated with worse outcomes following DFO.