No study has yet assessed the effect of medial open-wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint according to postoperative alignment. To evaluate the effect of MOWHTO on the patellofemoral joint according to postoperative alignment by comparing the cartilage status before and after surgery and assessing the clinical and radiological outcomes. Cohort study; Level of evidence, 3. A total of 135 patients who underwent MOWHTO were retrospectively investigated. The patients were divided into 3 groups according to the postoperative weightbearing line ratio (WBLR): undercorrection (WBLR 66.3%, highest quartile). The postoperative change in the cartilage status was assessed arthroscopically during implant removal at 2 years after MOWHTO. The clinical and radiological outcomes were evaluated at a mean follow-up of 52.1 months. A regression analysis was performed to identify the factors affecting the deterioration of the patellofemoral joint cartilage status. A receiver operating characteristic curve was employed to identify the cutoff point for the postoperative WBLR associated with the deterioration of the cartilage status in the patellofemoral joint. Of all patients, progression of cartilage degeneration was noted in 39.3% for femoral trochlea and 23.7% for patella. The incidence of cartilage progression was significantly higher in the overcorrection group than in the undercorrection and acceptable correction groups (femoral trochlea: undercorrection group = 30.3%, acceptable correction group = 32.4%, and overcorrection group = 61.8% [P = .008]; patella: undercorrection group = 15.2%, acceptable correction group = 17.7%, and overcorrection group = 44.1% [P = .005]). The functional outcomes, including Lysholm knee score, Knee injury and Osteoarthritis Outcome Score (Pain, Symptoms, and Activities of Daily Living subscales), and Shelbourne and Trumper score, were significantly worse in the overcorrection group. The regression analysis showed that only the postoperative WBLR had a significant effect on cartilage deterioration. The cutoff point for the postoperative WBLR associated with progression of the International Cartilage Repair Society grade was 62.1% for the femoral trochlea (sensitivity = 61.5%, specificity = 62.7%, accuracy = 66.2%) and 62.2% for the patella (sensitivity = 59.4%, specificity = 60.2%, accuracy = 67.8%). The patellofemoral joint was adversely affected by MOWHTO. Overcorrection causing excessive valgus alignment led to further progression of degenerative changes in the patellofemoral joint and inferior clinical outcomes. The postoperative WBLR can be used as a predictive factor for deterioration of the cartilage status in the patellofemoral joint after MOWHTO.

Background: The purpose of this retrospective study was to assess the clinical and radiographic outcomes of large and massive rotator tears treated with arthroscopic complete repair with a posterior interval slide compared with partial repair without a posterior interval slide at a minimum follow-up of 5 years. Methods: This study included 58 patients with large and massive rotator cuff tears that were unable to be treated with arthroscopic complete repair with an anterior interval slide and margin convergence alone. Each patient underwent either arthroscopic complete repair with an additional posterior interval slide and a subsequent side-to-side repair of the interval slide edge (complete-repair group) or arthroscopic partial repair with margin convergence and without the additional posterior interval slide (partial-repair group). Patient assignment to treatment group was not randomized. Clinical assessments included the visual analog scale pain score, the Subjective Shoulder Value, the American Shoulder and Elbow Surgeons score, the University of California Los Angeles shoulder score, and active range of motion. Preoperative and 6-month follow-up magnetic resonance arthrography (MRA) images were compared within and between groups. Results: At the time of the latest follow-up evaluation, both groups had significant improvements in clinical outcomes (p < 0.001). There were no significant differences in the clinical outcomes between groups. A retear was identified in 22 (88%) of the 25 patients in the complete-repair group and 28 (85%) of the 33 patients in the partial-repair group. Patients in the complete-repair group had larger retear sizes (p = 0.001) and reduced acromiohumeral intervals (p = 0.007) compared with those in the partial-repair group. Conclusions: Although larger retear size on early postoperative MRA led to significantly reduced acromiohumeral intervals in the complete-repair group, there were no significant differences in clinical outcomes between groups during the minimum 5-year follow-up period. Therefore, it may be preferable to perform partial rotator cuff repair rather than aggressive release in large and massive rotator cuff tears to achieve complete repair. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Tardy ulnar nerve palsy is a common late complication of traumatic cubitus valgus deformity. Whether both problems can be corrected together, safely and effectively, in a single surgical procedure remains unknown.