PMID- 31157542 OWN - NLM STAT- MEDLINE DCOM- 20200504 LR - 20231012 IS - 1552-3365 (Electronic) IS - 0363-5465 (Print) IS - 0363-5465 (Linking) VI - 47 IP - 8 DP - 2019 Jul TI - Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach. PG - 1854-1862 LID - 10.1177/0363546519849476 [doi] AB - BACKGROUND: High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty. PURPOSE: To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. RESULTS: We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (+/- 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range [IQR], 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up (P < .001). The mean Lysholm score at follow-up was 68 (SD, +/- 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76). CONCLUSION: More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors. FAU - Hoorntje, Alexander AU - Hoorntje A AD - Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands. AD - Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands. AD - Amsterdam Collaboration on Health & Safety in Sports, Amsterdam UMC IOC Research Center, Amsterdam, the Netherlands. AD - Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, the Netherlands. FAU - Kuijer, P Paul F M AU - Kuijer PPFM AD - Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. FAU - van Ginneken, Berbke T AU - van Ginneken BT AD - Department of Orthopaedic Surgery, Sint Maartenskliniek Woerden, Woerden, the Netherlands. FAU - Koenraadt, Koen L M AU - Koenraadt KLM AD - Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, the Netherlands. FAU - van Geenen, Rutger C I AU - van Geenen RCI AD - Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, the Netherlands. FAU - Kerkhoffs, Gino M M J AU - Kerkhoffs GMMJ AD - Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands. AD - Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands. AD - Amsterdam Collaboration on Health & Safety in Sports, Amsterdam UMC IOC Research Center, Amsterdam, the Netherlands. FAU - van Heerwaarden, Ronald J AU - van Heerwaarden RJ AD - Department of Orthopaedic Surgery, Sint Maartenskliniek Woerden, Woerden, the Netherlands. AD - Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands. LA - eng PT - Journal Article DEP - 20190603 PL - United States TA - Am J Sports Med JT - The American journal of sports medicine JID - 7609541 SB - IM MH - Adult MH - Case-Control Studies MH - Cohort Studies MH - Cross-Sectional Studies MH - Female MH - Humans MH - Knee Joint/*surgery MH - Lysholm Knee Score MH - Male MH - Middle Aged MH - Osteoarthritis, Knee/*surgery MH - *Osteotomy MH - Postoperative Period MH - Prognosis MH - *Return to Sport MH - Sports/statistics & numerical data MH - Surveys and Questionnaires MH - Tibia/surgery PMC - PMC6604251 OTO - NOTNLM OT - de-rotation osteotomy OT - directed acyclic graph OT - high tibial osteotomy (HTO) OT - lateral closing wedge OT - medial opening wedge OT - participation OT - prognosis OT - return to sport COIS- One or more of the authors has declared the following potential conflict of interest or source of funding: R.C.I.v.G. is a paid consultant for Zimmer Biomet. R.J.v.H. has received fees for organizing an educational program from Clockwork Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. EDAT- 2019/06/04 06:00 MHDA- 2020/05/06 06:00 PMCR- 2019/07/02 CRDT- 2019/06/04 06:00 PHST- 2019/06/04 06:00 [pubmed] PHST- 2020/05/06 06:00 [medline] PHST- 2019/06/04 06:00 [entrez] PHST- 2019/07/02 00:00 [pmc-release] AID - 10.1177_0363546519849476 [pii] AID - 10.1177/0363546519849476 [doi] PST - ppublish SO - Am J Sports Med. 2019 Jul;47(8):1854-1862. doi: 10.1177/0363546519849476. Epub 2019 Jun 3.