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Longitudinal changes in subchondral bone structure as assessed with MRI are associated with functional outcome after high tibial osteotomy
  1. Alexandra S Gersing1,2,
  2. Pia M Jungmann1,
  3. Benedikt J Schwaiger1,
  4. Julia Zarnowski1,
  5. Felix K Kopp1,
  6. Saskia Landwehr3,
  7. Martin Sauerschnig3,4,
  8. Gabby B Joseph2,
  9. Andreas B Imhoff3,
  10. Ernst J Rummeny1,
  11. Jan S Kirschke1,5,
  12. Thomas Baum1,5
  1. 1 Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  2. 2 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
  3. 3 Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  4. 4 Trauma Hospital Graz, Unfallkrankenhaus der Allgemeinen Unfallversicherungsanstalt (AUVA), Graz, Austria
  5. 5 Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  1. Correspondence to Dr Alexandra S Gersing, Department of Radiology, Technical University of Munich, Klinikum rechts der Isar, Munich 81675, Germany; alexandra.gersing{at}


Objectives The primary objective of this study was to evaluate the effects of high tibial osteotomy (HTO) on subchondral bone structure assessed with MR-based trabecular bone imaging and the correlations of these effects with functional outcome and clinical symptoms.

Methods Patients with varus malalignment (6.2°±2.2°) and without a history of knee surgery (n=22; 3 women; 48.7±10.3 years) were included into this prospective study. 1.5T MRI was performed before and on average 1.5 years after HTO (amount of correction 4.7°±2.5°) and histomorphometric parameters of the trabecular bone were calculated for the medial/lateral tibia and femur. Functional outcome was assessed with validated scores focusing on sports activity including the Lysholm Score, Tegner Activity Scale and the adapted Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Score.

Results Apparent trabecular number significantly decreased in all compartments of the tibiofemoral joint when comparing values before and on average 1.5 years after HTO (p<0.05 for all). Decrease in apparent trabecular number was significantly higher within the medial tibia compared with the lateral compartment (mean difference −0.24 mm−1 (95% CI −0.33 to −0.14 mm−1); p<0.001). Apparent trabecular bone thickness significantly increased within 1.5 years after HTO in the lateral femur (p=0.002) and tibia (p<0.001). The Lysholm Score and Tegner Scale demonstrated an improvement of functional outcome, and the adapted WOMAC demonstrated an improvement of pain, stiffness and physical function within 1.5 years after HTO (p<0.01), with the improvement of WOMAC correlating significantly with changes in trabecular bone thickness within the medial tibia (r=−0.48; p=0.01).

Conclusion These findings indicate a reversal of the previous subchondral bone alterations in patients with varus malalignment after undergoing HTO, while pronounced subchondral changes were associated with a better functional outcome.

Level of evidence III

  • knee
  • MRI
  • bone
  • osteotomy
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  • Contributors ASG, BJS, JSK, MS, ABI, GBJ, JZ, FKK, EJR, PMJ, SL and TB designed the study. ASG, JSK, ABI, SL, MS, PMJ, EJR and TB coordinated and conducted data collection and preparation and image acquisition. JSK, MS, SL, BJS, ASG, PMJ, GBJ, JZ, EJR, ABI, FKK and TB wrote the analysis plan. FKK, ASG, GBJ, JZ, PMJ, TB, SL and BJS provided data, analysis tools, and coordinated data analysis. ASG, BJS, JSK, MS, ABI, GBJ, JZ, FKK, EJR, PMJ, SL and TB performed image and data analysis. ASG, BJS, JSK, MS, ABI, GBJ, JZ, FKK, EJR, PMJ, SL and TB drafted the manuscript. All authors reviewed and approved the manuscript before submission.

  • Funding This study was funded by the National Institutes of Health (NIH); contract grant numbers: NIH P50-AR060752 and NIH R01-AR064771.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Study protocol and informed consent documentation was reviewed and approved by the local institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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