Patellofemoral Osteoarthritis Progresses After Medial Open‐Wedge High Tibial Osteotomy: A Systematic Review
Bibliographic record
Abstract
Purpose To investigate the progression of patellofemoral (PF) osteoarthritis (OA) after medial open‐wedge high tibial osteotomy (OWHTO) and whether PF OA progression has an influence on clinical outcomes. Methods According to the Preferred Reporting Items for Systematic Review and Meta‐analyses (PRISMA), EMBASE, PubMed, and Cochrane Library were searched in June 2020 for English‐language studies that presented data on PF OA or cartilage degeneration before and after OWHTO. Descriptive statistics are presented. Results Twenty studies comprising 1,173 patients were included. The mean age was 57.1 years (range 18‐84) with 826 (70.4%) female. The mean follow‐up was 27.1 months (range 7‐144). Ten studies reported the trochlear International Cartilage Research Society (ICRS) scores, with each of these studies reporting a greater proportion of patients with grades 2‐4 OA postoperatively compared with preoperatively (relative risk = 1.19‐2.76, I 2 = 1.9%). Similarly, 7 studies reported patellar ICRS scores and found a greater proportion with grades 2‐4 OA postoperatively (relative risk = 1.08‐2.44, I 2 = 0%). Four studies assessed PF Kellgren–Lawrence grade, each of which reported a greater proportion of patients with grades 2‐4 OA postoperatively (relative risk = 1.25‐21.0, I 2 = 31%). The PF OA assessments were heterogenous, and studies using classifications except the ICRS score or Kellgren‐Lawrence grade were not included in statistical analysis. Fifteen studies assessed patellar height; 10 studies reported significant decrease in patellar height after OWHTO. Only 3 studies reported clinical outcomes for patients with and without PF OA progression. Outcome reporting was variable across these studies, and a relationship between PF OA progression and clinical outcome could not be definitively determined. Conclusions Patients appear to have progression of PF OA after medial OWHTO. However, there are currently insufficient studies with inconsistent measurements of outcomes to make meaningful conclusions regarding the impact of PF OA on clinical outcomes. Level of Evidence Level IV, systematic review of Level III‐IV studies.
Stored with the screening record, where it is evidence for the labels above.
How this classification was reachedexpand
The three-model screen
all 5,600 screened works →All three models called this out of scope.
Systematic review used to answer a clinical question about osteoarthritis progression after osteotomy.
This systematic review answers a clinical question about osteoarthritis progression rather than studying evidence synthesis methods.
Clinical systematic review answering a surgical/OA outcomes question; uses synthesis method rather than studying it.
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.031 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.012 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".