Return to Sport and Duty in French Military Personnel after Medial Opening Wedge High Tibial Osteotomy

Bernard de Geofroy; Lucas Chateau; Olivier Barbier; Thomas Demoures; Sébastien Coste; Laurent Mathieu; Nicolas de L'Escalopier; Camille Choufani

doi:10.1093/milmed/usae005

Return to Sport and Duty in French Military Personnel after Medial Opening Wedge High Tibial Osteotomy

Mil Med. 2024 Jan 23:usae005. doi: 10.1093/milmed/usae005. Online ahead of print.

Authors

Bernard de Geofroy^{1

2}, Lucas Chateau³, Olivier Barbier^{2

4}, Thomas Demoures³, Sébastien Coste³, Laurent Mathieu⁴, Nicolas de L'Escalopier⁵, Camille Choufani^{2

4}

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, Laveran Military Hospital, Marseille 13013, France.
² Department of Orthopaedic Surgery and Traumatology Sainte Anne Military Hospital, Toulon Mediterranean Orthopaedic and Trauma, TMOST, Toulon 83000, France.
³ Department of Orthopaedic surgery and traumatology, Begin Military Hospital, Saint-Mandé 94160, France.
⁴ Department of Orthopaedic Surgery and Traumatology, Edouard Herriot Hospital, Lyon 69003, France.
⁵ Department of Orthopaedic Surgery and Traumatology, Percy Military Hospital, Clamart 92140, France.

PMID: 38294141
DOI: 10.1093/milmed/usae005

Abstract

Introduction: Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical option for medial femorotibial osteoarthritis, which preserves articular cartilage by correcting the extra-articular deformities of the lower limbs that cause osteoarthritis. This is an increasingly popular treatment in a population with high functional demand, such as the French military population. The aim of this study was to evaluate the rate of return to work and military activities at 6 months postsurgery and at last follow-up in this military population following MOWHTO.The hypothesis of this study was that MOWHTO enabled a majority of service members to return to the same level of activity within 6 months of surgery.

Materials and methods: This was a retrospective, multicenter study including all French military personnel operated on for MOWHTO alone for osteoarthritis of medial compartment between 2008 and 2018 in different Military Teaching Hospitals. We excluded civilian patients. For each patient, a questionnaire was used to collect epidemiological, professional, sports, and functional data. The primary endpoint was the rate of return to work at 6 months postsurgery. We also studied the recovery of sports activities and functional results at a 6.6-year follow-up by standardized questionnaires (Tegner activity scale, Lysholm, IKDC subjective (International Knee Documentation Commitee)).

Results: Twenty-four MOWHTOs were performed during this period in a cohort of 22 French military personnel. Return to work at 6 months was possible in 20/24 cases (83.3%). Of the four patients who did not return to work at 6 months, two changed their activities, while the other two returned to their jobs after 6 months. The rate of resumption of sporting activities at an equal or higher level was 50% (11/22). There was no difference between pre- and postoperative Tegner Activity Scale scores at the longest follow-up (P = .08). The mean postoperative Lysholm scores were 73.5 (standard deviation 17.8) and IKDC 59 (standard deviation 8.7). No intraoperative complications were found, and one case of postoperative infection was found.

Conclusions: A total of 83% of the operated soldiers were able to return to their professional activities in less than 6 months. We observed a functional improvement at the last follow-up. Comparing these results with data from civilian populations, the rate of occupational recovery is comparable. However, the return to sport is much better in the series of nonmilitary patients with approximately 90% return to work and sport in the year following surgery. MOWHTO improves the functional results of the knee, enabling a return to work and sport in most cases in young, active populations such as the French military.