Kinesiophobia and High-Impact Sport Activity Are Associated With a Reduced Rate of Return to Sport After High Tibial Osteotomy: A Risk Factor Analysis of a Young and Active Population

Background: High tibial osteotomy (HTO) is usually performed in patients older than 50 years with medial knee osteoarthritis. However, little is known about return-to-sport (RTS) and return-to-work (RTW) rates when HTO is performed in younger patients. Moreover, the risk factors for RTS and the impact of kinesiophobia on RTS have been poorly investigated. Purpose: To assess RTS and RTW rates, risk factors for RTS, complications, and activity levels at long-term follow-up in young and active patients after isolated HTO. Study Design: Case series; Level of evidence, 4. Methods: Consecutive HTO procedures performed at a single institution with a minimum 2-year follow-up were screened. Data were collected regarding clinical scores (Lysholm score, visual analog scale for pain, Tampa Scale for Kinesiophobia, Subjective Patient Outcome for Return to Sports score, Tegner activity score, Likert scale), RTS and RTW rates, type of sport, and impact activity level. Multivariate regression analysis evaluated the effect of sex, age, body mass index, Tegner score, and Tampa score on RTS. Differences were considered statistically significant if P < .05. Results: A total of 60 patients with a mean age at the time of surgery of 28.9 ± 7.5 years were included at a mean follow-up of 8.8 ± 3.8 years. There were 4 (6.7%) major complications. The overall RTS rate was 86.7%, and 68.3% of patients were still participating in sports at the final follow-up (mean, 3.7 ± 2.1 h/wk). Additionally, 34.6% returned to the same sport level, 21.2% improved their status, and 44.2% decreased their sport level. Moreover, patients playing soccer had a lower RTS rate compared with the rest of the patients (72.7% vs 94.7%, respectively; P = .04). The overall RTW rate was 100.0%, with a mean time to RTW of 5.9 ± 6.2 months. The Tampa score was the only predictor of absolute RTS ( P = .015; coefficient = –0.13). Conclusion: HTO performed in a young and active population resulted in high RTS rates and continuous sport participation even up to 9 years after surgery. Interestingly, the Tampa score was the only predictive factor for a reduced RTS rate. Finally, soccer participation was associated with a lower RTS rate compared with other sports.