LAUSR

Purpose The aim of this study was to investigate whether the tibial tuberosity–trochlear groove (TT–TG) distance and lateral patellar tilt, which induce patellofemoral osteoarthritis (OA), are related to the coronal deformity of the lower limb in varus knee OA. It was hypothesized that varus inclination of the tibia was negatively correlated with the TT–TG distance and lateral patellar tilt in Japanese female patients with moderate knee OA. Methods A total of 104 female patients (139 knees) scheduled to undergo knee osteotomy for varus knee OA were enrolled. The coronal lower limb alignment was measured on anteroposterior whole-leg radiographs. The TT–TG distance, patellar tilt angle, and the patellofemoral joint space were measured both medially and laterally on computed tomography images. The correlations between coronal lower limb alignment and the TT–TG distance or patellar tilt angle, and the correlations between the TT–TG distance or patellar tilt angle and patellofemoral joint space were evaluated. Results The medial proximal tibial angle was negatively correlated with the TT–TG distance ( r  =  − 0.383, P  < 0.01) and patellar tilt angle ( r  =  − 0.34, P  < 0.01). Lateral patellofemoral joint space was negatively correlated with the TT–TG distance ( r  =  − 0.256, P  = 0.002) and patellar tilt angle ( r  =  − 0.205, P  = 0.016). Conclusions Varus inclination of the proximal tibia may induce lateralization of the tibial tuberosity and lateral patellar tilt. The tibial tuberosity lateralization and lateral patellar tilt may induce lateral patellofemoral OA in patients with varus knee OA. Level of evidence III.