1
|
Ferner F, Klinder A, Woerner M, Morris P, Harrer J, Dickschas J, Lutter C. Intraoperative control by Schanz-screws is inaccurate to achieve the exact amount of correction in de-rotational osteotomies. Knee Surg Sports Traumatol Arthrosc 2023; 31:4319-4326. [PMID: 37329368 DOI: 10.1007/s00167-023-07485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE The accuracy of intraoperative control of correction commonly is achieved by K-wires or Schanz-screws in combination with goniometer in de-rotational osteotomies. The purpose of this study is to investigate the accuracy of intraoperative torsional control in de-rotational femoral and tibial osteotomies. It is hypothesized, that intraoperative control by Schanz-screws and goniometer in de-rotational osteotomies around the knee is a safe and well predictable method to control the surgical torsional correction intraoperatively. METHODS 55 consecutive osteotomies around the knee joint were registered, 28 femoral and 27 tibial. The indication for osteotomy was femoral or tibial torsional deformity with the clinical occurrence of patellofemoral maltracking or PFI. Pre- and postoperative torsions were measured according to the method of Waidelich on computed tomography (CT) scan. The scheduled value of torsional correction was defined by the surgeon preoperatively. Intraoperative control of torsional correction was achieved by 5 mm-Schanz-screws and goniometer. The measured values of torsional CT scan were compared to the preoperative defined and intended values and deviation was calculated separately for femoral and tibial osteotomies. RESULTS The surgeon's intraoperative measured mean value of correction in all osteotomies was 15.2° (SD 4.6; range 10-27), whereas the postoperatively measured mean value on CT scan was 15.6 (6.8; 5.0-28.5). Intraoperatively the femoral mean value measured 17.9° (4.9; 10-27) and 12.4° (1.9; 10-15) for the tibia. Postoperatively the mean value for femoral correction was 19.8 (5.5; 9.0-28.5) and 11.3 (5.0; 5.0-26.0) for tibial correction. When considering a deviation of plus or minus 3° to be acceptable femorally 15 osteotomies (53.6%) and tibially 14 osteotomies (51.9%) fell within these limits. Nine femoral cases (32.1.%) were overcorrected, four cases undercorrected (14.3%). Four tibial cases of overcorrection (14.8%) and 9 tibial cases of undercorrection (33.3%) were observed. However, the observed difference between femur and tibia regarding the distribution of cases between the three groups did not reach significance. Moreover, there was no correlation between the extent of correction and the deviation from the intended result. CONCLUSION The use of Schanz-screws and goniometer in de-rotational osteotomies as an intraoperative control of correction is an inaccurate method. Every surgeon performing derotational osteotomies must consider this and include postoperative torsional measurement in his postoperative algorithm until new tools or devices are available to guarantee a better intraoperative accuracy of torsional correction. STUDY DESIGN Observational study. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Felix Ferner
- Klinik für Orthopädie, Unfallchirurgie, Handchirurgie, Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2B, 96125, Lichtenfels, Germany.
- Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Germany.
- Osteotomie Komitee, Deutsche Kniegesellschaft, Lichtenfels, Germany.
| | - Annett Klinder
- Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Germany
| | - Michael Woerner
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Germany
| | - Patrick Morris
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Germany
| | - Joerg Harrer
- Klinik für Orthopädie, Unfallchirurgie, Handchirurgie, Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2B, 96125, Lichtenfels, Germany
- Osteotomie Komitee, Deutsche Kniegesellschaft, Lichtenfels, Germany
| | - Joerg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Germany
| | - Christoph Lutter
- Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Germany
- Osteotomie Komitee, Deutsche Kniegesellschaft, Lichtenfels, Germany
| |
Collapse
|
2
|
Dickschas J, Schmeling A, Perl M, Simon M. [Treatment of Permanent Patellar Dislocation in Flexion by Patellar Osteotomy Combined with Modified Trochleoplasty and Tibial Tubercle Medialisation]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37604169 DOI: 10.1055/a-2113-1750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Jörg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Deutschland
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Arno Schmeling
- Sporthopaedicum Berlin, Sporthopaedicum Berlin, Berlin, Deutschland
| | - Mario Perl
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Michael Simon
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| |
Collapse
|
3
|
Ferner F, Dickschas J, Jasinski M, Huettner F, Harrer J, Lutter C. Correction of tibial tubercle trochlea groove distance is related to torsional correction in high tibial derotational osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:1176-1182. [PMID: 36198835 DOI: 10.1007/s00167-022-07190-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE High tibial osteotomy with internal tibial derotation (high tibial derotation osteotomy = HTDRO) is a common surgical treatment in patients with patellofemoral malalignment alone or in combination with patellofemoral instability. Operative techniques and theoretical calculations may assume that correction of the tibial tubercle-trochlear groove (TTTG) distance is related to the amount of torsional correction. The purpose of this investigation was to predict the change in TTTG distance in HTDRO through a clinical study. METHODS Twenty-one consecutive cases of derotational HTO were evaluated by torsional CT scanning in terms of the pre- and postoperative tibial torsion and TTTG distance. Changes in the TTTG distance were related to the changes in the amount of torsional correction. The change in patellar height was measured pre- and postoperatively, and the Caton-Deschamps Index (CDI) was calculated. RESULTS The mean change in tibial torsion was 13.9°, and the mean change in the TTTG distance was 6.3 mm. A strong relationship (0.90) between the change in torsion and the change in TTTG distance from pre- to postoperative status was found (p < 0.001). No statistically significant change in CDI could be seen between the preoperative [mean value (MV) 1.0] and postoperative (MV 1.1) periods. CONCLUSIONS In patients with patellofemoral instability or patellofemoral maltracking with both a high tibial external torsion and a high TTTG distance, a derotational HTO can correct both bony deformities. Patella height does not change significantly with this surgical technique. With 1° of torsional correction, the TTTG distance decreases 0.45 mm with our surgical technique of derotational HTO.
Collapse
Affiliation(s)
- Felix Ferner
- Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2b, 96125, Lichtenfels, Germany.
| | | | - Markus Jasinski
- Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2b, 96125, Lichtenfels, Germany
| | - Felix Huettner
- Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2b, 96125, Lichtenfels, Germany
| | - Joerg Harrer
- Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2b, 96125, Lichtenfels, Germany
| | - Christoph Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany
| |
Collapse
|
4
|
The Impact of Anatomical Predisposition and Mechanism of Trauma on Dislocation of the Patella: A Retrospective Analysis of 104 Cases. J Pers Med 2022; 13:jpm13010084. [PMID: 36675745 PMCID: PMC9863944 DOI: 10.3390/jpm13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of this study was to determine whether traumatic dislocation of the patella is provoked by the presence of predisposing factors and examine the role of the mechanism of injury. METHODS Cases diagnosed with dislocation of the patella and covered by the workers' compensation program were identified and classified as traumatic based on insurance regulations. We examined predisposing factors (e.g., frontal axis, torsional deviation, trochlear dysplasia, patella alta) in case groups based on age at dislocation and trauma mechanism. Retrospective cohort study, level of evidence III. RESULTS Our sample size comprised 104 cases, consisting of 54 children and 50 adults. The most common mechanism of injury in children and adults was rotational trauma. Only 20% of the children and 21% of the adults exhibited no relevant predisposing factors. Group specifically, falls accounted for the highest number of cases exhibiting none of the defined anatomical predisposing factors. Children are more frequently affected by predisposition-related dislocations than adults. CONCLUSION The proportion of predispositions is high. A fall, direct impact, or rotational trauma can be viewed as an adequate mechanism of trauma. For successful treatment, it is paramount to analyze the exact mechanism of the trauma and address any underlying predispositions.
Collapse
|
5
|
Zhou K, Bai P, Sun Z, Jia Y, Wang F, Wang X, Niu Y. Distalization of tibial tubercle osteotomy is not necessary for patients with recurrent patellar dislocation accompanied by patella alta and increased TT-TG distance. BMC Musculoskelet Disord 2022; 23:838. [PMID: 36057569 PMCID: PMC9440549 DOI: 10.1186/s12891-022-05779-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study is to determine whether distalization of the tibial tubercle is necessary for patients with recurrent patellar dislocation accompanied by patella alta and increased TT-TG. Methods In this retrospective study, all 70 patients (70 knees) with recurrent patellar dislocation accompanied by TT–TG distance ≥20 mm and patella alta (CD-I ≥ 1.4) were surgically treated using MPFLR combined with medialization of the tibial tubercle or medialization and distalization of the tibial tubercle in the Third Hospital of Hebei Medical University between 2017 and 2019. 33 patients(33 knees) received MPFLR combined with medialization of the tibial tubercle (MPFLR + TTm group), 37 patients(37 knees) received MPFLR combined with medialization and distalization of the tibial tubercle (MPFLR + TTm-d group). Evaluation indicators included knee injury and osteoarthritis prognostic score (KOOS) and Kujala score evaluation, congruence angle (CA), patellar tilt angle (PTA), TT-TG distance, Blackburne-Peel index (BP-I), Caton-Deschamps index (CD-I). Results A total of 70 knees (70 patients) with a mean follow-up time of 32 ± 6 months were evaluated in the present study. The postoperative, the PTA, CA, CD-I, BP-I, and TT-TG distance significantly improved in the two groups (P < 0.05), and there was no statistical difference between the two groups (>0.05). The KOOS and Kujala scores of the two groups at the last follow-up were significantly higher than the preoperative scores (P < 0.05), and there was no statistical difference between the two groups (P>0.05). No complications were noted in either group. Conclusion For patients with recurrent patellar dislocation accompanied by increased TT-TG distance and patella alta, distalization is not needed and medialization is sufficient even in the presence of patella alta.
Collapse
Affiliation(s)
- Kezhen Zhou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Pengchen Bai
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhiwen Sun
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanfeng Jia
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaofeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| |
Collapse
|
6
|
蔡 国, 李 彦, 宁 梓, 韩 睿, 贾 笛, 李 松, 宋 恩, 王 旭. [Mid-term effectiveness analysis of combined knee extensor mechanism realignment with bone anchor for recurrent patella dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:963-968. [PMID: 35979787 PMCID: PMC9379466 DOI: 10.7507/1002-1892.202201087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/14/2022] [Indexed: 01/24/2023]
Abstract
Objective To explore the mid-term effectiveness of combined knee extensor mechanism realignment with bone anchor for recurrent patella dislocation. Methods Between August 2017 and May 2019, 21 patients with recurrent patella dislocation underwent combined knee extensor mechanism realigament with bone anchor and followed up more than 3 years. There were 8 males and 13 females with an average age of 19.4 years (range, 13-26 years). All 21 patients had a history of recurrent patellar dislocation for 2-5 times (median, 3 times), and the disease duration was 1-16 years (mean, 5 years). The preoperative Lysholm score was 67.5±6.3 and the Kujula score was 64.1±7.0. The defect of meniscus, anterior and posterior cruciate ligaments, and medial and lateral collateral ligaments were excluded by MRI examination; CT examination showed that the tibial tuberosity-trochlear groove distance was 2.05-2.56 cm, with an average of 2.16 cm; X-ray examination showed that lower limb force line was abnormal. The effectiveness were evaluated by Lysholm score and Kujula score before operation and at 3 years after operation, and Insall evaluation standard at 3 years after operation. Results All the incisions healed by first intention, and there was no surgical complication such as lower extremity deep vein thrombosis, incision infection, and nerve injury. All 21 patients were followed up 3.0-3.5 years, with an average of 3.2 years. Anteroposterior and lateral X-ray films of the knee joint at 3 years after operation showed that the position of the patella was normal, and the axial X-ray films of the patella (30°, 60°, 90°) showed that the patellofemoral joint had a good relationship. During the follow-up, there was no anchor drop or fracture, no obvious pseudarthrosis formation, and no epiphyseal injury in the minor patients. The Lysholm score was 91.5±7.1 and the Kujula score was 88.1±7.6 at 3 years after operation, which were significantly improved when compared with those before operation ( t=11.57, P=0.00; t=12.78, P=0.00). According to the Insall evaluation criteria, 12 cases were excellent, 4 cases were good, 4 cases were fair, and 1 case was poor, with an excellent and good rate of 76.2%. Conclusion Combined knee extensor mechanism realignment with bone anchor is a simple and reliable way to treat the recurrent patella dislocation, with a satisfactory mid-term effectiveness and less complications; however, its long-term effectiveness needs further follow-up.
Collapse
Affiliation(s)
- 国锋 蔡
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 彦林 李
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 梓文 宁
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 睿 韩
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 笛 贾
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 松 李
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 恩 宋
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 旭 王
- 昆明医科大学第一附属医院运动医学科(昆明 650032)Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| |
Collapse
|