1
|
Ferreira B, Gomes E, Figueiredo I, Ribeiro R, Valente C, Delgado D, Sánchez M, Andrade R, Espregueira-Mendes J. Derotational high tibial osteotomy in cases of anterior knee pain and/or patellofemoral instability: a systematic review. J ISAKOS 2024; 9:401-409. [PMID: 38430984 DOI: 10.1016/j.jisako.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/09/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
IMPORTANCE Derotational high tibial osteotomy (HTO) is a surgical intervention for correcting rotational malalignments in the lower limb, which may contribute to anterior knee pain (AKP) and/or patellofemoral instability (PFI). This surgical technique is not yet widely implemented and requires a systematic evaluation of its outcomes. AIM To assess the effectiveness of derotational HTO in correcting rotational malalignments of the lower limb in patients with AKP and/or PFI through radiological, clinical, and patient-reported outcome measures. EVIDENCE REVIEW Searches were conducted in the PubMed, Embase, and Web of Science databases up to March 3, 2023, to identify studies utilizing derotational HTO in patients with AKP and/or PFI. The primary outcome measures of interest were measurements of lower limb angular correction. Other radiological, clinical, and patient-reported outcome measures were also analyzed. The risk of bias was judged with the RoBANS tool. FINDINGS A total of 8 studies were included, comprising 215 patients (27.0 ± 3.9 years) and 245 knees. The most reported angle was tibial torsion (k = 6 studies, n = 173 knees), with a mean difference between postoperative and preoperative values (postsurgical correction) ranging from -37.8° to -10.8°. Patient-reported outcome measures showed significant improvements in the postoperative moment, exceeding the minimal clinically important difference in almost all cases, and with high patient satisfaction (93.6%). CONCLUSIONS AND RELEVANCE Derotational HTO allows the correction of rotational malalignments of the lower limb (tibial torsion) and promotes patient satisfaction. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
| | - Eluana Gomes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal
| | - Inês Figueiredo
- School of Medicine, Minho University, 4710-057, Braga, Portugal
| | - Ricardo Ribeiro
- School of Medicine, Minho University, 4710-057, Braga, Portugal
| | - Cristina Valente
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal; Dom Henrique Research Centre, 4350-415, Porto, Portugal
| | - Diego Delgado
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
| | - Mikel Sánchez
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain; Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal; Dom Henrique Research Centre, 4350-415, Porto, Portugal; Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, 4200-450, Porto, Portugal
| | - João Espregueira-Mendes
- School of Medicine, Minho University, 4710-057, Braga, Portugal; Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal; Dom Henrique Research Centre, 4350-415, Porto, Portugal; ICVS/3B's-PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal; 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4806-909, Barco, Guimarães, Portugal.
| |
Collapse
|
2
|
Ferner F, Lutter C, Perl M, Harrer J. [Double-Level De-Rotational Osteotomy of the Knee]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38242149 DOI: 10.1055/a-2232-3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
ZusammenfassungDie kniegelenknahe Derotationsosteotomie ist ein gängiges Verfahren zur Korrektur von kongenitalen oder posttraumatischen Torsionsdeformitäten der unteren Extremität. Klinisches
Erscheinungsbild ist ein alleiniger „vorderer Knieschmerz“ oder in Kombination mit einer patellofemoralen Instabilität. Die kausale operative Therapie bei solchen Fehlstellungen stellt die
Derotationsosteotomie dar. Da es sich häufig um kombinierte femorale und tibiale Fehlstellungen handelt, ist auch eine kombinierte Operationstechnik erforderlich. Diese Technik der tibialen
Innentorsions- und femoralen Außentorsionsosteotomie, jeweils temporär mittels Fixateur externe und definitiv mittels Plattenosteosynthese stabilisiert, wird im aktuellen Video vorgestellt.
Die tibiale Osteotomie wird hierbei mit einer Fasziotomie der Tibialis-anterior-Loge und Neurolyse des N. peronaeus kombiniert.
Collapse
Affiliation(s)
- Felix Ferner
- Klinik für Orthopädie und Unfallchirurgie, REGIOMED Klinikum Lichtenfels, Lichtenfels, Deutschland
- Orthopädische Klinik und Poliklinik, Universität Rostock, Medizinische Fakultät, Rostock, Deutschland
| | - Christoph Lutter
- Orthopädische Klinik und Poliklinik, Universität Rostock, Medizinische Fakultät, Rostock, Deutschland
| | - Mario Perl
- Unfallchirurgische und Orthopädische Klinik, Universität Erlangen, Erlangen, Deutschland
| | - Jörg Harrer
- Klinik für Orthopädie und Unfallchirurgie, REGIOMED Klinikum Lichtenfels, Lichtenfels, Deutschland
| |
Collapse
|
3
|
Nakamura R, Kawashima F, Amemiya M, Shimakawa T, Okano A. Derotational Hybrid Closed-Wedge High Tibial Osteotomy for Knee Osteoarthritis With Patellar Subluxation Caused by Tibial Torsional Deformity. Arthrosc Tech 2023; 12:e1687-e1694. [PMID: 37942092 PMCID: PMC10627868 DOI: 10.1016/j.eats.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/28/2023] [Indexed: 11/10/2023] Open
Abstract
Patellar subluxation and recurrent dislocation are commonly treated with medial patellofemoral ligament reconstruction, and patients with predisposing factors for these problems often require additional bony realignment procedures. However, these procedures mainly address problems in the axial plane, and patients with medial-compartmental knee osteoarthritis may require further realignment in the coronal plane. In this Technical Note article, we introduce our technique for derotational hybrid closed-wedge high tibial osteotomy. Using this technique, simultaneous 3-dimensional realignment in the axial, coronal, and sagittal planes can be achieved in patients with medial compartmental knee osteoarthritis and patellar subluxation caused by a tibial torsional deformity. The indications for the technique and the preoperative planning assessments involving a static torsional deformity analysis on computed tomography images and a dynamic gait analysis by our walking-on-paper method are presented. This is followed by a detailed description of the surgical procedure, together with consideration of the pearls and pitfalls of the procedure. A video of the surgery performed in a representative case with medial knee osteoarthritis and patellar subluxation in the right knee owing to an outward tibial torsion deformity is also provided.
Collapse
Affiliation(s)
- Ryuichi Nakamura
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Japan
| | - Fumiyoshi Kawashima
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Japan
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Masaki Amemiya
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Japan
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoyuki Shimakawa
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Japan
- Department of Orthopedic Surgery, Yaese-kai Doujin Hospital, Urasoe, Japan
| | - Akira Okano
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Japan
| |
Collapse
|