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Otsuki S, Ikeda K, Ishitani T, Okamoto Y, Wakama H, Neo M. Effect of lateral hinge fractures for bone union and clinical outcomes following opening-wedge distal tibial tubercle osteotomy in comparison with opening-wedge high tibial osteotomy. J Exp Orthop 2023; 10:140. [PMID: 38095818 PMCID: PMC10721766 DOI: 10.1186/s40634-023-00701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Although the effects of lateral hinge fractures (LHF) on bone union and clinical outcomes after opening-wedge high tibial osteotomy (OWHTO) have been established, the effects of LHF after opening-wedge distal tibial tubercle osteotomy (OWDTO) are unclear. We hypothesised that LHF after OWDTO would be associated with delayed bone union and result in poorer clinical outcomes than expected for LHF after OWHTO. METHODS This study enrolled 100 patients, with 50 OWDTO patients (18 men; mean age, 63.2 years) and 50 OWHTO patients compared based on the propensity score matched analysis. The effect of LHF on bone union was compared between the groups. Clinical outcomes were assessed using the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at the mean follow-up of 28 months. RESULTS There was no between-group difference in the incidence rate of LHF. However, the rate of bone union at the anterior flange in the presence of an LHF was significantly lower in the OWDTO (26%) than in the OWHTO (80%) 3 months postoperatively (p < 0.05), but no difference was observed 12 months postoperatively. The Lysholm score was significantly lower for patients with LHF following OWDTO than for OWDTO patients without LHF or OWHTO patients with/without LHF 3 and 12 months postoperatively (p < 0.001); Lysholm score and KOOS were not different at the final follow-up. CONCLUSIONS LHF after OWDTO was associated with delayed bone union and poor clinical outcomes until 12 months. This information can guide decisions regarding the indications and the management of patients after OWDTO. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
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Choe JS, Bin SII, Kim JM, Lee BS, Song JH, Cho HK, Kee TH. Association of Medial Meniscal Volume With Decreased Joint Space Width After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2023; 11:23259671231166920. [PMID: 37223072 PMCID: PMC10201151 DOI: 10.1177/23259671231166920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 05/25/2023] Open
Abstract
Background Medial opening-wedge high tibial osteotomy (MOWHTO) reduces contact stress by altering the weightbearing axis from the medial to the lateral compartment, relieves knee pain, and slows the progression of osteoarthritis. Purpose/Hypothesis To evaluate whether the volume of the medial meniscus affects outcomes after MOWHTO. It was hypothesized that reduced medial meniscal volume would be associated with worse midterm clinical and radiographic outcomes. Study Design Cohort study; Level of evidence, 3. Methods Included were 59 patients who underwent MOWHTO and had ≥4 years of follow-up data. The mean follow-up period was 66.5 ± 15.1 months (range, 48-110 months). The cohort was classified into 3 groups according to the status of the medial meniscus on arthroscopic examination before osteotomy: no meniscal tear, degenerative tear leading to partial meniscectomy, and degenerative tear leading to subtotal meniscectomy. The Hospital for Special Surgery score and Knee Society objective and functional scores were compared among the groups at 2 time points (preoperative and latest follow-up), and the medial joint space width (JSW) was compared among the groups at 3 time points (preoperative, 1 year postoperative, and latest follow-up). Results Overall, 9 patients had no meniscal tear, 20 patients underwent partial meniscectomy, and 30 patients underwent subtotal meniscectomy. The clinical scores improved significantly from preoperatively to the latest follow-up (P ≤ .001 for all), with no significant difference among the groups. Post hoc analysis indicated that at the latest follow-up, JSW was significantly lower in the subtotal meniscectomy group compared with the no-tear group on both 45° of flexion posterior-anterior (2.5 ± 1.3 vs 3.9 ± 1.8 mm; P = .004) and anterior-posterior (3.4 ± 1.1 vs 4.5 ± 0.9 mm; P = .011) radiographs. Conclusion Subtotal meniscectomy of the medial meniscus performed during arthroscopic examination with MOWHTO was associated with decreased JSW at midterm follow-up. Efforts should be made to preserve the medial meniscus as much as possible during MOWHTO.
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Affiliation(s)
- Jung-Su Choe
- Department of Orthopedic Surgery, Cheju
Halla General Hospital, Jeju, Republic of Korea
| | - Seong-II Bin
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Ju-Ho Song
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Hyung-Kwon Cho
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Tae-Hong Kee
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
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Koh DTS, Soong J, Yeo W, Tan MWP, Teo SJ, Wilson A, Lee KH. Large Versus Small Opening Wedge High Tibial Osteotomies Performed With a Protective Wire Over the Lateral Hinge: Incidence of Lateral Hinge Fracture and Early Clinical Outcomes. Am J Sports Med 2023; 51:672-677. [PMID: 36856282 DOI: 10.1177/03635465221148496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND The incidence of lateral hinge fractures (LHFs) during medial opening wedge high tibial osteotomy (MOW-HTO) is unacceptably high, especially with distractions >10 mm. LHFs result in malunion, loss of correction, and recurrence of symptoms adversely affecting clinical outcomes. PURPOSE (1) To investigate the incidence of LHF when a protective guide wire is utilized during MOW-HTO in small and large corrections and (2) to study the effect of correction size on early clinical outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was performed of 96 knees that underwent MOW-HTO between 2019 and 2020. A protective wire applied intraoperatively across the lateral hinge point before opening wedge distraction was performed for all patients. Patients were divided into 2 groups based on opening wedge sizes: group A (opening distraction <10 mm) and group B (opening distraction ≥10 mm). LHF and wound complications were recorded. Prospective Knee Score and Function Score (Knee Society), Oxford Knee Score, and Physical and Mental Component Summaries of the 36-Item Short Form Health Survey questionnaire were recorded preoperatively and at 6 months and 2 years after surgery. RESULTS Incidence of LHF was low in group A (n = 2; 6.1%) and group B (n = 3; 9.1%). A single case of intraoperative LHF was noted in each group, with each case resulting in a type 1 fracture. The incidence of postoperative fractures was comparable between groups (groups A vs B, n = 1 vs 2). At 6 months, clinical outcomes in group A were superior to those of group B (Knee Score, 85.7 ± 14.7 vs 73.1 ± 20.3, P = 0.028; Function Score, 73.5 ± 16.5 vs 63.1 ± 19.5, P = 0.047; Oxford Knee Score, 20.2 ± 4.7 vs 25.6 ± 8.5, P = 0.008; Physical Component Summary, 46.8 ± 8.1 vs 40.2 ± 10.9, P = 0.018). However, clinical outcomes were comparable at 2 years (P > .05). CONCLUSION A protective wire was associated with a low incidence of LHF, even in larger MOW-HTO corrections. Large corrections had poorer clinical outcomes as compared with small corrections at 6 months. However, clinical outcomes between groups were comparable at 2 years.
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Affiliation(s)
| | - Junwei Soong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Shao Jin Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Adrian Wilson
- London Osteotomy Centre, Harley Street Specialist Hospital, London, UK.,Department of Sports and Exercise, University of Winchester, Winchester, UK
| | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Superior survivorship and plate-related results of TomoFix compared to Puddu plate fixation for opening-wedge high tibial osteotomy: A systematic review of the literature. Knee 2023. [PMID: 36863116 DOI: 10.1016/j.knee.2023.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE This systematic review aimed to compare survivorship and plate-related results of Puddu and TomoFix plates in opening-wedge high tibial osteotomy (OWHTO). METHODS PubMed, Scopus, EMBASE, and CENTRAL databases were searched from January 2000 until September 2021 for clinical studies involving patients with medial compartment knee disease and varus deformity undergoing OWHTO using the Puddu or TomoFix plating systems. We extracted survival data, plate-related complications, and functional and radiological outcomes. The risk of bias assessment had been carried out using Cochrane Collaboration's quality assessment tool for randomised controlled trials (RCTs) and Methodological Index for Non-Randomised Studies (MINORS). RESULTS Twenty-eight studies were included. The total number of knees was 2568 in 2372 patients. The Puddu plate was used in 677 knees, while the TomoFix plate was used in 1891. The follow-up ranged from 5.8 to 147.6 months. Both plating systems were able to delay conversion to arthroplasty at different follow-up intervals. However, osteotomies fixed by the TomoFix plate achieved higher survival rates, especially at mid-term and long-term follow-ups. In addition, fewer complications were reported with the TomoFix plating system. Although both implants achieved satisfactory functional outcomes, high scores could not be maintained throughout long-term intervals. Regarding radiological results, TomoFix plate was able to achieve and maintain larger degrees of varus deformity, while preserving the posterior tibial slope. CONCLUSIONS This systematic review demonstrated the superiority of the TomoFix over the Puddu system as a safer and more effective fixation device in OWHTO. Nevertheless, these results should be interpreted with caution due to the lack of comparative evidence through high-quality RCTs.
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Morita Y, Kuriyama S, Yamawaki Y, Nakamura S, Nishitani K, Ito H, Matsuda S. Opening-Wedge High Tibial Osteotomy With High Hinge Position Risks Lateral Hinge Fracture in Men With Posterolateral Tibial Condyle Protrusion. Arthroscopy 2023; 39:324-334. [PMID: 35961443 DOI: 10.1016/j.arthro.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to evaluate the 3-dimensional morphology of the proximal tibia around the osteotomy plane in open-wedge high tibial osteotomy, focusing on the posterolateral (PL) and posteromedial (PM) tibial condyles, and to clarify the changes in morphologic parameters due to differences in patient characteristics and hinge position. The secondary aim was to examine whether morphologic features were associated with insufficient osteotomy, which increases the risk of lateral hinge fracture (LHF). METHODS The PL and PM anteroposterior distance, asymmetry ratio, and discrepancy between PL and PM distances along the tibial osteotomy plane were measured. We investigated changes in the parameters due to differences in patient characteristics and hinge position. Osteotomy configurations and LHFs were evaluated using postoperative computed tomography scans. RESULTS The 3-dimensional preoperative plans of 117 knees (male, 41 knees; female, 76 knees) were evaluated. PL distances were larger than PM distances in almost all cases. The average asymmetry ratio was 1.35, and the standard deviation was 0.22. Higher hinge position was associated with a larger asymmetry ratio and discrepancy (P < .001). The asymmetry ratio and discrepancy were independently positively correlated with male sex (P = .002 and P = .001, respectively) and gentle posterior tibial slope (P < .001 and P < .001, respectively). Osteotomies with type III LHFs showed lower osteotomy sufficiency than osteotomies without LHFs (P < .001). CONCLUSIONS PL tibial condyle protrusion was more pronounced in male patients and those with a high hinge position, and may result in insufficient PL osteotomy, which is a risk factor for type III LHF during open-wedge high tibial osteotomy. The optimal hinge position was located approximately 15 mm and 20 mm distal to the lateral tibial plateau in female and male patients, respectively. LEVEL OF EVIDENCE IV: retrospective case series.
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Affiliation(s)
- Yugo Morita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto.
| | - Yusuke Yamawaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
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Editorial Commentary: High Tibial Osteotomy Lateral Hinge Fracture Is More Common in Patients With Posterolateral Tibial Condylar Protrusion. Arthroscopy 2023; 39:335-336. [PMID: 36604000 DOI: 10.1016/j.arthro.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 01/04/2023]
Abstract
The most common adverse event during opening-wedge high tibial osteotomy is lateral hinge fracture. It may be caused by a variety of factors, including an insufficient osteotomy, a large opening gap, an inappropriate hinge position, and early weight bearing with compromised fixation. In addition, particularly in men, posterolateral protrusion of the proximal tibial condyle often results in an insufficient posterior cortical osteotomy owing to surgical overprotection in an effort to avoid popliteal vessel injury. An insufficient posterolateral osteotomy shifts the hinge point posteriorly, resulting in an unstable hinge fracture during opening of the osteotomy wedge, as well as undesirable changes in the mechanical axis. A solution in patients with a large posterolateral proximal tibial condyle could be to shift the osteotomy slightly distally. Surgeons should be mindful of individual proximal tibial morphology in the area of the lateral hinge.
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Pan CS, Wang X, Ding LZ, Zhu XP, Xu WF, Huang LX. The best position of bone grafts in the medial open-wedge high tibial osteotomy: A finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 228:107253. [PMID: 36434962 DOI: 10.1016/j.cmpb.2022.107253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE The application of wedge-shaped bone grafts can increase the biomechanical stability of knee during the medial open-wedge high tibial osteotomy (MOWHTO) by reducing the von Mises stress of the medial plate and lateral cortical hinge area. However, the optimal position of bone grafts it remains unclear, so we aimed to determine search for the optimal position of the bone grafts in MOWHTO by using finite element analysis. METHODS In the finite element analysis, MOWHTO models were established with three different osteotomy distraction heights and assembled into four groups according to different conditions, including the no bone grafts (NBG) group, the anterior bone grafts (ABG) group, the middle bone grafts (MBG) group, and the posterior bone grafts (PBG) group. Based on previous studies, 600 N and 1800 N loads were applied to the knee joint to simulate the static forces during a double and single leg stance to measure the von Mises stress of the medial implant area and lateral hinge area, the maximum displacement of different models, the relative displacement of the osteotomy area and the stress distribution in the bone grafts. RESULTS Compared to the NBG and ABG groups, the stress of the lateral cortical hinge area and the medial implate area was significantly lower in the PBG group. For example, under the 600N force load, when the height of the osteotomy area was 10 mm, 15 mm, and 20 mm, the maximum von Mises stress of the medial implate area and lateral cortical hinge area in the NBG group were 140, 141, 172, and 53, 57, 60 MPa, respectively. Compared with the NBG group, the maximum von Mises stress of the medial implate area and lateral cortical hinge area in the PBG group were reduced by 45%, 56%, 63% and 14%, 39%, 68% at distraction height of 10 mm, 15 mm, and 20 mm, respectively. The bone grafts in the posterior parts provide the best stability,with the stress of the middle and posterior bone grafts are mainly concentrated in the edge. CONCLUSIONS The posterior part of the osteotomy area is the best position for bone graft placement since it provides optimal stability and reduces von Mises stress in the medial plate and lateral cortex hinge area, with the stress of the posterior bone grafts mainly concentrated in the edge. These findings guide bone graft placement sites in clinical surgery and are a basis for future research on bone graft materials and structures in MOWHTO.
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Affiliation(s)
- Chen-Shuai Pan
- Department of Orthopedic, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, Jiangsu Province 215006, PR China; Department of Orthopedic, Taizhou Central Hospital (Taizhou University Hospital), No.999, Donghai Avenue, Jiaojiang District, Taizhou City, Zhejiang Province 318000, PR China
| | - Xiao Wang
- Department of Ophthalmology,Taizhou Central Hospital (Taizhou University Hospital), No.999, Donghai Avenue, Jiaojiang District, Taizhou City, Zhejiang Province 318000, PR China
| | - Ling-Zhi Ding
- Department of Orthopedic, Taizhou Central Hospital (Taizhou University Hospital), No.999, Donghai Avenue, Jiaojiang District, Taizhou City, Zhejiang Province 318000, PR China
| | - Xian-Ping Zhu
- Department of Orthopedic, Taizhou Central Hospital (Taizhou University Hospital), No.999, Donghai Avenue, Jiaojiang District, Taizhou City, Zhejiang Province 318000, PR China
| | - Wei-Fang Xu
- Department of Orthopedic, Taizhou Central Hospital (Taizhou University Hospital), No.999, Donghai Avenue, Jiaojiang District, Taizhou City, Zhejiang Province 318000, PR China
| | - Li-Xin Huang
- Department of Orthopedic, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, Jiangsu Province 215006, PR China.
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Comparative outcomes of patient-specific instrumentation, the conventional method and navigation assistance in open-wedge high tibial osteotomy: A prospective comparative study with a two-year follow up. Knee 2022; 39:18-28. [PMID: 36115179 DOI: 10.1016/j.knee.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/11/2022] [Accepted: 08/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare and analyze the correction precision, clinical outcomes and complications among the three methods of performing open-wedge high tibial osteotomy (HTO), including patient-specific instrumentation (PSI), conventional method and navigation assistance. METHODS In this prospective, single-center study, we randomly assigned patients with knee osteoarthritis in a 1:1:1 ratio to undergo Open-wedge high tibial osteotomy (OWHTO) with conventional method, navigation assistance or PSI. The primary outcome was the target/observed hip-knee-ankle (HKA) angle difference at 1 month postoperatively. Secondary outcomes were changes in the postoperative posterior tibial slope (PTS) at 1 month and clinical outcomes including knee pain on a visual analogue scale (ranging from 0 to 100, with higher scores indicating more severe pain), Lysholm and Western Ontario and McMaster Universities Osteoarthritis Index (ranging from 0 to 240) scores at 1 month, 6 months, 12 months, and 24 months. RESULTS From 2017 through 2019, a total of 608 patients were screened; of those patients, 144 were enrolled, with 48 in each group. The primary outcome of the HKA difference was 2.6 ± 2.0° in the conventional group, 2.3 ± 1.5° in the navigation group and 0.6 ± 1.0° in the PSI group (P < 0.001). Secondary outcomes including changes in the postoperative PTS and clinical outcomes at 1 month, 6 months, and 12 months were in the same direction as the primary outcome. There were no significant differences in the complications among the three groups. CONCLUSIONS In the present study, none of the three methods showed superiority in objective correction precision and clinical outcomes at 2 years.
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Takahashi T, Handa M, Kimura Y, Takeshita K. Intraoperative Laximetry-Based Selective Transtibial Anterior Cruciate Ligament Reconstruction Concomitant With Medial Open Wedge High Tibial Osteotomy for Treating Varus Knee Osteoarthritis With Anterior Cruciate Ligament Deficiency. Arthrosc Tech 2022; 11:e959-e963. [PMID: 35782859 PMCID: PMC9243668 DOI: 10.1016/j.eats.2022.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/17/2022] [Indexed: 02/03/2023] Open
Abstract
High tibial osteotomy (HTO) is used in the treatment of varus knee osteoarthritis (KOA) in young and active patients. At times, a concomitant anterior cruciate ligament (ACL) deficiency is found, and there is no conclusive evidence comparing the osteotomy options for an ACL-deficient knee despite the popularity of medial opening-wedge (MOW) HTO in varus KOA with ACL deficiency. To minimize the incidence of an unnecessary ACL reconstruction with MOW-HTO, we developed an intraoperative laximetry-based selective technique for transtibial ACL reconstruction concomitant with MOW-HTO using a sterilizable metal laximeter. To successfully use the device required for this procedure, surgeons must understand the proper techniques. Hence, this Technical Note aims to give a comprehensive description of the technique.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan,Address correspondence to Tsuneari Takahashi, M.D., Ph.D., Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, 1-15-4 Shimokoyama, 329-0502, Japan.
| | - Mikiko Handa
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Yuya Kimura
- Department of Orthopedic Surgery, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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