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Herman ZJ, Keeling LE, Fox MA, Dadoo S, Musahl V. The Role of Osteotomy in Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:383-398. [PMID: 38811117 DOI: 10.1016/j.csm.2023.08.006] [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] [Indexed: 05/31/2024]
Abstract
Coronal and sagittal plane knee malalignments have been shown to increase the forces on anterior cruciate ligament (ACL) grafts after ACL reconstruction (ACLR). Studies have shown the benefit of high tibial osteotomy to address coronal and sagittal imbalance in revision ACLR. The purpose of this article is to further describe the use of osteotomy by reviewing preoperative planning, indications, techniques, and outcomes of high tibial opening and closing wedge as well as anterior tibial closing wedge osteotomies in the setting of ACLR.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Laura E Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Michael A Fox
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
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Legnani C, Ventura A, Mangiavini L, Maffulli N, Peretti GM. Management of Medial Femorotibial Knee Osteoarthritis in Conjunction with Anterior Cruciate Ligament Deficiency: Technical Note and Literature Review. J Clin Med 2024; 13:3143. [PMID: 38892854 PMCID: PMC11172484 DOI: 10.3390/jcm13113143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
In recent years, there has been increased interest in the management of medial femorotibial knee osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency. Traditional treatment modalities included conservative therapy, high tibial osteotomy with or without ACL reconstruction, and total knee replacement. Since younger patients with higher physical demands are more likely to suffer from this pathological condition, reduced invasiveness, faster recovery time, and improved knee kinematics are preferred to allow for satisfying clinical and functional outcomes. Thus, a new surgical strategy combining medial unicompartmental knee replacement (UKR) and ACL reconstruction has been proposed to allow bone stock preservation, to reduce surgical morbidity and recovery time, and ultimately to improve joint kinematics and clinical outcomes. Based on the data present in the literature, in the setting of unicompartmental OA in association with ACL deficiency, UKR combined with ACL reconstruction provided encouraging early results. Studies evaluating the outcomes of combined ACL reconstruction and UKR demonstrate promising results in select patient populations. Improved knee stability, pain relief, functional recovery, and patient satisfaction improved after surgery. Moreover, the combined approach offered advantages such as reduced surgical trauma, faster rehabilitation, and preservation of native knee anatomy compared with traditional treatment strategies. However, still, high-level studies on this topic are lacking; therefore, more comparative studies reporting long-term outcomes are needed to support the potential of this combined procedure to become mainstream. In this paper, we discuss the relevant features and rationale behind the indications and technique of this combined surgical procedure, to help surgeons choose the correct therapeutic approach for a patient with concomitant medial OA and ACL insufficiency. Continued advancements in surgical techniques, patient selection criteria, and rehabilitation strategies will further enhance the success of this combined approach, offering hope to individuals with concomitant ACL injuries and unicompartmental knee OA.
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Affiliation(s)
- Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, 20161 Milan, Italy
| | - Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, 20161 Milan, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent ST4 7QB, UK
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
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Lott A, James MG, Kaarre J, Höger S, Kayaalp ME, Ollivier M, Getgood A, Hughes JD, Musahl V. Around-the-knee osteotomies part II: Surgical indications, techniques and outcomes - State of the art. J ISAKOS 2024:S2059-7754(24)00072-5. [PMID: 38604568 DOI: 10.1016/j.jisako.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
Recent advances in surgical techniques and planning for knee-based osteotomies have led to improvements in addressing lower extremity malalignment. Part 1 of this review presented the biomechanical and clinical rationale of osteotomies, emphasizing the importance of osteotomies for restoring normal knee kinematics. In Part 2 of this review, indications, surgical technique and outcomes of osteotomies to correct coronal, sagittal and axial plane deformities will be examined. Traditional high tibial and distal femoral osteotomies will be discussed in addition to more recent advanced techniques including biplanar corrections and double-level osteotomies, as well as slope-correcting osteotomies. Patient-specific instrumentation and its use in more complex corrections will also be addressed.
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Affiliation(s)
- Ariana Lott
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael G James
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Svenja Höger
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Enes Kayaalp
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedics and Traumatology, Istanbul Kartal Training and Research Hospital, Istanbul, Turkey
| | | | - Al Getgood
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA.
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Mabrouk A, Risebury M, Yasen S. High survivorship and low complication rate in a single-centre series of 651 medial opening wedge high tibial osteotomy cases with a mean follow-up of 13 years. Knee Surg Sports Traumatol Arthrosc 2024; 32:736-749. [PMID: 38410856 DOI: 10.1002/ksa.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE This study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single-centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient-reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisions and survivorship up to 10 years postoperatively. METHODS A prospectively maintained single-centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management; varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass index of 29.6 ± 5.2 kg/m2 , were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow-up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury and Osteoarthritis Outcome Scores, the Oxford Knee Score, the Oxford Knee Score-Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ-5D, which is a standardised measure of health-related quality of life. All lower limb alignment measurements were recorded pre- and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5- and 10-year survivorship were recorded. RESULTS A total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4 and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from -5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7° and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow-up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10-year survivorship was 97.2% and 91.9%, respectively. CONCLUSION MOWHTO is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Michael Risebury
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Sam Yasen
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Jörgens M, Keppler AM, Ahrens P, Prall WC, Bergstraesser M, Bachmeier AT, Zeckey C, Cavalcanti Kußmaul A, Böcker W, Fürmetz J. 3D osteotomies-improved accuracy with patient-specific instruments (PSI). Eur J Trauma Emerg Surg 2024; 50:3-10. [PMID: 35879618 PMCID: PMC10923740 DOI: 10.1007/s00068-022-02060-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Three-dimensional (3D) printed patient-specific instruments (PSI) have been introduced to increase precision and simplify surgical procedures. Initial results in femoral and tibial osteotomies are promising, but validation studies on 3D planning, manufacturing of patient-specific cutting blocks and 3D evaluation of the attained results are lacking. METHODS In this study, patient-specific cutting blocks and spacers were designed, fabricated, and used to perform a high tibial osteotomy (HTO). After segmentation of CT data sets from 13 human tibiae, 3D digital planning of the HTO was performed with a medial opening of 8 mm. These 3D models were used to fabricate patient-specific cutting blocks and spacers. After the surgical procedure, accuracy was evaluated measuring 3D joint angles and surface deviations. RESULTS The lowest mean deviation was found to be 0.57° (SD ± 0.27) for the MPTA. Medial and lateral tibial slope deviated from the 3D planning by an average of 0.98° (SD ± 0.53) and 1.26° (SD ± 0.79), respectively, while tibial torsion deviated by an average of 5.74° (SD ± 3.24). Color analysis of surface deviations showed excellent and good agreement in 7 tibiae. CONCLUSION With 3D cutting blocks and spacers, the 3D planning of the HTO can be translated into reality with small deviations of the resulting joint angles. Within this study, the results of the individual steps are examined for errors and thus a critical evaluation of this new and promising method for performing patient-specific HTOs is presented.
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Affiliation(s)
- Maximilian Jörgens
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
| | - Alexander M Keppler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | | | - Wolf Christian Prall
- FIFA Medical Centre of Excellence, Division of Knee, Hip, Shoulder and Ellbow Surgery, Schoen Clinic Munich, Munich, Germany
| | - Marcel Bergstraesser
- OT Medizintechnik GmbH (Medical Engineering in Orthopedics and Traumatology), Munich, Germany
| | - Andreas T Bachmeier
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christian Zeckey
- Department of Trauma Surgery and Orthopaedics, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Julian Fürmetz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Department of Trauma Surgery, BG Unfallklinikum Murnau, Murnau, Germany
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Barnett SC, Portila G, Sanborn R, Perone GS, Emami A, Kiapour AM. Comparison of Size of Posterior Tibial Slope and Medial Tibial Depth in Patients With an Isolated Meniscal Tear Requiring Surgery and Matched Uninjured Controls. Am J Sports Med 2023; 51:3706-3713. [PMID: 37924211 DOI: 10.1177/03635465231204362] [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] [Indexed: 11/06/2023]
Abstract
BACKGROUND Meniscal injuries are extremely common. Several anatomic features of the knee, including the tibial plateau morphology, have been shown to influence knee biomechanics and the risk of ligamentous injuries. Little is known, however, how these morphological features influence the risk of isolated meniscal injuries in the anterior cruciate ligament (ACL)-intact knee. HYPOTHESIS There are differences in the slopes and concavity of the tibial plateau between patients with isolated meniscal tears and matched uninjured controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In total, 89 patients with first-instance isolated medial (n = 37) or lateral (n = 52) meniscal injuries requiring surgical treatment (mean age, 16 ± 1 years; 35% female) were matched to 89 controls with uninjured knees and no previous injuries (mean age, 16 ± 2 years; 35% female) based on age and sex. Magnetic resonance imaging scans (preoperative for injured group) were used to measure the coronal slope of the tibial plateau, posterior slope of the medial and lateral tibial plateaus, and maximum depth of the medial tibial plateau. General linear models were used to evaluate the differences in tibial plateau morphology between the knees with and without meniscal injuries, with and without adjustment for age and sex. RESULTS Compared with matched controls, patients with surgically treated isolated meniscal tears had a smaller lateral tibial slope (by 2.2° [medial meniscal injury] and 1.6° [lateral meniscal injury]; P < .02), a smaller medial tibial slope (by 2.3° [medial meniscal injury] and 2.4° [lateral meniscal injury]; P < .001) and a larger medial tibial depth (by 0.8 mm [medial meniscal injury] and 0.9 mm [lateral meniscal injury]; P < .001). There were no differences in coronal tibial slope between the injured and uninjured groups. There were no differences in quantified anatomic features between the isolated medial and lateral meniscal injury groups. The same trends were observed after adjusting for age and sex. CONCLUSION This study suggests that patients with an isolated meniscal tear requiring surgery have a smaller posterior tibial slope and a larger medial tibial depth (more concave medial tibial plateau) than matched uninjured controls. This is contrary to what is known for ACL tears, in which a steeper posterior tibial slope and a shallower medial tibial depth have been associated with an increased risk of ACL tear.
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Affiliation(s)
- Samuel C Barnett
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriella Portila
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Ryan Sanborn
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabrielle S Perone
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedics, Tufts Medical School, Boston, Massachusetts, USA
| | - Alex Emami
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kraeutler MJ, McCulloch PC, Sherman SL, Vidal AF. The Principles of Knee Joint Preservation: Operative Treatment Strategies. J Bone Joint Surg Am 2023; 105:1638-1646. [PMID: 37616413 DOI: 10.2106/jbjs.23.00212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
➤ Joint alignment, meniscal status, and ligament stability are codependent factors involved in knee joint preservation, and any injury or imbalance can impact the knee articular cartilage status and can result in adverse clinical outcomes.➤ Cartilage preservation procedures in the knee will not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligamentous instability.➤ Lower-extremity varus or valgus malalignment is a risk factor for the failure of an anterior cruciate ligament (ACL) reconstruction. It represents an indication for a high tibial osteotomy or distal femoral osteotomy in the setting of failed ACL reconstruction, and may even be considered in patients who have an initial ACL injury and severe malalignment.➤ An elevated posterior tibial slope increases the risk of failure of ACL reconstruction, whereas a decreased posterior tibial slope increases the risk of failure of posterior cruciate ligament reconstruction.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Seth L Sherman
- Department of Orthopedic Surgery, Stanford University, Redwood City, California
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Takahashi T, Watanabe S, Hino M, Takeda H, Ito T. Excellent short-term results of dome-shaped high tibial osteotomy combined with all-inside anterior cruciate ligament reconstruction. J Exp Orthop 2023; 10:69. [PMID: 37428298 DOI: 10.1186/s40634-023-00632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023] Open
Abstract
PURPOSE This study aimed to evaluate short-term outcomes at least 2 years after dome-shaped high tibial osteotomy (HTO) combined with all-inside anterior cruciate ligament reconstruction (ACL) in patients with persistent ACL insufficiency accompanied by pain due to varus deformity. METHODS The study enrolled 19 knees of 18 patients. The mean age was 58.4 ± 13.4 years and the mean postoperative follow-up period was 31.4 ± 6.6 months (24-49 months). JOA(Japanese Orthopaedic Association)-OA(osteoarthritis) score, Lysholm score, radiographic outcomes such as femoro-tibia angle (FTA) in a standing position, side-to-side difference in KT-1000 measurements were evaluated at pre op. and post operative final follow up. And arthroscopic evaluation was evaluated at the time of the HTO plate-removal procedure. RESULTS Before surgery, the mean JOA-OA score was 65.0 ± 13.5, the mean Lysholm score was 47.2 ± 16.2, the mean femoro-tibia angle (FTA) in a standing position was 183.8 ± 3.4° (range;180-190°), and the mean side-to-side difference in KT-1000 measurements was 4.1 ± 1.3 mm. After surgery, the mean JOA-OA score, Lysholm score, and side-to-side difference in KT-1000 measurements improved to 93.1 ± 6.0 (P < 0.00001), 94.2 ± 5.9 (P < 0.00001), and -0.2 ± 0.8 mm (P < 0.00001), respectively. The mean FTA decreased to 168.0 ± 3.3 (P < 0.00001), and the mean posterior tibial slope angle decreased to 5.0 ± 3.6° from 6.9 ± 2.6° preoperatively (P = 0.024). Arthroscopic evaluation during the HTO plate-removal procedure of 17 knees were performed at a mean of 16 months after the surgery. The reconstructed ACL graft in 13 knees were successful, a cyclops lesion in one knee, and looseness of the graft in three knees. CONCLUSIONS Dome-shaped HTO allows for a relatively high degree of varus correction and decreases the steep posterior tibial slope that causes excessive load on the ACL. Therefore, its use in combination with ACL reconstruction seems to be effective.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Faculty of Collaborating Regional Innovation, Ehime University, 3 Bunkyo-Cho, Matsuyama, Ehime, 790-8577, Japan.
| | - Seiji Watanabe
- Department of Orthopaedic Surgery, Watanabe Hospital, Matsuyama, Ehime, 791-0054, Japan
| | - Masanori Hino
- Department of Orthopaedic Surgery, Saijo Central Hospital, Saijo, Ehime, 793-0027, Japan
| | - Haruhiko Takeda
- Department of Orthopaedic Surgery, Saijo Central Hospital, Saijo, Ehime, 793-0027, Japan
| | - Toshio Ito
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Saijo, Ehime, 793-0030, Japan
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Lee SS, Oh J, Lee DH. Change in Cartilage Status of Medial Compartment after Open-Wedge High Tibial Osteotomy without Cartilage Regeneration Procedure: Second Look Arthroscopic Assessment. Biomedicines 2023; 11:1639. [PMID: 37371734 DOI: 10.3390/biomedicines11061639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
This study investigated the rate of cartilage regeneration after an open-wedge high tibial osteotomy (HTO) without cartilage regeneration by second-look arthroscopy. This study included patients who underwent an open-wedge HTO between July 2014 and March 2019. A total of 65 patients were enrolled. Pre- and postoperative (second-look arthroscopy) hip-knee-ankle (HKA) angle and tibial slope were measured. All patients underwent arthroscopic examination prior to osteotomy. Medial femoral condyle (MFC) and medial tibial plateau (MTP) articular cartilage were evaluated according to the International Cartilage Repair Society (ICRS) grading system. After 26.5 months, second-look arthroscopy was performed with plate removal to identify the cartilage status of the MFC and MTP. The preoperative HKA angle (6.4° ± 2.7°) was well corrected postoperatively (-2.7° ± 2.7°, p < 0.001). In terms of MFC on second-look arthroscopy, 29 patients (44.6%) showed an improved ICRS grade, 31 patients (47.7%) were maintained, and 5 patients (7.7%) showed a worse ICRS grade since the prior operation. In the MTP group, 19 patients (29.2%) improved, 44 patients (67.7%) were maintained, and 2 patients (3.1%) worsened. Approximately 44.6% and 29.2% of patients showed improved cartilage statuses on the MFC and MTP after open-wedge HTO without any cartilage regeneration procedures. Cartilage regenerations in both the MFC and MTP did not influence clinical outcomes.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi 10380, Republic of Korea
| | - Juyong Oh
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Erquicia JI, Gil-Gonzalez S, Ibañez M, Leal-Blanquet J, Combalia A, Monllau JC, Pelfort X. A lower starting point for the medial cut increases the posterior slope in opening-wedge high tibial osteotomy: a cadaveric study. J Exp Orthop 2022; 9:124. [PMID: 36577908 PMCID: PMC9797634 DOI: 10.1186/s40634-022-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the effects on the posterior tibial slope of different distances from the joint line to start the osteotomy and of varying the placement of the opening wedge in high tibial osteotomy. Starting the osteotomy more distally and an incorrect location for the tibial opening wedge were hypothesized to increase the posterior tibial slope. METHODS A cadaveric study was conducted using 12 knees divided into two groups based on the distance from the joint line to the start of the osteotomy: 3 and 4 cm. The preintervention posterior tibial slope was measured radiologically. Once the osteotomy was performed, the medial cortex of the tibia was divided into anteromedial, medial, and posteromedial thirds. A 10° opening wedge was sequentially placed in each third, and the effect on the posterior tibial slope was evaluated radiographically. RESULTS Significant changes were observed only in the 3-cm group (p = 0.02) when the wedge was placed in the anteromedial zone. In contrast, in the 4-cm group, significant differences were observed when the opening wedge was placed at both the medial (p = 0.04) and anteromedial (p = 0.012) zones. CONCLUSION Correct control of the posterior tibial slope can be achieved by avoiding a low point when beginning the osteotomy and placing the opening wedge in the posteromedial third of the tibia when performing an opening-wedge high tibial osteotomy. LEVEL OF EVIDENCE Controlled laboratory study.
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Affiliation(s)
- Juan Ignacio Erquicia
- grid.488391.f0000 0004 0426 7378Department of Orthopedic Surgery and Traumatology, Althaia Xarxa Assistencial Universitària de Manresa, Carrer Dr. Joan Soler, 1-3, 08243 Manresa, Spain ,IMOVE, Mi Tres Torres, Av. Via Augusta, 281, 08017 Barcelona, Spain
| | - Sergi Gil-Gonzalez
- grid.7080.f0000 0001 2296 0625Department of Orthopedic Surgery and Traumatology, Consorci Corporació Sanitària Parc Taulí. Universitat Autònoma de Barcelona (UAB), Parc del Taulí, 1, 08208 Sabadell, Spain
| | - Maximiliano Ibañez
- grid.7080.f0000 0001 2296 0625ICATME. Hospital Universitari Dexeus, Universitat Autònoma de Barcelona (UAB), Carrer de Sabino Arana 5, 08028 Barcelona, Spain
| | - Joan Leal-Blanquet
- grid.488391.f0000 0004 0426 7378Department of Orthopedic Surgery and Traumatology, Althaia Xarxa Assistencial Universitària de Manresa, Carrer Dr. Joan Soler, 1-3, 08243 Manresa, Spain ,IMOVE, Mi Tres Torres, Av. Via Augusta, 281, 08017 Barcelona, Spain
| | - Andrés Combalia
- grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Carrer Casanova 143, 08036 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Carrer Casanova 143, 08036 Barcelona, Spain
| | - Juan Carlos Monllau
- grid.7080.f0000 0001 2296 0625ICATME. Hospital Universitari Dexeus, Universitat Autònoma de Barcelona (UAB), Carrer de Sabino Arana 5, 08028 Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Orthopedic Surgery and Traumatology. Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Passeig Marítim, 25, 08003 Barcelona, Spain
| | - Xavier Pelfort
- grid.7080.f0000 0001 2296 0625Department of Orthopedic Surgery and Traumatology, Consorci Corporació Sanitària Parc Taulí. Universitat Autònoma de Barcelona (UAB), Parc del Taulí, 1, 08208 Sabadell, Spain
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Matassi F, Giabbani N, Arnaldi E, Tripodo A, Bonaspetti G, Bait C, Ronga M, Di Benedetto P, Zaffagnini S, Jannelli E, Schiavone Panni A, Berruto M. Controversies in ACL revision surgery: Italian expert group consensus and state of the art. J Orthop Traumatol 2022; 23:32. [PMID: 35840726 PMCID: PMC9287504 DOI: 10.1186/s10195-022-00652-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors’ aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction. Methods A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants’ answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience. Conclusions The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case. Level of evidence V (Expert opinion).
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Affiliation(s)
| | - Niccolò Giabbani
- Orthopaedic Clinic CTO, University of Florence, Florence, Italy.
| | | | | | - Giovanni Bonaspetti
- U.O. Ortopedia e Traumatologia 2, Istituto Clinico Sant'Anna, Brescia, Italy
| | | | - Mario Ronga
- Orthopaedic and Trauma Operative Unit, Department of BIOMORF, University Hospital G. Martino, University of Messina, Messina, Italy
| | | | | | - Eugenio Jannelli
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Berruto
- UOS Knee SURGERY-1st University Clinic of Orthopaedics, ASST Pini-CTO, Milan, Italy
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12
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[Osteotomy close to the knee joint in adults]. DER ORTHOPADE 2022; 51:511-520. [PMID: 35419619 DOI: 10.1007/s00132-022-04250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Osteotomy close to the knee joint in cases of axial deformities or in the context of corrective interventions is still an elementary component of the spectrum of orthopedic surgery. The precise localization and analysis of the pathology are crucial in order to restore approximate physiological loading conditions by means of a suitable osteotomy procedure. Thus, above all, the medial open-wedge tibial osteotomy has become established as a standard procedure for the treatment of knee osteoarthritis caused by extra-articular tibial varus deformity. Furthermore, corrective osteotomy of the sagittal axis of the tibia and of the distal femur also show good long-term results when the indications are correctly interpreted. The osteotomies described in this article are corrections that should be performed after careful consideration of the biological and mechanical aspects. Correct planning, attention to risk factors and the surgical technique are the main factors that determine the long-term success of the procedure.
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Vadhera AS, Knapik DM, Gursoy S, Farviar D, Perry AK, Cole BJ, Chahla J. Current Concepts in Anterior Tibial Closing Wedge Osteotomies for Anterior Cruciate Ligament Deficient Knees. Curr Rev Musculoskelet Med 2021; 14:485-492. [PMID: 34907514 DOI: 10.1007/s12178-021-09729-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Anterior closing wedge osteotomies (ACWO) are utilized to better restore knee stability and in situ forces on anterior cruciate ligament (ACL) grafts during ACL revision reconstruction while reducing the risk of retearing and subsequent revision procedures. However, clinical outcomes following ACWO for patients undergoing ACL reconstruction remains largely limited. The purpose of this review was to provide a concise overview of the current literature on indication, techniques, and outcomes following ACWO in ACL-deficient patients undergoing primary or revision ACL reconstruction while discussing the authors' preferred technique to ACWO during a staged ACL revision reconstruction. RECENT FINDINGS Currently available clinical studies and case reports have demonstrated ACWO to improve knee stability and outcomes for patients with an increased posterior tibial slope undergoing primary or revision ACL reconstruction with low complication rates. The ACWO provides an adjunct surgical option to decrease graft failure while improving knee stability and post-surgical outcomes for patients with an increased posterior tibial slope undergoing primary or revision ACL reconstruction. Further investigations are warranted to validate currently reported outcomes following ACWO in higher-level clinical studies with longer-term follow-up.
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Affiliation(s)
- Amar S Vadhera
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Daniel Farviar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Allison K Perry
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL, 60612, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL, 60612, USA.
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Femur originated genu varum in a patient with symptomatic ACL deficiency: a case report and review of literature. BMC Musculoskelet Disord 2021; 22:437. [PMID: 33985470 PMCID: PMC8120728 DOI: 10.1186/s12891-021-04274-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) injury may be associated with genu varum. There are a few indications in which the varus deformity can be corrected at the time of ACL reconstruction. However, as the genu varum originates mostly from the tibia and the simultaneous presence of ACL deficiency and femur originated genu varum is uncommon, only a few papers have described their management for ACL deficient patients with femur originated genu varum. Case presentation A young patient visited our clinic with a complaint of right knee pain and giving way. Further work up revealed a full mid substance ACL tear, mild medial knee osteoarthritis and femur originated genu varum of his right knee. He was managed with simultaneous ACL reconstruction and distal femoral valgus osteotomy. Conclusions Any corrective osteotomy for genu varum should be performed at center of rotation angle. Isolated ACL reconstruction in patients with simultaneous ACL deficiency and genu varum may hasten the knee degeneration. Level of evidence IV
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Legnani C, Muzzi S, Peretti GM, Borgo E, Ventura A. Anterior cruciate ligament reconstruction combined to partial knee replacement in active patients with ACL deficiency and knee osteoarthritis. PHYSICIAN SPORTSMED 2021; 49:12-17. [PMID: 32654576 DOI: 10.1080/00913847.2020.1795558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To report, through a systematic review of the literature, the clinical and radiographic outcomes of unicompartmental knee replacement (UKR) combined to anterior cruciate ligament (ACL) reconstruction. It was hypothesized that this combined technique is a safe and effective procedure providing satisfactory post-operative functional outcomes. METHODS A systematic review was performed by searching Pubmed/MEDLINE, CINAHL, SCOPUS, Embase, and Ovid. Only studies in English pertaining all levels of evidence reporting on subjects with medial osteoarthritis and ACL deficiency undergoing UKR combined to ACL reconstruction were considered. Review articles and expert opinion or editorial pieces were excluded. Outcomes of interest included indications, clinical assessment including activity level, associated procedures, rate of complications such as revision surgery. RESULTS Overall, nine studies met all the inclusion criteria for this review. All were published between 2006 and 2019. The search resulted in one comparative case series (Level III), four prospective cohort studies (Level III) and four case series (Level IV). From these studies, 249 patients were identified. CONCLUSIONS The combination of UKR and ACL reconstruction appears a safe and effective procedure providing satisfying outcomes and limited complications in selected patients with medial OA and ACL insufficiency. Further comparative studies reporting long-term outcomes are needed, as high-level studies on this topic are lacking.
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Affiliation(s)
- Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center , Milan, Italy
| | | | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan , Milan, Italy
| | - Enrico Borgo
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center , Milan, Italy
| | - Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center , Milan, Italy
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Abstract
INTRODUCTION The incidence of anterior cruciate ligament reconstruction (ACLR) surgeries is increasing and so is the number of revision surgeries for a failed ACLR. The spectrum of ACL failure includes symptoms of recurrent instability, pain, and/or stiffness. DISCUSSION Factors contributing to ACL failure may be classified as patient-related, surgeon-related, and biological factors. Of these, tunnel malposition and recurrent trauma are the most common causes. Detailed patient assessment, imaging, and studying details of the index surgery are critical prior to planning revision surgery. Infection has to be ruled out prior to planning any reconstructive surgical procedure. Osseous malalignment in the coronal or sagittal planes would also need correction along with or prior to revision ACL surgery. Revision ACL reconstruction maybe performed as a one-stage or two-stage procedure. Severe tunnel dilatation, infection, or arthrofibrosis necessitates a two-stage approach. Autografts are preferred for revision ACL due their lesser re-tear rates and better outcomes. Associated meniscus tears and cartilage injuries are more common in revision than in primary surgery and need to be managed appropriately. Extra-articular reconstruction for controlling anterolateral instability is frequently required as well. CONCLUSION Revision ACL reconstruction is a complex undertaking due to limited graft options, compromised anatomy and high frequency of associated injuries. Patient expectations must be tempered because functional outcomes and return to pre-injury sports are inferior to a primary surgery.
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Song GY, Ni QK, Zheng T, Zhang ZJ, Feng H, Zhang H. Slope-Reducing Tibial Osteotomy Combined With Primary Anterior Cruciate Ligament Reconstruction Produces Improved Knee Stability in Patients With Steep Posterior Tibial Slope, Excessive Anterior Tibial Subluxation in Extension, and Chronic Meniscal Posterior Horn Tears. Am J Sports Med 2020; 48:3486-3494. [PMID: 33112647 DOI: 10.1177/0363546520963083] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Steep posterior tibial slope (PTS; >13°), excessive anterior tibial subluxation (ATS) in extension (>10 mm), and meniscus posterior horn tears (MPHTs) have been identified to be associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure. Recent studies have reported that steep PTS is directly correlated with excessive ATS in extension and concomitant MPHTs, especially for those patients with chronic (>6 months) ACL deficiency. There is increasing biomechanical evidence that slope-reducing tibial osteotomy decreases ATS in extension and protects the ACL graft. HYPOTHESIS Slope-reducing tibial osteotomy combined with primary ACLR is effective for producing improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months). STUDY DESIGN Case series; Level of evidence, 4. METHODS Between June 2016 and January 2018, 18 patients with ACL injuries who had steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months) underwent slope-reducing tibial osteotomy combined with primary ACLR. The PTS and anterior subluxation of the lateral and medial compartment (ASLC and ASMC) in extension before and after the index procedures were regarded as primary clinical outcomes. Moreover, Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) objective grade, pivot-shift test, and KT-1000 side-to-side difference were evaluated preoperatively and at the minimum 2-year follow-up visit. RESULTS The mean PTS was 18.5° (range, 17°-20°) preoperatively and 8.1° (range, 7°-9°) postoperatively (P < .01). The mean ASLC and ASMC in extension were 12.1 mm and 11.9 mm preoperatively, which reduced to 1.0 mm and 1.5 mm at the last follow-up visit (P < .05). In addition, all of the following showed significant improvements (pre- vs postoperatively): mean Lysholm score (46.5 vs 89.5; P < .05), mean Tegner activity score (5.7 vs 7.3; P < .05), IKDC objective grading results (18 grade D vs 14 grade A and 4 grade B; P < .05), pivot-shift tests (15 grade 2+ and 3 grade 3+ vs 18 grade 0; P < .01), and KT-1000 side-to-side difference (13.0 mm vs 1.6 mm; P < .01). Moreover, no graft reruptures were found at the final follow-up visit. CONCLUSION In this study, slope-reducing tibial osteotomy combined with primary ACLR effectively improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months).
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Affiliation(s)
- Guan-Yang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Qian-Kun Ni
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Tong Zheng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Zhi-Jun Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Hua Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
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Preoperative planning by osteotomy master software helps to improve the accuracy of target limb alignment in high tibial osteotomy. J Orthop Surg Res 2020; 15:504. [PMID: 33138838 PMCID: PMC7607877 DOI: 10.1186/s13018-020-02033-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background The accuracy of targeted lower limb alignment correction following HTO is closely related to patients’ pain relief and knee joint survival time. How to accurately perform osteotomy and how to obtain the ideal target limb alignment to maximize the curative effect are the difficulty in HTO practice. The purpose of this study is to evaluate the predictive and application value of osteotomy master software (OsteoMaster) in coronal plane preoperative planning of high tibial osteotomy. Method Sixty-seven patients with medial compartment osteoarthritis and varus deformity treated by medial open-weight high tibial osteotomy were enrolled and divided into observation group (31 cases) and control group (36 cases). The observation group was planned by OsteoMaster, while the control group was planned by Miniaci. The preoperative predicted values of osteotomy depth, open height, correction angle, WBL ratio, and FTA of the observation group were compared with the actual intraoperative values to study their accuracy. The operative time, blood loss, number of fluoroscopy, and WBL ratio were compared between the observation group and the control group to study its application value. Result There was no significant difference between two groups in preoperative prediction and intraoperative reality of osteotomy depth, open height, correction angle, FTA, and WBL ratio (P > 0.05). The operation time and number of fluoroscopy in the observation group were significantly less than those in the control group (P < 0.05), while the difference in blood loss was not statistically significant (P > 0.05). The good rate of WBL ratio was 87.1% in the observation group and 75% in the control group. Conclusion OsteoMaster has predictive value in osteotomy depth, open height, correction angle, FTA, and WBL ratio of HTO, which is also helpful to reduce the number of fluoroscopy, shorten the operation time, and improve the accuracy of target limb alignment. The drawback of this approach is 2-dimensional approach in contrast to 3-dimensional preoperative planning that is including the more real study.
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Kii S, Sonohata M, Matsumura Y, Ide S, Shimazaki T, Hashimoto A, Nagamine S, Nakashima T, Tsuruta T, Mawatari M. Simultaneous medial closed wedge distal femoral osteotomy combined with anterior cruciate ligament reconstruction: Report of 2 cases. J Orthop Sci 2020; 28:703-709. [PMID: 33109436 DOI: 10.1016/j.jos.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Yosuke Matsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shuya Ide
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Takafumi Shimazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Akira Hashimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Satomi Nagamine
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Takema Nakashima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Toshiyuki Tsuruta
- Tsuruta Orthopaedic Clinic, 1241-6 Katsu, Ushizu-Machi, Ogi City, Saga, 849-0306, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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李 宇, 张 豪, 肖 世, 郑 秋, 曾 亚, 杨 洪. [Effectiveness comparison of LARS artificial ligament and autogenous hamstring tendon in one-stage reconstruction of anterior and posterior cruciate ligaments]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1018-1024. [PMID: 32794672 PMCID: PMC8171912 DOI: 10.7507/1002-1892.201908051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 03/03/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the effectiveness of arthroscopic one-stage reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with LARS artificial ligament and autogenous hamstring tendon, respectively. METHODS A retrospective study was performed on 23 patients with ACL and PCL injuries, who were treated with one-stage reconstruction, between June 2013 and June 2017. The ACL and PCL were reconstructed with LARS artificial ligament in 11 patients (artificial ligament group) and autogenous hamstring tendon in 12 patients (autogenous tendon group). There was no significant difference in gender, age, side of injury, cause of injury, time from injury to operation, and preoperative Lysholm score and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The operation time, the time of recovery of daily activities and preoperative exercise level, the occurrence of surgical-related complications, Lysholm score, IKDC score, and the results of knee stability assessment were recorded and compared between the two groups. RESULTS The operation time and the time of recovery of daily activities and preoperative exercise level were significantly shorter in artificial ligament group than in autogenous tendon group ( P<0.05). All incisions healed primarily. In autogenous tendon group, the common fibular nerve injury occurred in 1 case and intermuscular vein thrombosis occurred in 1 case. No complication occurred in the remaining patients of the two groups. All the patients were followed up 24-54 months (mean, 36.4 months). At last follow-up, the Lysholm score and IKDC score of the two groups were significantly higher than preoperative scores ( P<0.05). There was no significant difference between the two groups ( P>0.05). The varus and valgus stress tests of the two groups were negative. There was no significant difference in anterior drawer test, posterior drawer test, and Lachman test between the two groups ( P>0.05). CONCLUSION The effectiveness of arthroscopic one-stage reconstruction of ACL and PCL with LARS artificial ligament or autogenous hamstring tendon was similar. The knee function and stability recover well. But the patients with LARS artificial ligament reconstruction can resume daily activities and return to exercise earlier.
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Affiliation(s)
- 宇 李
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
- 宜宾市第一人民医院骨科(四川宜宾 644000)Department of Orthopedics, the First People’s Hospital of Yibin, Yibin Sichuan, 644000, P.R.China
| | - 豪 张
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 世卓 肖
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 秋 郑
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 亚兰 曾
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 洪彬 杨
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
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Klek M, Dhawan A. The Role of High Tibial Osteotomy in ACL Reconstruction in Knees with Coronal and Sagittal Plane Deformity. Curr Rev Musculoskelet Med 2019; 12:466-471. [PMID: 31760623 DOI: 10.1007/s12178-019-09589-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Coronal and sagittal malalignment in the setting of anterior cruciate ligament (ACL) deficiency alters knee biomechanics and is shown to increase stress and strain on the native ACL and on the ACL graft during reconstruction. The purpose of this review was to determine the role and indications of high tibial osteotomy to correct coronal and/or sagittal plane malalignment with ACL reconstruction. RECENT FINDINGS Recent literature illustrates that an increase in varus malalignment and increased posterior tibial slope increases the biomechanical stress that is seen in a native or reconstructed ACL graft. It has been proposed to correct the sagittal and coronal malalignment by employing a high tibial osteotomy either prior to or at the time of ACL reconstruction to correct these deformities and to decrease the stress placed on the reconstructed ACL graft. The use of high tibial osteotomy for deformity correction creates a more stable knee for ACL reconstruction and has been shown to have good outcomes with regard to post-operative pain, stability, satisfaction scores, and function.
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Affiliation(s)
- Michal Klek
- Department of Orthopaedics, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
| | - Aman Dhawan
- Department of Orthopaedics, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
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