Patellofemoral cartilage defects are acceptable in patients undergoing high tibial osteotomy for medial osteoarthritis of the knee

High Tibial Osteotomy in Knee Reconstruction and Joint Preservation

High tibial osteotomy is a dynamic operation, used as an effective procedure in both joint preservation and knee stability. Applications and indications are expanding, with good results in the treatment of malalignment associated with arthrosis, knee instability, meniscus deficiency or transplants, and/or cartilage restoration. Appropriate patient selection and preoperative planning are critical to achieving good outcomes after surgery. Coronal and sagittal plane corrections made through the proximal tibia can effectively alter joint mechanics creating a more favorable environment for cartilage, meniscus, and ligamentous structures about the knee. Advancing techniques and technologies have allowed for more precise planning and execution of osteotomies.

Medial opening wedge high tibial osteotomy for the treatment of medial unicompartmental knee osteoarthritis: A state-of-the-art review

Medial unicompartmental knee osteoarthritis is a common condition that is frequently associated with significant pain and dysfunction. Medial opening wedge high tibial osteotomy (MOWHTO) offers a unique opportunity to preserve the knee joint and potentially alter the course of the degenerative process. Recent advances in this field of surgery have enabled surgeons to perform a MOWHTO in a safe, reliable and reproducible manner. This state-of-the-art review highlights the most important advances in the field of MOWHTO. Key concepts related to patient selection, pre-operative planning, surgical accuracy and patient outcome are considered. The importance of an individualized approach is emphasized and its influence on the future direction of the procedure is discussed.

Cartilage Degeneration of the Lateral Compartment of the Knee at Second-Look Arthroscopy Is Associated With Deterioration of 10-Year Clinical Outcomes After Opening-Wedge High Tibial Osteotomy

PURPOSE

To identify the arthroscopic findings associated with deterioration of 10-year clinical outcomes after opening-wedge high tibial osteotomy (OWHTO) in patients with knee osteoarthritis.

METHODS

A total of 114 consecutive knees of 91 patients with knee osteoarthritis who underwent OWHTO between 2007 and 2011 were retrospectively reviewed. Of these patients, those who underwent second-look arthroscopy and were followed up for a minimum of 10 years were enrolled. The Knee Society Score (KSS) and hip-knee-ankle angle were assessed. Cartilage status was graded at the time of osteotomy (first look) and plate removal (second look) according to the International Cartilage Repair Society (ICRS) grading system. The KSS knee subscale score and function subscale score were assessed separately, and on the basis of the changes in each of these scores from 1 to 10 years postoperatively and the minimal clinically important difference (MCID), the patients were divided into 2 groups: deteriorated (deterioration of score ≥ MCID) and non-deteriorated (deterioration of score < MCID).

RESULTS

Sixty-nine knees were included in this study. The mean knee score improved continuously from 48.7 ± 11.3 preoperatively to 86.8 ± 10.3 at 1 year (P < .001), 87.5 ± 9.9 at 5 years (P < .001), and 86.5 ± 10.5 at 10 years (P < .001) postoperatively. The mean function score also improved continuously from 62.5 ± 12.1 preoperatively to 90.7 ± 12.9 at 1 year (P < .001), 91.6 ± 12.1 at 5 years (P < .001), and 88.5 ± 13.1 at 10 years (P < .001) postoperatively. Three knees underwent conversion to total knee arthroplasty within 10 years postoperatively. The deteriorated KSS group showed significantly progressed ICRS grades in the lateral compartment compared with the non-deteriorated KSS group. The ICRS grade in the lateral compartment at second-look arthroscopy was identified as the only significant factor associated with both knee score deterioration (odds ratio, 4.89; P = .03) and function score deterioration (odds ratio, 3.91; P = .03) on multivariable logistic regression analysis.

CONCLUSIONS

The presence of cartilage degeneration of the lateral compartment of the knee at second-look arthroscopy is associated with deterioration of long-term clinical outcomes after OWHTO.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament

BACKGROUND

The tibial stop of anterior cruciate ligament (ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine, which is located between the anterior horn of the medial and lateral meniscus. The incidence of this fracture is low previously reported, which is common in children and adolescents. With the increase of sports injury and traffic injury and the deepening of under-standing, it is found that the incidence of the disease is high at present.

AIM

To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.

METHODS

Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People's Hospital from April 2018 to June 2020 were retrospectively analyzed. According to the surgical methods, they were divided into group A (40 cases) and group B (36 cases). Patients in group A were treated with arthroscopic high-strength non-absorbable suture, and patients in group B were treated with small incision open reduction and internal fixation. The operation time, fracture healing time, knee joint activity and functional score before and after operation, and surgical complications of the two groups were compared.

RESULTS

The operation time of group A was higher than that of group B, and the difference was statistically significant (P < 0.05); the fracture healing time of group A was compared with that of group B, and the difference was not statistically significant (P > 0.05); The knee joint function activity was compared between two groups before operation, 3 mo and 6 mo after operation, and the difference was not statistically significant (P > 0.05); the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation (P < 0.05); the limp, support, lock, instability, swelling, upstairs, squatting, pain and Lysholm score were compared between the two groups before and 6 mo after operation, and the difference was not statistically significant (P > 0.05); the scores of limp, support, lock, instability, swelling, upstairs, squatting, pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation (P > 0.05); the surgical complication rate of group A was 2.63%, which was lower than 18.42% of group B, and the difference was statistically significant (P > 0.05).

CONCLUSION

Both small incision open reduction and internal fixation and arthroscopic high-strength non-absorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures. The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer, but the complication rate is lower.