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Chen P, Yu J, Guo H, Yuwen P, Zhu Y, Zhang Y. Clinical outcome after open-wedge high tibial osteotomy: comparison of double-triangle locking compression plate (DT-LCP) and T-shaped locking compression plate (T-LCP). BMC Musculoskelet Disord 2024; 25:609. [PMID: 39085837 PMCID: PMC11292875 DOI: 10.1186/s12891-024-07658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The objective of this study was to compare the clinical outcomes of two internal fixation methods for high tibial osteotomy (HTO): double-triangle locking compression plate (DT-LCP) and T-shaped locking compression plate (T-LCP). METHODS 202 adult patients in our hospital between January 2018 and December 2021 were included and followed up for at least one year: group 1(DT-LCP, 98 patients) and group 2 (T-LCP, 104 patients). Detailed information on demographics, preoperative and postoperative follow-up, surgical procedures, and complications were collected. The information of the International Knee Documentation Committee Knee Evaluation Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected before surgery and at the last follow-up. RESULTS A total of 202 patients were included in the per-protocol analysis. No significant difference was found in terms of demographic data between groups, except for age and BMI. Clinically relevant improvements in knee pain were reached up to last follow-up after the operation in both groups. The mean pain scores (KOOS, WOMAC) at the final follow-up were significantly higher among group 1 compared to group 2 (P = 0.040 and P = 0.023). Furthermore, the DT-LCP internal fixation exerted more excellent effects on other symptoms, function and quality of life than T-LCP internal fixation. CONCLUSIONS Our study demonstrated that DT-LCP provided better clinical performance due to its implant irritant pain, compared with T-LCP. Thus, DT-LCP is a feasible alternative for the fixation of OW-HTO.
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Affiliation(s)
- Pengzhao Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Jiahao Yu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Haichuan Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Peizhi Yuwen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang 050051, Hebei, People's Republic of China.
- Chinese Academy of Engineering, Beijing 100088, People's Republic of China.
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Lee DW, Kang SJ, Kim RJ, Cho SI, Moon SG, Yang SJ, Kim JG. Clinical and Radiological Outcomes of Medial Meniscal Allograft Transplantation Combined With Realignment Surgery. Am J Sports Med 2024; 52:2260-2269. [PMID: 38910353 DOI: 10.1177/03635465241255346] [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: 06/25/2024]
Abstract
BACKGROUND The outcomes of medial meniscal allograft transplantation (MMAT) combined with high tibial osteotomy (HTO) compared with isolated MMAT remain unclear. PURPOSE To compare the clinical and radiological results of MMAT combined with HTO and isolated MMAT. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective study included 42 consecutive patients, who were divided into group M (isolated MMAT; n = 22) and group H (MMAT combined with HTO with a varus angle >3°; n = 20). Group differences in subjective knee scores, isokinetic muscle strength test, and radiological outcomes (Kellgren-Lawrence grade, mechanical axis, graft extrusion, graft status, and articular cartilage loss) were compared. RESULTS The mean follow-up period was 29.2 ± 4.9 months and 27.4 ± 5.3 months for groups M and H, respectively. The Lysholm score improved from 55.4 ± 9.5 to 81.3 ± 9.7 and from 52.6 ± 8.9 to 84.2 ± 10.2 in groups M and H, respectively (both P < .001). The International Knee Documentation Committee subjective score improved from 51.4 ± 10.3 to 79.6 ± 9.4 and from 49.3 ± 11.4 to 81.4 ± 8.3 in groups M and H, respectively (both P < .001). Both groups showed no significant differences in subjective knee scores and isokinetic extensor strength at the final follow-up. The rate of preoperative and postoperative high International Cartilage Regeneration & Joint Preservation Society grade (≥3) did not differ between the 2 groups. Group M showed greater coronal graft extrusion than did group H (3.3 ± 0.7 mm vs 2.7 ± 0.8 mm; P = .014); the rate of pathologic graft extrusion (≥3 mm) was not higher in group M (40.9%) than in group H (20%) with the number of patients available (P = .143). Both groups showed no significant difference in the graft status. Graft tears were observed in 2 patients (9%) in group M and 1 patient (5%) in group H (P = .607). CONCLUSION Clinical scores significantly improved after isolated MMAT and MMAT combined with HTO compared with preoperative values, and their short-term outcomes were similar. Postoperative graft extrusion was greater in patients who underwent isolated MMAT, implying that active correction of varus alignment during MMAT may help in intra-articular biomechanics.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Jin Kang
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Rak Jun Kim
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seung Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Gyu Moon
- Department of Radiology, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Jin Yang
- Department of Health and Exercise Management, Tongwon University, Gwangju-si, Gyeonggi-do, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
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McLean EJ, Cashmore RG. Novel crescentic, medial-closing, medially translating, centre-of-rotation-of-angulation-based, levelling osteotomy for lateral compartment stifle disease with partial cranial cruciate ligament tear in two dogs. N Z Vet J 2024; 72:162-169. [PMID: 38296654 DOI: 10.1080/00480169.2024.2308291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
CASE HISTORY Two mature, large breed dogs presented with chronic lameness and discomfort localised to the stifle. CLINICAL FINDINGS No hindlimb deformities were present on physical examination or radiographic evaluation. No stifle instability was present. Arthroscopy revealed severe (grade 5/5 modified Outerbridge score) cartilage erosion in the lateral compartment (femorotibial), marked degeneration of the lateral meniscus and early cranial cruciate ligament disease in both patients. TREATMENT AND OUTCOME Medial-closing, medially translating, centre-of-rotation-of-angulation-based, levelling osteotomy (mcmtCBLO) was performed in both patients. The procedure aims to shift the pelvic limb's mechanical axis medially to reduce pressure in the lateral compartment while also reducing craniocaudal shear forces by lowering the tibial plateau angle.Eight weeks after surgery one patient's lameness had resolved while the other had improved significantly. Second-look arthroscopy performed at this time revealed fibrocartilage formation in the lateral compartment without progression of cruciate disease in both cases. At long-term follow-up (approximately 3 and 5 years), favourable outcomes (no or minimal lameness, mild or moderate osteoarthritis) were identified on the long-term owner survey, lameness examination and radiographs. CLINICAL RELEVANCE mcmtCBLO reduced or eliminated short- and long-term lameness in these two cases afflicted by concurrent lateral compartment and early cranial cruciate ligament disease.
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Affiliation(s)
- E J McLean
- Southpaws Specialty Surgery for Animals, Melbourne, Australia
| | - R G Cashmore
- Southpaws Specialty Surgery for Animals, Melbourne, Australia
- Melbourne Animal Referral Services, Melbourne, Australia
- Geelong Animal Referral Services, Geelong, Australia
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Mabrouk A, An JS, Kley K, Tapasvi K, Tapasvi S, Ollivier M. Combined knee osteotomy and cartilage procedure for varus knees: friend or foe? A narrative review of the literature. EFORT Open Rev 2024; 9:173-180. [PMID: 38457915 PMCID: PMC10958248 DOI: 10.1530/eor-23-0180] [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] [Indexed: 03/10/2024] Open
Abstract
Varus knees with associated cartilage pathologies are not uncommon scenarios that present to orthopaedic surgeons. There is no agreement on the ideal management of varus knees with concomitant cartilage pathology. Through a literature review, the authors tried to answer three main questions: On October 2022, OVID MEDLINE, EMBASE, and COCHRANE databases were searched. Clinical studies reporting on clinical, radiologic, or macroscopic cartilage regeneration following either isolated knee osteotomy or concomitant osteotomy and a cartilage procedure were reviewed. Despite controversies, the literature demonstrated favourable outcomes of combined knee osteotomy and a cartilage procedure in patients with substantial deformity and cartilage defects. Isolated high tibial osteotomy may induce cartilage regeneration in several scenarios and severities of concomitant malalignment and cartilage defects. There are recommendations that knee osteotomy should be added to a cartilage procedure when an extra-articular deformity of > 5° is detected. Some studies report good outcomes for combining a knee osteotomy with cartilage grafting, but they lack a control group of isolated osteotomy. There is still scarce of evidence on the influence of osteotomies on cartilage regeneration and the outcomes of concomitant osteotomy and different cartilage procedures vs isolated osteotomies. With advanced statistical evaluation (artificial intelligence, machine learning) of big datasets, more answers and better results will be delivered.
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Affiliation(s)
- Ahmed Mabrouk
- Mid Yorkshire Teaching Hospitals, Yorkshire, United Kingdom
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
| | - Jae-Sung An
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
| | | | | | | | - Matthieu Ollivier
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
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Lin L, Jiang S, Yang S, Yang G, Xie B, Zhang L. Identical clinical outcomes between neutral and classic targeted alignments after high tibial osteotomy in medial meniscus posterior root tear: a prospective randomized study. INTERNATIONAL ORTHOPAEDICS 2024; 48:427-437. [PMID: 37676496 DOI: 10.1007/s00264-023-05960-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE This study aimed to compare the clinical and radiographic outcomes and arthroscopic findings after high tibial osteotomy (HTO) between neutral and classic targeted coronal alignments in patients with medial meniscus posterior root tears (MMPRTs). METHODS Ninety-eight patients with MMPRT were prospectively enrolled in the final cohort and randomized into two groups. Fifty-two patients with the targeted alignment through the Fujisawa point (60-62.5% of the entire tibial plateau width measured from the medial side) during HTO were included in group A, whereas 46 patients with the targeted alignment through the point at 50-55% of the tibial plateau width were included in group B. The clinical and radiographic outcomes and second-look arthroscopic findings were statistically compared for comprehensive assessments. RESULTS After a mean follow-up of 37.1 months, we found no significant differences between the two groups regarding the final Lysholm (p = 0.205) and Hospital for Special Surgery scores (p = 0.084). However, we only observed significant differences between the two groups in terms of the final hip-knee-ankle angle, weight-bearing line ratio, and medial proximal tibial angle (p < 0.001). Second-look arthroscopy did not reveal a significant difference in meniscal healing rate (p = 0.786). CONCLUSIONS Performing HTO with the aim to achieve neutral alignment leads to similar clinical outcomes in patients with MMPRT compared to classic alignment. Although subsequent research is required, the current study provides clinical evidence for the safety and efficacy of the new targeted alignment during HTO, which may avoid long-term complications associated with overcorrection when using the traditional technique.
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Affiliation(s)
- Lan Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China
| | - Songli Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China
| | - Shengwu Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China.
| | - Guojing Yang
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, No.108, Wansong Road, Ruian, Wenzhou, 325200, China
| | - Bingju Xie
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, No.108, Wansong Road, Ruian, Wenzhou, 325200, China.
| | - Lei Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China.
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, No.108, Wansong Road, Ruian, Wenzhou, 325200, China.
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Jung SH, Jung M, Chung K, Kim S, Kang KT, Park J, Sim W, Choi CH, Kim SH. Preoperative joint line obliquity, a newly identified factor for overcorrection, can be incorporated into a novel preoperative planning method to optimise alignment in high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2024; 32:64-77. [PMID: 38226764 DOI: 10.1002/ksa.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The aim of this study was to analyse the factors associated with additional postoperative alignment changes after accurate bony correction by selecting only patients with well-performed bony correction as planned and develop a method of incorporating significant factors into preoperative planning. METHODS Among 104 consecutive patients who underwent medial open wedge high tibial osteotomy (MOWHTO) between October 2019 and July 2022, 61 with well-performed bony corrections were retrospectively reviewed. The major criterion for well-performed bony correction was a difference of <1° between the simulated medial proximal tibial angle (MPTA) and the actual postoperative MPTA as measured in three dimensions. Radiographic parameters, such as the joint line convergence angle (JLCA) and joint line obliquity (JLO), were measured preoperatively and postoperatively, utilising standing and supine whole lower extremity anteroposterior, valgus and varus stress radiographs. Multiple linear regression analysis identified the factors affecting alignment changes, and a prediction model was developed. A method for applying this prediction model to preoperative planning was proposed. RESULTS Preoperative JLCA on standing (preJLCAstd ), preoperative JLCA on 0° valgus stress radiograph (vgJLCA0 ), and preoperative JLO (preJLO) were significantly correlated with JLCA change (∆JLCA) (p < 0.001, p < 0.001, p = 0.006). The prediction model was estimated as ∆JLCA = 0.493 × (vgJLCA0 ) - 0.727 × (preJLCAstd ) + 0.189 × (preJLO) - 1.587 in. (R = 0.815, modified R2 = 0.646, p < 0.001). The proposed method resulted in a reduced overcorrection rate (p = 0.003) and an improved proportion of acceptable alignments (p = 0.013). CONCLUSION PreJLCAstd , vgJLCA0 and preJLO can be used to estimate ∆JLCA. PreJLO was recently identified as a significant factor associated with additional alignment changes. Utilising the proposed preoperative planning and a prediction model with these factors shows promise in calibrating postoperative alignment after MOWHTO. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Se-Han Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
- Skyve R&D LAB, Seoul, Republic of Korea
| | - Jisoo Park
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woongseob Sim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Reale D, Feltri P, Franceschini M, de Girolamo L, Laver L, Magalon J, Sanchez M, Tischer T, Filardo G. Biological intra-articular augmentation for osteotomy in knee osteoarthritis: strategies and results : A systematic review of the literature from the ESSKA Orthobiologics Initiative. Knee Surg Sports Traumatol Arthrosc 2023; 31:4327-4346. [PMID: 37330935 DOI: 10.1007/s00167-023-07469-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE To assess whether there is evidence supporting the use of augmentation strategies, either cartilage surgical procedures or injective orthobiologic options, to improve the results of osteotomies in knees with osteoarthritis (OA). METHODS A systematic review of the literature was performed on the PubMed, Web of Science and the Cochrane databases in January 2023 on osteotomies around the knee associated with augmentation strategies (either cartilage surgical procedures or injective orthobiologic options), reporting clinical, radiological, or second-look/histological outcomes at any follow-up. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS). RESULTS Out of the 7650 records identified from the databases, 42 articles were included for a total of 3580 patients and 3609 knees treated; 33 articles focused on surgical treatments and 9 on injective treatments performed in association with knee osteotomy. Out of the 17 comparative studies with surgical augmentation, only 1 showed a significant clinical benefit of an augmentation procedure with a regenerative approach. Overall, other studies showed no differences with reparative techniques and even detrimental outcomes with microfractures. Regarding injective procedures, viscosupplementation showed no improvement, while the use of platelet-rich plasma or cell-based products derived from both bone marrow and adipose tissue showed overall positive tissue changes which translated into a clinical benefit. The mean modified CMS score was 60.0 ± 12.1. CONCLUSION There is no evidence to support the effectiveness of cartilage surgical treatments combined with osteotomies in terms of pain relief and functional recovery of patients affected by OA in misaligned joints. Orthobiologic injective treatments targeting the whole joint environment showed promising findings. However, overall the available literature presents a limited quality with only few heterogeneous studies investigating each treatment option. This ORBIT systematic analysis will help surgeons to choose their therapeutic strategy according to the available evidence, and to plan further and better studies to optimize biologic intra-articular osteotomy augmentation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Davide Reale
- Ortopedia e Traumatologia, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
| | - Marco Franceschini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli-1, 40136, Bologna, Italy.
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
| | - Lior Laver
- Department of Orthopaedics, Hillel Yaffe Medical Center (HYMC), 38100, Hadera, Israel
- Arthrosport Clinic, Tel-Aviv, Israel
- Rappaport Faculty of Medicine, Technion University Hospital, Israel Institute of Technology, 32000, Haifa, Israel
| | - Jeremy Magalon
- Cell Therapy Department, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille (AP-HM), INSERM CIC BT 1409, 13005, Marseille, France
- INSERM, INRA, C2VN, Aix Marseille Univ, 13005, Marseille, France
- SAS Remedex, 13008, Marseille, France
| | - Mikel Sanchez
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
| | - Thomas Tischer
- Department of Orthopaedic Surgery, University of Rostock, 18051, Rostock, Germany
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
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Yoon KH, Song SJ, Hwang SH, Kim DH, Park CH. Additional anteromedial staple fixation prevents changes in the posterior tibial slope in retrotuberosity bi-planar open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:3956-3963. [PMID: 37100895 DOI: 10.1007/s00167-023-07427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To compare the changes in posterior tibial slope (PTS) between retrotuberosity biplane open-wedge high tibial osteotomies (RT-OWHTOs) with and without additional anteromedial staple fixation. METHODS Seventy-nine and 77 cases of RT-OWHTOs without (Group N) and with (Group S) additional staple fixation, respectively, were retrospectively reviewed. All procedures were performed using a locking spacer plate. Demographics and preoperative knee condition were similar between the groups. Clinically, the Western Ontario and McMaster Universities Arthritis Index and range of motion were evaluated preoperatively and 2 years postoperatively. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and PTS were evaluated preoperatively and within 2 years postoperatively. Hinge fractures were investigated using computed tomography at 2 weeks postoperatively. PTS loss was defined as the difference between the corresponding values at 2 weeks and 2 years postoperatively. The incidence of PTS failure (PTS loss ≥ ± 3°) was also investigated. RESULTS The clinical results were not significantly different between groups N and S preoperatively and 2 years postoperatively. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively; changes in these variables did not differ significantly between the groups. The incidence of hinge fractures, all of which were categorized as Takeuchi type 1, did not differ significantly. PTS loss within 2 years postoperatively was significantly greater in group N than in group S (1.0° vs. 0.1°; p < 0.01). The incidence of the PTS failure was 16.5% (13/79) and 2.6% (2/77) in groups N and S, respectively (p < 0.01). CONCLUSION Additional anteromedial staple fixation could prevent changes in the PTS in RT-OWHTO. It is a simple method for preventing an increase in the PTS after RT-OWHTO. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Sung Hyun Hwang
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Dae Hyeok Kim
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea.
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Clinical efficacy and feasibility of laser correction technology with an ordinary laser pen and surgical instrument box in open-wedge high tibial osteotomy. BMC Musculoskelet Disord 2022; 23:1019. [PMID: 36435822 PMCID: PMC9701429 DOI: 10.1186/s12891-022-05993-4] [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: 02/09/2022] [Accepted: 11/16/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Background
The clinical outcomes of open-wedge high tibial osteotomy (OWHTO) for medial knee osteoarthritis primarily depend on the corrective precision. The present study aimed to determine the efficacy and feasibility of laser correction technology with an ordinary laser pen and surgical instrument box.
Methods
This prospective and randomized trial included 71 patients randomly divided into laser (n = 36) and traditional groups (n = 35). In the laser group, the hip centre, knee (Fujisawa point), and ankle centre were located preoperatively using the surgical instrument box lid. The leg was aligned with an ordinary laser pen. In the traditional group, the lower limb alignment was corrected by a metal cable. Radiation exposure, operative time, and rate of outliers (lower limb force line does not pass through 62–66% of the lateral tibial plateau) were evaluated. The visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded. After 24 months, the femoral tibial angle (FTA), medial proximal tibial angle (MPTA), and posterior slope angle (PSA), were recorded. The Kaplan-Meier method was used to evaluate the survival time of affected knees, and postoperative complications were recorded.
Results
The radiation exposure, operative time and rate of outliers were lower in the laser correction group (P < 0.05). Six months postoperatively, the VAS and WOMAC scores were significantly improved in both groups (P < 0.001). At 24 months, the FTA, MPTA, and PSA were corrected in both groups (P < 0.001). There were no differences in the postoperative knee survival time from OWHTO to knee arthroplasty between the groups or postoperative complications (P = 0.53; P = 0.61).
Conclusions
Laser correction technology can effectively reduce radiation exposure, the operative time, and the rate of outliers (trial identification number (retrospectively registered): ChiCTR2200060480; date of register: 03/06/2022).
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Cazor A, Schmidt A, Shatrov J, Alqahtani T, Neyret P, Sappey-Marinier E, Batailler C, Lustig S, Servien E. Less risk of conversion to total knee arthroplasty without significant clinical and survivorship difference for opening-wedge high tibial osteotomies in varus knee deformities at 10-year minimum follow-up compared to closing-wedge high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 2022; 31:1603-1613. [PMID: 36038667 DOI: 10.1007/s00167-022-07122-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes and survivorship at minimum 10-year follow-up of patients undergoing primary valgisation high tibial osteotomy (HTO) for medial osteoarthritis (OA), treated by Opening-Wedge HTO (OW-HTO) or Closing-Wedge HTO (CW-HTO). METHODS This was a retrospective cohort study of consecutive patients presenting to a single institution undergoing HTO for isolated medial compartment OA. Two hundred and twenty three HTOs for isolated medial tibio-femoral OA were performed between January 2002 and December 2010. Patients were eligible if they had minimum 10-year follow-up and received either a CW or OW-HTO. Fifteen (6.7%) patients died and twenty-five (11.2%) were lost to follow-up. One hundred and eighty three (82.1%) patients were included in the final analysis and divided into two groups: OW-HTO (96/183; 52.4%) and CW-HTO (87/183; 47.6%). Range of motion, KSS, KOOS scores, and conversion to TKA rate were analyzed between groups. Both groups were comparable regarding age, arthrosis stage, gender, ASA score and BMI at the time of HTO. Survival analysis was conducted with re-intervention for TKA as the end point. RESULTS At the time of HTO, mean age was 55 years ± 7.9 (27-73.9) with 72.7% of patients being male. The mean follow-up was 13.3 years ± 2.7 (10-19). Sixty-four (34.9%) patients underwent TKA at a mean delay of 9.3 years ± 3 (3-16). The conversion to TKA rate was significantly higher in the CW-HTO group versus the OW-HTO group: 42.5% (37/87) versus 28.1% (27/96) (p = 0.04). The survival at 15-year follow-up was 59.2% in the OW-HTO group versus 54.6% in the CW-HTO group (n.s.). At 13-year follow-up, KSS Function score was significantly better in the OW-HTO (90.9 versus 82.4; p = 0.007). No significant difference was observed between the two groups regarding the KOOS score, KSS Knee Score and complication rate. CONCLUSION At mean follow-up of 13 years, no significant clinical and survivorship difference was observed between the two groups. The conversion to TKA was significantly lower following OW-HTO. Minor correction was associated with risk of requiring subsequent TKA. LEVEL OF EVIDENCE Retrospective case series, IV.
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Affiliation(s)
- A Cazor
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - A Schmidt
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.
| | - J Shatrov
- Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia Orthopaedic Research Institute, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - T Alqahtani
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - P Neyret
- Infirmerie Protestante, 3 rue Penthod, 69300, Lyon, France
| | - Elliot Sappey-Marinier
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - C Batailler
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - S Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.,IFSTTAR, LBMC UMR_T9406, Univ Lyon, Claude Bernard Lyon 1 University, 25 Avenue François Mitterand, Lyon, France
| | - E Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 29 Boulevard du 11 Novembre 1918, Lyon, France
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11
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Kang BY, Lee DK, Kim HS, Wang JH. How to achieve an optimal alignment in medial opening wedge high tibial osteotomy? Knee Surg Relat Res 2022; 34:3. [PMID: 35135631 PMCID: PMC8822774 DOI: 10.1186/s43019-021-00130-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used surgical treatment option for medial compartmental osteoarthritis with varus deformity. It is important that proper lower limb alignment is achieved. However, there has been no consensus about an optimal alignment in MOWHTO. Most studies suggest that achieving valgus alignment is necessary, and recent studies support slight valgus mechanical alignment of less than 3° of mechanical femorotibial angle. Overcorrection and undercorrection is not recommended for achieving good surgical outcomes. To prevent undercorrection and overcorrection in MOWHTO, the method of placing the weight-bearing line in the target range must be precise. There are several ways to place a weight-bearing line within the target range. While the most important factor for a successful MOWHTO is achieving an ideal mechanical axis correction, there are a few other factors to consider, including joint line obliquity, posterior tibial slope, ligament balancing, and patellar height. Several factors exist that lead to undercorrection and overcorrection. Preoperative amount of varus deformity, lateral hinge fracture, and fixation failure can result in undercorrection, while medial soft tissue laxity and the amount of correction angle and target point beyond hypomochlion can result in overcorrection. This study aimed to review the literature on optimal alignment in MOWHTO and report on the factors to be considered to prevent correction errors and how to achieve an optimal alignment.
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Affiliation(s)
- Byoung Youl Kang
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyeon Soo Kim
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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12
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Faber S, Angele P, Zellner J, Bode G, Hochrein A, Niemeyer P. Comparison of Clinical Outcome following Cartilage Repair for Patients with Underlying Varus Deformity with or without Additional High Tibial Osteotomy: A Propensity Score-Matched Study Based on the German Cartilage Registry (KnorpelRegister DGOU). Cartilage 2021; 13:1206S-1216S. [PMID: 33371734 PMCID: PMC8808839 DOI: 10.1177/1947603520982347] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Even though realignment procedures have gained popularity as concomitant techniques in cartilage repair approaches with underlying malalignment, the clinical efficacy has not been proven to full extent. METHODS Out of 5474 patients from the German Cartilage Registry, 788 patients with focal cartilage defects on the medial femoral condyle having received either no accompanying surgery or high tibial osteotomy (HTO) were identified. After a 1:1 propensity score matching, outcome of 440 patients was evaluated using KOOS (Knee Injury and Osteoarthritis Outcome Score), VAS (visual analogue scale), and satisfaction during the 3-year follow-up. RESULTS Patients having received a concomitant HTO had significantly higher postoperative KOOS values (12 months: 67.26 ± 15.69 vs.75.10 ± 16.12, P = 0.001; 24 months: 67.14 ± 23.85 vs. 77.11 ± 16.50, P = 0.010; 36 months: 74.40 ± 16.57 vs. 81.75 ± 14.22, P = 0.023) and lower pain levels (6 months: 3.43 ± 2.18 vs. 2.89 ± 2.15, P = 0.009; 12 months: 3.64 ± 2.20 vs. 2.17 ± 1.96, P < 0.001; 24 months: 4.20 ± 3.12 vs. 2.94 ± 2.45, P = 0.005; 36 months: 3.20 ± 2.18 vs. 2.02 ± 1.98, P = 0.003). One and 3 years postoperatively, concomitant HTO led to significantly higher satisfaction in patients. These advantages of accompanying HTO were also seen in the group of patients with a varus deformity of 5° or more, in which pain levels without concomitant HTO even increased during the 3-year follow-up. CONCLUSION The results of the present study underline the importance and safety of concomitant HTO in patients with cartilage defects and varus deformity. HTO should therefore be considered and recommended generously in patients with focal cartilage defects of the medial femoral condyle and varus deformity.
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Affiliation(s)
- Svea Faber
- OCM
- Orthopädische Chirurgie München,
Munich, Germany
| | - Peter Angele
- Sporthopaedicum, Berlin, Germany,Sporthopaedicum, Straubing,
Germany,Sporthopaedicum, Regensburg,
Germany,Klinik für Unfallchirurgie,
Universitätsklinikum, Regensburg, Bayern, Germany
| | - Johannes Zellner
- Klinik für Unfallchirurgie,
Caritas-Krankenhaus St. Josef Regensburg, Bayern, Germany
| | - Gerrit Bode
- Sporthopaedicum, Berlin, Germany,Sporthopaedicum, Straubing,
Germany,Sporthopaedicum, Regensburg,
Germany,Klinik für Orthopädie und Traumatologie,
Universitätsklinikum Freiburg, Baden-Württemberg, Germany
| | | | - Philipp Niemeyer
- OCM
- Orthopädische Chirurgie München,
Munich, Germany,Klinik für Orthopädie und Traumatologie,
Universitätsklinikum Freiburg, Baden-Württemberg, Germany,Philipp Niemeyer, OCM
- Orthopädische
Chirurgie München, Steinerstrasse 6, Munich, 812306, Germany.
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Yang HY, Kwak WK, Kang SJ, Song EK, Seon JK. Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy. Bone Joint J 2021; 103-B:1686-1694. [PMID: 34719267 DOI: 10.1302/0301-620x.103b11.bjj-2020-2130.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. METHODS We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. RESULTS Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). CONCLUSION Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686-1694.
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Affiliation(s)
- Hong-Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Woo-Kyoung Kwak
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Sung Ju Kang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Eun-Kyoo Song
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Jong-Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
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14
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Ryu DJ, Lee SS, Jung EY, Kim JH, Shin TS, Wang JH. Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy. Orthop J Sports Med 2021; 9:23259671211034151. [PMID: 34631902 PMCID: PMC8495530 DOI: 10.1177/23259671211034151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Soft tissue laxity around the knee joint has been recognized as a crucial factor affecting correction error during medial open-wedge proximal tibial osteotomy (MOWPTO). Medial laxity in particular, which represents the changes in joint-line convergence angle (JLCA), affects soft tissue correction. Purpose: The purpose of this study was to quantify medial laxity and develop a preoperative planning method that considers medial laxity. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed 139 knees in 117 patients who underwent navigation-assisted MOWPTO from January 2014 to July 2019 for symptomatic medial compartment osteoarthritis with varus alignment >5°. We compared the results of 2 preoperative planning methods: conventional Miniaci (n = 47) and latent medial laxity reduction (LMLR) (n = 92). We evaluated the incidence of undercorrection, acceptable correction, and overcorrection. The radiologic parameters were analyzed using multiple linear regression with a stepwise selection model to establish an equation for the optimal preoperative planning method. The intraclass correlation coefficients (ICCs) of intraobserver, interobserver, and intermethod reliability were calculated. Results: The Miniaci method showed a higher incidence of overcorrection (55.3%) than the LMLR method (22.8%) at postoperative 6 months (P = .0006). Multiple linear regression with a stepwise selection model revealed a high correlation coefficient (R2 = 0.888) for the following equation: Adjusted planned correction angle = 0.596 + 0.891 × Target correction angle – 0.255 × ΔJLCAvalgus. Upon simplification, the following equation showed the highest intermethod ICC value (0.991): Target correction angle – ⅓ΔJLCAvalgus, while the Miniaci method showed a relatively low ICC value of 0.875. Conclusion: There was a risk of overcorrection after MOWPTO using the conventional Miniaci method. An equation that considers medial laxity may help during preoperative planning for optimal correction during MOWPTO.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Republic of Korea
| | - Eui Yub Jung
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Joo Hwan Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Soo Shin
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Joon Ho Wang, MD, PhD, Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea ()
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15
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Grimm NL, Levy BJ, Jimenez AE, Arciero RA. Osteotomies for the Management of Medial Compartment Defects of the Knee. J Knee Surg 2020; 33:1164-1171. [PMID: 32583399 DOI: 10.1055/s-0040-1712985] [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] [Indexed: 02/07/2023]
Abstract
For nearly three-quarters of a century the proximal tibia osteotomy has been used as an effective treatment for cartilage injuries of the knee. Over this same timeframe several advancements have been made in our diagnostic, preoperative planning, and technical execution of this procedure. As such, good-to-excellent short-, mid-, and long-term outcomes have been reported. Since its inception, the most important step in deciding on this procedure is identifying the ideal candidate. This candidate should be a young patient (<55 years old), active, with isolated medial compartment arthrosis without significant comorbidities. With appropriate patient selection and careful preoperative planning, the patient should achieve excellent results and high satisfaction.
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Affiliation(s)
- Nathan L Grimm
- Pediatric & Adult Sports Medicine Surgeon, Idaho Sports Medicine Institute, Boise, Idaho.,Division of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Benjamin J Levy
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Andrew E Jimenez
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Robert A Arciero
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
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16
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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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