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Sanchis-Alfonso V, Teitge RA. Decision Making and Management of Anterior Knee Pain in Young Patients With Pathological Femoral Anteversion: A Critical Analysis Review. J Am Acad Orthop Surg 2024:00124635-990000000-01046. [PMID: 39018576 DOI: 10.5435/jaaos-d-23-01155] [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: 12/01/2023] [Accepted: 05/13/2024] [Indexed: 07/19/2024] Open
Abstract
Pathological femoral anteversion (FAV) or femoral maltorsion is often overlooked as a cause of anterior knee pain (AKP). Therefore, it should be routinely evaluated during physical examination of the patient with AKP. FAV is a problem because it changes the direction of the quadriceps and thereby the force acting on the patellofemoral joint. The Murphy CT method comes closest to showing the anatomical reality when FAV is evaluated. The treatment of choice in a patient with AKP with symptomatic excessive FAV is the femoral derotational osteotomy. Before doing a derotational osteotomy, the hip joint should be evaluated to avoid hip pain. Currently, no scientific evidence supports the cutoff point at which derotational femoral osteotomy should be the treatment of choice in young patients with AKP with symptomatic pathological FAV. Furthermore, no evidence exists regarding the level at which the osteotomy must be done.
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Affiliation(s)
- Vicente Sanchis-Alfonso
- From the Department of Orthopedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain (Sanchis-Alfonso), and Emeritus, Wayne State University, Detroit, MI (Teitge)
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Gholinezhad S, Rasmussen J, Halloum A, Kold S, Rahbek O. A surface registration-based approach for assessment of 3D angles in guided growth interventions in the growing femur. J Exp Orthop 2024; 11:e12111. [PMID: 39076850 PMCID: PMC11284963 DOI: 10.1002/jeo2.12111] [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: 04/08/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose Postoperative assessment of surgical interventions for correcting femoral rotational deformities necessitates a comparative analysis of femoral rotation pre- and post-surgery. While 2D assessment methods are commonly employed, ongoing debate surrounds their accuracy and reliability. To address the limitations associated with 2D analysis, we introduced and validated a 3D model-based analysis method for quantifying the angular and rotational impact of corrective rotational osteotomy in the growing femur. Methods The method is based on surface registration of the pre- and post-intervention 3D femoral models. To this end, 3D triangulated surface models were generated using CT images for the right femurs of 11 skeletally immature pigs, each scanned at two distinct time points with a 12-week interval between scans. In our validation procedures, femoral corrective rotational osteotomy of the post-12-week femur was simulated at varying angles of 5, 10, 15 and 20 degrees in three dimensions. Subsequently, a surface 3D/3D registration-based approach was applied to determine the 3D femoral angulation and rotation between the two models to assess the method's detection accuracy of the predefined twist angles as ground truth references. Results The results document the precision and accuracy of the registration-based method in evaluating rotation angles. Consistently high accuracy was observed across all angles, with an accuracy rate of 92.97% and a coefficient of variance of 8.14%. Conclusion This study has showcased the potential for improving post-operative assessments with significant implications for experimental studies evaluating the effects of correcting rotational deformities in the growing femur. Level of Evidence Not applicable.
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Affiliation(s)
- Shima Gholinezhad
- Department of Orthopedic SurgeryAalborg University HospitalAalborgDenmark
- Department of MedicineAalborg UniversityAalborgDenmark
| | - John Rasmussen
- Department of Materials and ProductionAalborg UniversityAalborgDenmark
| | - Ahmed Halloum
- Department of Orthopedic SurgeryAalborg University HospitalAalborgDenmark
| | - Søren Kold
- Department of Orthopedic SurgeryAalborg University HospitalAalborgDenmark
- Department of MedicineAalborg UniversityAalborgDenmark
| | - Ole Rahbek
- Department of Orthopedic SurgeryAalborg University HospitalAalborgDenmark
- Department of MedicineAalborg UniversityAalborgDenmark
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Functional gait analysis reveals insufficient hindfoot compensation for varus and valgus osteoarthritis of the knee. INTERNATIONAL ORTHOPAEDICS 2023; 47:1233-1242. [PMID: 36840777 PMCID: PMC10079753 DOI: 10.1007/s00264-023-05738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/16/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The hindfoot is believed to compensate varus and valgus deformities of the knee by eversion and inversion movements. But these mechanisms were merely found in static radiologic measurements. The aim of this study was, therefore, to assess dynamic foot posture during gait using pressure-sensitive wireless insoles in patients with osteoarthritis of the knee and frontal knee deformities. METHODS Patients with osteoarthritis of the knee were prospectively included in this study. Patients were clinically and radiologically (mechanical tibiofemoral angle (mTFA), hindfoot alignment view angle (HAVA), and talar tilt (TT)) exa mined. Gait line analysis was conducted using pressure-sensitive digital shoe insoles. RESULTS Eighty-two patients (varus n = 52, valgus n = 30) were included in this prospective clinical study. Radiologically, the mTFA significantly correlated with the HAVA (cor = -0.72, p < 0.001) and with the TT (Pearson's cor = 0.32, p < 0.006). Gait analysis revealed that the gait lines in varus knee osteoarthritis were lateralized, despite the hindfoot valgus. In valgus knee osteoarthritis, gait lines were medialized, although the hindfoot compensated by varization. CONCLUSIONS Functional dynamic gait analysis could demonstrate that the hindfoot is not able to sufficiently compensate for frontal malalignments of the knee joint, contrary to static radiologic findings. This led to a narrowing of the joint space of the ankle medially in varus and laterally in valgus knee osteoarthritis.
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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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Hamad MN, Livshetz I, Sood A, Patetta M, Gonzalez MH, Amirouche FA. Effects of pelvic obliquity and limb position on radiographic leg length discrepancy measurement: a Sawbones model. J Exp Orthop 2022; 9:71. [PMID: 35881204 PMCID: PMC9325940 DOI: 10.1186/s40634-022-00506-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/12/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Potential sources of inaccuracy in leg length discrepancy (LLD) measurements commonly arise due to postural malalignment during radiograph acquisition. Preoperative planning techniques for total hip arthroplasty (THA) are particularly susceptible to this inaccuracy, as they often rely solely on radiographic assessments. Owing to the extensive variety of pathologies that are associated with LLD, an understanding of the influence of malpositioning on LLD measurement is crucial. In the present study, we sought to characterize the effects of varying degrees of lateral pelvic obliquity (PO) and mediolateral limb movement in the coronal plane on LLD measurement error (ME). Methods A 3-D sawbones model of the pelvis with bilateral femurs of equal-length was assembled. Anteroposterior pelvic radiographs were captured at various levels of PO: 0°, 5°, 10°, and 15°. At each level of PO, femurs were individually rotated medio-laterally to produce 0°, 5°, 10°, and 15° of abduction/adduction. LLD was measured radiographically at each position combination. For all cases of PO, the right-side of the pelvis was designated as the higher-side, and the left as the lower-side. Results At 0° PO, 71% of tested variations in femoral abduction/adduction resulted in LLD ME < 0.5-cm, while 29% were ≥ 0.5-cm, but < 1-cm. ME increased progressively as one limb was further abducted while the contralateral limb was simultaneously further adducted. The highest ME occurred with one femur abducted 15° and the other adducted 15°. Similar magnitudes of ME were seen in 98% of tested femoral positions at 5° of PO. The greatest ME (~ 1 cm) occurred at the extremes of right-femur abduction and left-femur adduction. At 10° of PO, a higher prevalence of cases exhibited LLD ME > 0.5-cm (39%) and ≥ 1-cm (8%). The greatest errors occurred at femoral positions similar to those seen at 5° of PO. At 15° of PO, half of tested variations in femoral position resulted in LLD ME > 1-cm, while 22% of cases produced errors > 1.5-cm. These clinically significant errors occurred at all tested variations of right-femur abduction, with the left-femur in either neutral position, abduction, or adduction. Conclusion This study aids surgeons in understanding the magnitude of radiographic LLD ME produced by varying degrees of PO and femoral abduction/adduction. At a PO of ≤5°, variations in femoral abduction/adduction of up to 15° produce errors of marginal clinical significance. At PO of 10° or 15°, even small changes in mediolateral limb position led to clinically significant ME (> 1-cm). This study also highlights the importance of proper patient positioning during radiograph acquisition, demonstrating the need for surgeons to assess the quality of their radiographs before performing preoperative templating for THA, and accounting for PO (> 5°) when considering the validity of LLD measurements.
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Affiliation(s)
- Mohammed Nazmy Hamad
- Department of Orthopedic Surgery, University of Illinois Chicago College of Medicine, 835 S. Wolcott Avenue, Chicago, IL, 60612, USA.
| | - Isaac Livshetz
- Orthopedic Surgery, White Plains Hospital Physician Associates, White Plains, NY, 10605, USA
| | - Anshum Sood
- Department of Orthopedic Surgery, University of Illinois Chicago College of Medicine, 835 S. Wolcott Avenue, Chicago, IL, 60612, USA
| | - Michael Patetta
- Department of Orthopedic Surgery, University of Illinois Chicago College of Medicine, 835 S. Wolcott Avenue, Chicago, IL, 60612, USA
| | - Mark H Gonzalez
- Department of Orthopedic Surgery, University of Illinois Chicago College of Medicine, 835 S. Wolcott Avenue, Chicago, IL, 60612, USA
| | - Farid A Amirouche
- Department of Orthopedic Surgery, University of Illinois Chicago College of Medicine, 835 S. Wolcott Avenue, Chicago, IL, 60612, USA
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Konrads C, Ahmad SS, Histing T, Ibrahim M. Iatrogenic ischiofemoral impingement due to high tibial osteotomy with overvalgization: a case report. J Med Case Rep 2022; 16:43. [PMID: 35115048 PMCID: PMC8815136 DOI: 10.1186/s13256-022-03257-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Open wedge high tibial osteotomy is a standard procedure for frontal realignment. It is indicated in varus knee with reduced mechanical medial proximal tibia angle. Overcorrection producing a mechanical medial proximal tibia angle out of the normal range (85–90°) is not recommended because this would lead to unphysiological joint-line orientation. Osteotomies around the knee also influence the adjacent ankle and hip joints. For the hip, it is known that frontal alignment of the leg influences the ischiofemoral space. A decreased ischiofemoral space can lead to painful impingement between the ischial bone and the lesser trochanter. Case presentation A 53-year-old German woman presented with severe ischiofemoral impingement symptoms and valgus malalignment of the left leg after open wedge high tibial osteotomy, which was indicated and performed by an orthopedic surgeon with intention to treat medial knee pain due to degenerative arthritis of the medial compartment years after medial meniscectomy. The mechanical medial proximal tibia angle was 100.5°. We performed closed wedge high tibial osteotomy producing a mechanical medial proximal tibia angle of 90.0° and normal joint-line orientation. The hip pain was gone immediately after the surgery, and the patient had no signs of ischiofemoral impingement or hip pain at last follow-up 12 months after closed wedge high tibial osteotomy. Conclusions Frontal realignment osteotomy around the knee can create problems at adjacent joints. Overvalgization of the proximal tibia made the patient compensate by hyperadduction of the hip to enable full foot sole contact with the floor. Hyperadduction of the hip decreased the ischiofemoral space, leading to severe impingement. Therefore, meticulous planning of osteotomies is important not to produce unphysiological situations or unwanted negative effects at the level of an adjacent joint.
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Affiliation(s)
- Christian Konrads
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Sufian S Ahmad
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.,Center for Musculoskeletal Surgery, Charité - University Medical Center Berlin, Berlin, Germany
| | - Tina Histing
- Department for Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Maher Ibrahim
- Department of Orthopaedic Surgery, Nyon Hospital, Nyon, Switzerland
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