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Capella M, Sabatini L, Bosco F, Barberis L, Giustra F, Risitano S, Camazzola D, Massè A. A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies. Arch Orthop Trauma Surg 2023; 143:6685-6693. [PMID: 37505270 PMCID: PMC10541832 DOI: 10.1007/s00402-023-04997-6] [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: 10/23/2022] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Precise preoperative planning is mandatory when a double-level osteotomy (DLO) is required to correct a severe knee deformity. Literature does not report a validated planning method regarding DLO that could be performed directly on digital radiographs using simple measurement tools. This study aims to validate a novel DLO planning method called New Mikulicz-Joint Line (NM-JL) based on essential measurement tools, in which the correction angles are induced by the predicted post-operative joint line obliquity (JLO). METHODS Twenty-three patients who satisfied the inclusion criteria were enrolled. NM-JL planning method was performed using basic measurement tools to detect corrective angles and gaps. The correction was then simulated using a Virtual Segmentation Software method to obtain the osteotomy fragments. Both planning procedures were performed independently and later repeated by two orthopaedic surgeons to assess the inter and intra-observer reliability. RESULTS The intraclass correlation coefficient (ICC) regarding corrective angles and gaps showed a significant positive correlation between the values determined using the two procedures by both raters (p < 0.05). Pearson's correlation analysis revealed a significant correlation between the measured results of the two planning methods. (p < 0.05). Finally, the Bland-Altman analysis showed an excellent agreement (p < 0.05) for all measurements performed. CONCLUSIONS The NM-JL method showed high values of intra and inter-rater reliability. The procedure is built up starting from the predicted value of post-operative joint line obliquity, allowing to maintain this parameter fixed. Other advantages include the quickness, adaptability, and possibility to be performed on any Digital Imaging and Communication in Medicine (DICOM) viewer. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
| | - Luca Barberis
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Daniele Camazzola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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Wang H, Man Q, Gao Y, Xu L, Zhang J, Ma Y, Meng Q. The efficacy of medial meniscal posterior Root tear Repair with or without high tibial osteotomy: a systematic review. BMC Musculoskelet Disord 2023; 24:464. [PMID: 37280599 DOI: 10.1186/s12891-023-06520-9] [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: 01/19/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with obvious varus alignment are at an increased risk for MMPRT and can suffer from a greater degree of medial meniscus extrusion, which leads to the development of osteoarthritis following repair. The efficacy of high tibial osteotomy (HTO) as a means of correcting this malformation, and its potential benefits for MMPRT repair, remains unclear. PURPOSE To explore whether HTO influenced the outcome of MMPRT repair in clinical scores and radiological findings. STUDY DESIGN Systematic review. METHODS According to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of MMPRT repair and extracted data about characteristics of patients, clinical functional scores and radiologic outcomes. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the results of MMPRT repair with exact mechanical axis (registered in the International Prospective Register of Systematic Reviews, CRD42021292057). RESULTS Fifteen studies with 625 cases of high methodological quality were identified. Eleven studies were assigned to the MMPRT repair group (M) with 478 cases performing MMPRT repair only, and others belonged to the MMPRT repair and HTO group (M and T) performing HTO and MMPRT repair. Most of the studies had significantly improved clinical outcome scores, especially in M groups. And the radiologic outcomes showed that the osteoarthritis deteriorated in both groups with similar degree in about 2-year follow-up. CONCLUSION HTO is a useful supplement in treating MMPRT patients with severe osteoarthritis and the clinical and radiological outcomes were similar with MMPRT repair alone. Which would be better for patients' prognosis generally, performing MMPRT repair alone or a combination of HTO and MMPRT repair, was still controversial. We suggested taking K-L grade into account. Large-scale randomized control studies were called for in the future to help make better clinical decisions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hangle Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Qian Man
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Peking Unversity First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
| | - Yitian Gao
- Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Lingyi Xu
- Peking Unversity First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
| | - Jingwei Zhang
- Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Yong Ma
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China.
| | - Qingyang Meng
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China.
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Risitano S, Cacciola G, Capella M, Bosco F, Giustra F, Fusini F, Indelli PF, Massé A, Sabatini L. Comparison between gaits after a medial pivot and posterior stabilized primary total knee arthroplasty: a systematic review of the literature. ARTHROPLASTY 2023; 5:15. [PMID: 36927464 PMCID: PMC10022170 DOI: 10.1186/s42836-023-00165-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most performed orthopedic procedures worldwide. While excellent efficacy has been reported, about 20% of patients are not satisfied with the result. A potential cause is the problematic reproduction of knee kinematics. This systematic review examines gait analysis studies in primary medial pivot (MP) and posterior stabilized (PS) TKAs to investigate the differences between the two prosthesis designs. METHODS A systematic review was conducted by following PRISMA guidelines. Five databases (PubMed, Medline, Embase, Scopus and the Cochrane Database of Systematic Reviews) were analyzed, and eligible articles were evaluated in terms of the levels of evidence. The methodological quality of the articles was assessed by using the MINORS scoring. This review was registered in PROSPERO. RESULTS Nine studies were included. Gait analysis was performed in 197 MP TKA and 192 PS TKA patients. PS TKA cases showed (P < 0.05) a significantly higher peak of knee flexion angle during the swing phase, greater knee flexion angle at toe-off, an increased knee adduction angle, higher knee flexion and extension moment, increased anterior femoral roll during knee flexion and anterior translation on medial and lateral condyle during knee flexion compared to MP TKA. MP TKA showed statistically significant (P < 0.05) higher knee rotational moment and greater tibiofemoral external rotation motion during knee flexion than PS TKA. No statistically significant difference (P > 0.05) was reported regarding gait spatial-temporal parameters. The Forgotten Joint Score (FJS) and Western Ontario and McMaster Universities Comparison in terms of Arthritis Index (WOMAC) score (mean stiffness) showed that MP TKA yielded significantly better results than PS TKA. CONCLUSIONS This systematic review revealed significant kinematic and kinetic differences between MP and PS TKA at all gait analysis phases. Furthermore, the considerable difference between TKA design and the kinematics of healthy knee were highlighted in this study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Salvatore Risitano
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy. .,Department of Orthopaedic Surgery and Traumatology, CTO Hospital of Turin, Città Della Salute E Della Scienza, 10126, Turin, Italy.
| | - Giorgio Cacciola
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy
| | - Marcello Capella
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedic Surgery and Traumatology, CTO Hospital of Turin, Città Della Salute E Della Scienza, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco-ASL Città di Torino, Piazza del Donatore Di Sangue, 3, 10154, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco-ASL Città di Torino, Piazza del Donatore Di Sangue, 3, 10154, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic Surgery, Regina Montis Regalis Hospital, 12084, MondovìCuneo, Italy
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA, 94304, USA
| | - Alessandro Massé
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedic Surgery and Traumatology, CTO Hospital of Turin, Città Della Salute E Della Scienza, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedic Surgery and Traumatology, CTO Hospital of Turin, Città Della Salute E Della Scienza, 10126, Turin, Italy
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Bosco F, Giustra F, Crivellaro M, Giai Via R, Lavia AD, Capella M, Sabatini L, Risitano S, Rovere G, Massè A, Vaishya R. Is augmentation the best solution in partial anterior cruciate ligament tears? A literature systematic review and meta-analysis. J Orthop 2023; 36:11-17. [PMID: 36578974 PMCID: PMC9791693 DOI: 10.1016/j.jor.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose The appropriate management of partial anterior cruciate ligament (ACL) tears is still debated. There is a tendency in orthopedic clinical practice to prefer complete ACL reconstruction, while few surgeons perform ACL augmentation. The purpose of the present study is to evaluate the current evidence on the effectiveness of ACL augmentation compared with standard ACL reconstruction to assess whether ACL augmentation may be the treatment of choice in partial ACL injury. Methods According to PRISMA guidelines, literature research was performed in PubMed/Medline, Cochrane Library, Embase, Scopus, and Web of Science databases. A PICOS model was used, and a preliminary search resulted in 1101 articles. The methodological quality was assessed through ROBINS-I. A meta-analysis was conducted on postoperative Tegner, Lysholm scores and KT-1000 values between ACL augmentation and ACL reconstruction, and a p < 0.05 has been assumed as statistically significant. PROSPERO, ID: CRD42022343502. Results Seven papers were included. A total of 472 knees underwent ACL reconstruction, and 311 underwent ACL augmentation. A statistically significant discrepancy was found in the postoperative Tegner score in favor of ACL augmentation compared with ACL reconstruction (p < 0.05). Regarding the postoperative Lysholm score and KT-1000 measurement, no statistically significant difference was shown between ACL reconstruction and ACL augmentation (p > 0.05). Conclusions ACL augmentation has proved to be an effective and safe procedure and should be preferred to ACL reconstruction in partial ACL tears for the tendency to achieve better functional outcomes.
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Affiliation(s)
- Francesco Bosco
- Orthopaedic and Traumatology Department, Orthopaedic and Trauma Center, University of Turin, Italy
| | - Fortunato Giustra
- Orthopaedic and Traumatology Department, Orthopaedic and Trauma Center, University of Turin, Italy
| | - Michele Crivellaro
- Orthopaedic and Traumatology Department, Orthopaedic and Trauma Center, University of Turin, Italy
| | - Riccardo Giai Via
- Orthopaedic and Traumatology Department, Orthopaedic and Trauma Center, University of Turin, Italy
| | | | - Marcello Capella
- Orthopaedic and Traumatology Department, Orthopaedic and Trauma Center, University of Turin, Italy
| | - Luigi Sabatini
- Orthopaedic and Traumatology Department, Orthopaedic and Trauma Center, University of Turin, Italy
| | - Salvatore Risitano
- Orthopaedic and Traumatology Department, Orthopaedic and Trauma Center, University of Turin, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Massè
- Orthopaedic and Traumatology Department, Orthopaedic and Trauma Center, University of Turin, Italy
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Ciapini G, Simonettii M, Giuntoli M, Varchetta G, De Franco S, Ipponi E, Scaglione M, Parchi PD. Is the Combination of Platelet-Rich Plasma and Hyaluronic Acid the Best Injective Treatment for Grade II-III Knee Osteoarthritis? A Prospective Study. Adv Orthop 2023; 2023:1868943. [PMID: 36938102 PMCID: PMC10023227 DOI: 10.1155/2023/1868943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/21/2023] Open
Abstract
Background Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients' quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration. Materials and Methods Sixty cases with grade II-III knee osteoarthritis according to the Kellgren-Lawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment. Results At 6-month follow-up, Group C (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded. Conclusion The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone.
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Affiliation(s)
- Gianluca Ciapini
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Matteo Simonettii
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Michele Giuntoli
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Giorgio Varchetta
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Silvia De Franco
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
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Tibial Derotational Osteotomy for Patellofemoral Instability: A Systematic Review. Adv Orthop 2022; 2022:8672113. [PMID: 36620474 PMCID: PMC9812606 DOI: 10.1155/2022/8672113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/15/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction The etiology of patellofemoral (PF) instability is multifactorial. Excessive external tibial torsion has been associated with recurrent patellar subluxation and persistent anterior knee pain. Several surgical techniques have been historically used to correct this, including medial patellofemoral ligament reconstruction, tibial tuberosity transfer (TTT), trochleoplasty, and tibial derotation osteotomy (TDO). The purpose of this systematic review is to investigate the safety and efficacy of TDO for PF instability and pain. Methods A thorough search of the literature was conducted on July 15, 2022. Seven studies met the inclusion criteria for this systematic review. Results Among the included studies, there were 179 total subjects and 204 operative knees. Mean follow-up time was 66.31 months (range 11-192). Complication rate was low (12.8%) in studies that reported complications. Average degree of anatomical correction in the transverse plane was 19.9 degrees with TDO. This increased to 34 degrees when combined with TTT. All PROMs assessed were significantly increased postoperatively (p < 0.05). Age greater than 25 years and advanced PF chondromalacia may negatively affect postoperative outcomes. Conclusion The primary findings of this review were as follows: (1) TDO results in significantly improved pain and PROM ratings in patients with PF pain and/or instability, (2) the likelihood of complication, including recurrent patella subluxation after TDO, is low but may be increased by aging, and (3) the successful anatomical correction of TDO may be augmented by concurrent TTT in some cases.
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Kim KY, Huh YG, Ma SH, Yoon JH, Jeong KY, Park DY, Yoon SH. Efficacy of Adductor Canal Block on Medial Knee Pain in Patients with Knee Osteoarthritis: A Randomized Single-Blind Placebo-Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15419. [PMID: 36430138 PMCID: PMC9696118 DOI: 10.3390/ijerph192215419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aimed to confirm the efficacy of ultrasound-guided adductor canal block (ACB) as a treatment option for medial knee pain caused by knee osteoarthritis (KOA). METHODS In total, 31 participants with medial knee pain due to KOA were randomized to either the ACB (ultrasound-guided ACB, n = 15) or placebo group (1 mL of 1% lidocaine, n = 16). The primary outcome was a numerical rating scale (NRS) for knee pain intensity comparing before and 4 weeks after injection. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), average daily number of analgesics consumed, average daily opioid consumption, and Timed Up and Go (TUG) test results before and 4 weeks after injection. RESULTS Participants' baseline characteristics were not significantly different between the groups, except for age. At 4 weeks post-injection, the NRS score in the ACB group significantly improved compared to that in the placebo group (p = 0.009). However, the WOMAC, average daily number of analgesics consumed, average daily opioid consumption, and TUG test results did not show significant differences. CONCLUSION ACB can be an effective treatment for reducing medial knee pain in patients with KOA.
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Affiliation(s)
- Ki-Yong Kim
- Department of Physical Medicine and Rehabilitation, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Yool-Gang Huh
- Department of Physical Medicine and Rehabilitation, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Sang Hyeok Ma
- Department of Physical Medicine and Rehabilitation, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Jong Hyeon Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Kil-Yong Jeong
- Department of Physical Medicine and Rehabilitation, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Do Young Park
- Department of Orthopedic Surgery, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Seung-Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University Medical Center, Suwon 16499, Republic of Korea
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Bosco F, Giustra F, Giai Via R, Lavia AD, Capella M, Sabatini L, Risitano S, Cacciola G, Vezza D, Massè A. Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03419-4. [PMID: 36308547 PMCID: PMC10368555 DOI: 10.1007/s00590-022-03419-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 05/16/2023]
Abstract
PURPOSE This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR. METHODS A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant. RESULTS Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found. CONCLUSION ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Riccardo Giai Via
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | | | - Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Daniele Vezza
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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