Intra-Articular Osteotomy for Genu Valgum in the Knee with a Lateral Compartment Deficiency

Correction of lower limb deformity in an adult patient with Ellis-van Creveld syndrome: a rare case report

Ellis-van Creveld syndrome (EVC) is a rare disorder with marked valgus knee deformity, and orthopedic surgeons may experience challenges with lower limb treatment. Most previous reports have focused on EVC in childhood and few on its treatment in adulthood. Our patient was a 23-year-old woman with bilateral knee pain and gait abnormalities, with no history of orthopedic treatment. Valgus knee deformities with anterolateral depression of the lateral tibial plateaus and external rotation deformities of the lower legs were observed on radiography. We performed extra-articular osteotomy of the femurs and tibias and soft tissue release. Although the correction of each femur and tibia was good, mild valgus deformity of the lower limbs remained. This may be because the depression of the lateral tibial plateau was not repaired, and no postoperative remodeling was performed. However, 10 years post-surgery, no recurrence of the deformity was observed and walking was stable without pain.

Preservation of the posterolateral cortex may not affect the biomechanical stability of lateral intra-articular varus osteotomy of the proximal tibia

BACKGROUND

Lateral intra-articular varus osteotomy is an L-shaped osteotomy of the lateral tibial condyle to correct mild knee valgus and lateral plateau malunion of the proximal tibia. In order to minimize injury, it was modified to preserve the posterolateral cortex and the upper tibiofibular joint. The aim of this study was to evaluate the stability of modified lateral intra-articular varus osteotomy by comparing the biomechanical strength with lateral intra-articular varus osteotomy.

METHODS

Twenty-four synthetic tibia models were divided into 2 groups based on osteotomy type. Each model was then fixed with 2 commonly used plate systems. Biomechanical tests were conducted to measure parameters including construct stiffness, wedge displacement, and the number of failed specimens, and the results were compared among different groups.

FINDINGS

No significant difference was found in construct stiffness among all groups (P > 0.05). There was also no significant difference in wedge displacement among all groups (P > 0.05). When an axial load of 1500 N was applied, the number of failed specimens showed no significant difference among all groups (P > 0.05). The main failure pattern was additional fracture lines on the lateral tibial plateau.

INTERPRETATION

The findings indicate that there was no significant difference in stability between the 2 groups under the tested loading conditions. Furthermore, it appears that preserving the posterolateral cortex may have no impact on biomechanical stability.

Surgical Outcome of Complex Knee Deformity Correction in a Girl With Ellis-van Creveld Syndrome: A Report of a Rare Case

Ellis-van Creveld (EVC) syndrome is a rare inherited condition with inheritance, which is autosomal recessive in nature and is also described as skeletal dysplasia (chondroectodermal). The patients present with a grave genu valgum deformity which is a major challenge in orthopedics. The current case report presents a young girl of the juvenile age group who came with deformity over the bilateral lower limb with difficulty in walking and bilateral upper limb polydactyly. The patient underwent relevant investigations and examinations which were suggestive of bilateral genu valgum deformity. Since the deformity was significant, a corrective osteotomy with soft tissue release was planned followed by rehabilitative physiotherapy. Considering the extensive nature of the surgery, a staged procedure was planned. The patient on follow-up presented with a good range of motion and improved gait. Various treatment modalities have been described for the correction of the deformity but few of them are done in patients with EVC syndrome and they state varying results and high incidences of relapse. The present study focuses on corrective osteotomy with soft tissue release as a treatment modality and describes the outcome associated with the modality. Thus, stating that with proper planning and postoperative rehabilitation the patient can achieve a good functional outcome.

Posterolateral Complex Reconstruction With Distal Femoral Varus Opening-Wedge Osteotomy for Unstable Neglected Multiligamentous Knee Injury With Valgus Malalignment

We presented a case of a 25-year-old woman with early posttraumatic degenerative change to the articular cartilage accompanied with valgus malalignment despite receiving anterior cruciate ligament reconstruction after a multiligamentous injury sustained 2 years earlier. Rapid deteriorating valgus malalignment may result from chronic instability and intra-articular bone loss. Simultaneous distal femoral varus osteotomy and posterolateral complex reconstruction were performed during a single surgery. Six months after the surgery, the patient could walk briskly and climb stairs without any discomfort. Salvage procedures and biological reconstruction could be the primary choice for young patients to recover their knee function while avoiding joint replacement.

Intra-articular corrective osteotomies combined with the Ilizarov technique for the treatment of deformities of the knee

Aims

To present our experience of using a combination of intra-articular osteotomy and external fixation to treat different deformities of the knee.

Patients and Methods

A total of six patients with a mean age of 26.5 years (15 to 50) with an abnormal hemi-joint line convergence angle (HJLCA) and mechanical axis deviation (MAD) were included. Elevation of a tibial hemiplateau or femoral condylar advancement was performed and limb lengthening with correction of residual deformity using a circular or monolateral Ilizarov frame.

Results

At a mean follow-up of 2.8 years (1.5 to 4.1), the mean HJLCA improved from 15.6° (10° to 23°) pre-operatively to 0.4° (0° to 2°). The mean MAD improved from 70.0 mm (20.1 to 118.5) pre-operatively to 9.1 mm (3 to 15). The mean tibiofemoral angle improved from 31.0° (8° to 54°) pre-operatively to 4.9° (2° to 8°). The mean limb-length discrepancy decreased from 6.3 cm (2.9 to 13.6) pre-operatively to 1.1 cm (0 to 5). All osteotomies and distraction zones healed without complications.

Conclusion

The use of intra-articular corrective osteotomies combined with the Ilizarov technique allowed correction of deformities of the knee joint with satisfactory HJLCA and overall mechanical axis in six patients with a good functional and cosmetic outcome in the short term. Cite this article: Bone Joint J 2017;99-B:204–10.