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Guo H, Li Q, Zhang Z, Feng A, Qin S, Liu L, Sun R, Wang X. Better clinical outcomes and return to sport rates with additional medial meniscus root tear repair in high tibial osteotomy for medial compartmental knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2024; 32:1753-1765. [PMID: 38643405 DOI: 10.1002/ksa.12180] [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: 10/23/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE This retrospective study aimed to investigate whether the repair of medial meniscus posterior root tears (MMPRTs) is effective for improving clinical outcomes and return to sports rates in young patients (50 years old or younger) with medial compartment knee osteoarthritis (KOA) and MMPRTs. METHODS Between 2016 and 2019, 153 patients with KOA and MMPRTs who underwent open-wedge high tibial osteotomy (OWHTO) were retrospectively included. The patients were divided into OWHTO combined with MMPRT repair (n = 73) and isolated OWHTO (n = 80) groups. Lysholm scores, Hospital for Special Surgery (HHS) scores, Tegner scores, flexion contracture, range of knee flexion, return to sports rates and postoperative complications were compared. Radiological outcomes, including hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and Kellgren-Lawrence (K-L) grade, were compared between the two groups. RESULTS After a mean follow-up of 30.1 ± 3.0 months, the OWHTO + Repair group observed better clinical outcomes compared with the OWHTO group (Lysholm score: 86.7 ± 7.4 vs. 81.6 ± 6.9, p = 0.023. HHS score: 85.4 ± 8.20 vs. 80.5 ± 7.1, p = 0.039). The OWHTO + Repair group had higher Tegner scores and return to sports rates than the OWHTO group (Tegner score: 6 vs. 5, p = 0.020; return to sports rates: 38% vs. 15%, p = 0.001). No fracture or major complications occurred. Radiological outcomes showed no significant differences between the two groups (HKA: 181.1 ± 2.7 vs. 180.1 ± 1.5 n.s; MPTA: 90.1 ± 1.8 vs. 89.2 ± 1.4, n.s; JLCA:1.9 ± 0.7 vs. 2.1 ± 0.7, n.s). CONCLUSIONS Additional MMPRT repair during OWHTO was associated with better clinical outcomes and higher rates of return to sports in young patients with medial compartment KOA and MMPRTs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hailong Guo
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Qingyu Li
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Zirui Zhang
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Ao Feng
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Shiqi Qin
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Lei Liu
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Ran Sun
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Xiaofeng Wang
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
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Ifarraguerri AM, Trofa DP, Piasecki DP, Fleischli JE, Saltzman BM. Perioperative non-opioid analgesia strategies after high tibial osteotomy: a systematic review of prospective studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2315-2330. [PMID: 38758390 DOI: 10.1007/s00590-024-04000-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Little is known about the optimal analgesia regimen after HTO. Thus, this study systematically reviewed the literature on clinical and patient-reported outcomes of pain management strategies for patients after HTO. METHODS A comprehensive search of the PubMed, Cochrane CENTRAL, and CINAHL databases was conducted from inception through September 2023. Studies were included if they evaluated pain reduction with analgesia strategies after HTO and were excluded if they did not report pain control outcomes. RESULTS Five studies with 217 patients were included. Patients with a multimodal intraoperative injection cocktail to the knee, femoral nerve block (FNB), or adductor canal block (ACB) for HTO had significant improvement in visual analog scale (VAS) and numerical rating scale (NRS) scores in the first 12 h postoperatively compared to controls. Patients on duloxetine had significantly lower NRS scores at 1, 7, and 14 days postoperatively and significantly lower nonsteroidal anti-inflammatory drug (NSAID) usage throughout the two-week postoperative period than the control group. Patients receiving an ACB had significantly lower opioid consumption than controls at 12 h postoperative. In patients with an FNB or ACB, no significant difference in quadriceps strength or time to straight leg raise postoperatively was observed compared to controls. CONCLUSION A multimodal periarticular injection cocktail, FNB, or an ACB effectively reduces pain on the first day after HTO, with an ACB able to reduce opioid consumption on the first postoperative day. Duloxetine combined with an ACB effectively decreases pain for two weeks postoperatively while reducing NSAID consumption in patients after HTO. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anna M Ifarraguerri
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, 622 West 168th St, PH 111-1130, New York, NY, 10032, USA
| | - Dana P Piasecki
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA.
- Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA.
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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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Choi YS, Chang MJ, Lee JH, Lee JH, D'Lima DD, Kim TW, Chang CB, Kang SB. Repair of medial meniscus posterior root tear is effective for root healing and cartilage regeneration in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:5799-5811. [PMID: 37940662 DOI: 10.1007/s00167-023-07637-z] [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: 07/30/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE This study aimed to determine whether the repair of a medial meniscus posterior root tear (MMPRT) is effective for MMPRT healing, cartilage regeneration, and clinical outcomes in opening wedge high tibial osteotomy (OWHTO). METHODS This retrospective study included 80 patients who underwent OWHTO and subsequent second-look arthroscopy. The patients were divided into OWHTO-with-MMPRT-repair (n = 40) and OWHTO alone (n = 40) groups, and the healing rates (complete/partial/failure) were compared. Each group was further divided into over- and under-corrected subgroups to compare healing rates. The International Cartilage Repair Society (ICRS) grade, cartilage defect size, Koshino stage, ICRS cartilage repair assessment score of the medial femoral condyle (MFC), and International Knee Documentation Committee (IKDC) scores between the OWHTO-with-MMPRT-repair and OWHTO alone groups were compared according to whether microfracture was performed on the MFC. RESULTS The overall healing rate of the MMPRT was higher in the OWHTO-with-MMPRT-repair group than that in the OWHTO alone group (P < 0.001). In addition, in the subgroup analysis, no difference in the MMPRT healing rate between the over-correction and under-correction groups when MMPRT repair was performed (n.s). In contrast, without MMPRT repair, the healing rate was lower in the under-correction group than that in the over-correction group (P = 0.03). Cartilage regeneration of the OWHTO-with-MMPRT-repair group was superior to that of the OWHTO alone group (P < 0.05). The IKDC subjective scores of the OWHTO-with-MMPRT-repair and OWHTO alone groups were 34.5 and 33.1 before surgery (n.s) and 50 and 47.2 at one year after surgery, respectively (n.s). These differences between the two groups for cartilage regeneration and IKDC subjective scores showed the same pattern regardless of microfractures. CONCLUSIONS MMPRT repair during OWHTO might improve MMPRT healing, even with under-correction, and cartilage regeneration of MFC, regardless of microfracture. However, OWHTO with MMPRT repair might not improve short-term clinical outcomes compared to OWHTO alone. Further randomized clinical trials are necessary. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Ji Han Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jae Hee Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea.
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Omae H, Yanagisawa S, Hagiwara K, Ogoshi A, Omodaka T, Kimura M, Chikuda H. Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy. Knee 2023; 45:117-127. [PMID: 37925802 DOI: 10.1016/j.knee.2023.10.011] [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: 07/01/2023] [Revised: 09/16/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The aim of this study was to compare the outcomes of pullout repair with a metal button and suture anchor repair for medial meniscus posterior root tears in patients undergoing high tibial osteotomy with varus alignment. METHODS Patients who underwent arthroscopic pullout repair (P group) and suture anchor repair (SA group) in combination with open-wedge high tibial osteotomy between 2018 and 2021 were retrospectively examined. Patients who received second-look arthroscopy at 1 year and at least 2 years of follow up were included. Structural healing (complete/partial or failed healing) and chondral lesions at the initial surgery and the second-look arthroscopy, radiographic parameters around the knee, Lysholm score, and Tegner activity scale (before and 2 years after surgery) were compared. RESULTS A total of 88 patients (68 women/20 men, mean age 61.1 ± 7.9 years old) were included in the analysis. Of these, 51 patients underwent pullout repair, while the other 37 underwent suture anchor repair. The SA group showed a significantly higher rate of complete healing (64.9%) than the P group (21.6%, P < 0.001). The Lysholm score significantly improved after surgery in both treatment groups. At the final follow up, the SA group had a significantly higher Lysholm score (89.6 ± 10.7) than the P group (80.9 ± 17.4, P = 0.011). CONCLUSION Arthroscopic suture anchor repair had superior healing status and Lysholm Score in comparison with pullout repair with a metal button, as it achieved better tension adjustment. This result is meaningful particularly when medial meniscus root repair and high tibial osteotomy are performed simultaneously.
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Affiliation(s)
- Hiroaki Omae
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
| | - Shinya Yanagisawa
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Keiichi Hagiwara
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Atsuko Ogoshi
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Takuya Omodaka
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Masashi Kimura
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Karatekin YS, Altinayak H. Assessment of Radiological Outcomes of Medial Meniscus Posterior Root Tears Associated With Meniscal Extrusions After Open Wedge High Tibial Osteotomy. Cureus 2023; 15:e46884. [PMID: 37954804 PMCID: PMC10636517 DOI: 10.7759/cureus.46884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Objective The aim of this study is to compare preoperative and postoperative radiological results in knees with medial meniscus posterior root tears (MMPRT) and varus alignment, with a particular emphasis on medial meniscal extrusion (MME), following high tibial osteotomy (HTO) without root repair. Method Patients who underwent open wedge HTO for medial compartment osteoarthritis between January 2015 and December 2020 were retrospectively reviewed. The inclusion criteria were defined as patients with preoperative and postoperative magnetic resonance imaging (MRI) and weight-bearing radiographs including radiological images of the entire lower extremity. After conducting data screenings, patients diagnosed with a preoperative MMPRT were included in the study. Patients underwent measurements of medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), and mechanical axis deviation (MAD) on anteroposterior radiographs encompassing the entire lower extremity during the preoperative and postoperative first year. In order to determine the degree of arthritis, The Kellgren-Lawrence (KL) grading system was employed on preoperative and the most recent anteroposterior knee radiographs of the patients. MME, the distance (in millimeters) between the peripheral border of the meniscus body (meniscocapsular junction) and the medial border of the tibial plateau, was measured and calculated on coronal MRI. Preoperative and postoperative measurements of MPTA, MAD, MME, and KL staging were compared. Results The study included a total of 21 patients, comprising 7 males and 14 females. Among these, 6 were left-sided and 15 were right-sided cases, with an average age of 52.2 (±6.1) years. The mean follow-up duration for the patients was 5.4 (±2.3) years, with an average time of 2.2 (±1.6) years from surgery to the MRI. While significant differences were observed between preoperative and postoperative measurements for MAD and MPTA (p <0.01), no significant difference was found in MME measurement (p: 0.507). Pearson correlation analysis was employed to determine the correlation between preoperative and postoperative values of MME, MPTA, and MAD. A significant negative correlation was observed between preoperative MME and MPTA (r: -0.464, p:0.034). No significant correlation was found between postoperative MME and MAD or MPTA. Comparisons based on KL staging between the preoperative and postoperative periods did not reveal any significant differences (p: 0.525). Conclusion In knees with both MMPRT and varus alignment, our study demonstrated that postoperative MME and radiological progression of arthritis did not increase after HTO without MMPRT repair. These findings suggest that HTO treatment performed without MMPRT repair may prevent an increase in MME and the progression of arthritis. According to the results of our study, we observed a negative correlation between MME and MPTA during the preoperative period, which supports the relationship between varus deformity and MME.
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Affiliation(s)
- Yavuz Selim Karatekin
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun, TUR
| | - Harun Altinayak
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun, TUR
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Itou J, Kuwashima U, Itoh M, Okazaki K. Open-wedge high tibial osteotomy with a slight valgus correction from neutral limb alignment achieves clinical improvements comparable with those for knees with varus deformity. J Exp Orthop 2023; 10:75. [PMID: 37515658 PMCID: PMC10386984 DOI: 10.1186/s40634-023-00640-w] [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: 05/19/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
PURPOSE The effect of open-wedge high tibial osteotomy (OWHTO) on the preoperative neutral alignment of the knee is unknown. The purpose of this study was to clarify the clinical outcome of OWHTO with neutral alignment, defined as within 4 degrees of varus. METHODS This retrospective study included 72 knees with varus that underwent medial OWHTO. The knees were divided according to the preoperative hip-knee-ankle angle into a neutral alignment group (≤ 4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score-12 (FJS-12) were evaluated preoperatively and during at least 2 years of follow-up postoperatively. RESULTS There were no significant differences between the preoperative FJS-12 (17.9 versus 23.7; p = 0.16) and postoperative FJS-12 (57.3 versus 60.6; p = 0.52) or KOOS subscale scores (p > 0.05) in the neutral alignment group or the varus alignment group. Each group had a mean change in the KOOS subscale scores that exceeded the minimum clinically important difference. CONCLUSION The short-term clinical results of OWHTO for neutral alignment were as favourable as those for varus malalignment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
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Choe JS, Bin SII, Kim JM, Lee BS, Song JH, Cho HK, Kee TH. Association of Medial Meniscal Volume With Decreased Joint Space Width After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2023; 11:23259671231166920. [PMID: 37223072 PMCID: PMC10201151 DOI: 10.1177/23259671231166920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 05/25/2023] Open
Abstract
Background Medial opening-wedge high tibial osteotomy (MOWHTO) reduces contact stress by altering the weightbearing axis from the medial to the lateral compartment, relieves knee pain, and slows the progression of osteoarthritis. Purpose/Hypothesis To evaluate whether the volume of the medial meniscus affects outcomes after MOWHTO. It was hypothesized that reduced medial meniscal volume would be associated with worse midterm clinical and radiographic outcomes. Study Design Cohort study; Level of evidence, 3. Methods Included were 59 patients who underwent MOWHTO and had ≥4 years of follow-up data. The mean follow-up period was 66.5 ± 15.1 months (range, 48-110 months). The cohort was classified into 3 groups according to the status of the medial meniscus on arthroscopic examination before osteotomy: no meniscal tear, degenerative tear leading to partial meniscectomy, and degenerative tear leading to subtotal meniscectomy. The Hospital for Special Surgery score and Knee Society objective and functional scores were compared among the groups at 2 time points (preoperative and latest follow-up), and the medial joint space width (JSW) was compared among the groups at 3 time points (preoperative, 1 year postoperative, and latest follow-up). Results Overall, 9 patients had no meniscal tear, 20 patients underwent partial meniscectomy, and 30 patients underwent subtotal meniscectomy. The clinical scores improved significantly from preoperatively to the latest follow-up (P ≤ .001 for all), with no significant difference among the groups. Post hoc analysis indicated that at the latest follow-up, JSW was significantly lower in the subtotal meniscectomy group compared with the no-tear group on both 45° of flexion posterior-anterior (2.5 ± 1.3 vs 3.9 ± 1.8 mm; P = .004) and anterior-posterior (3.4 ± 1.1 vs 4.5 ± 0.9 mm; P = .011) radiographs. Conclusion Subtotal meniscectomy of the medial meniscus performed during arthroscopic examination with MOWHTO was associated with decreased JSW at midterm follow-up. Efforts should be made to preserve the medial meniscus as much as possible during MOWHTO.
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Affiliation(s)
- Jung-Su Choe
- Department of Orthopedic Surgery, Cheju
Halla General Hospital, Jeju, Republic of Korea
| | - Seong-II Bin
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Ju-Ho Song
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Hyung-Kwon Cho
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Tae-Hong Kee
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
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Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A, Omodaka T, Omae H. Evaluation of the bone tunnel position and state of healing on second-look arthroscopy after pullout repair of medial meniscus posterior root tear during open-wedge high tibial osteotomy. Knee 2023; 42:220-226. [PMID: 37086538 DOI: 10.1016/j.knee.2023.03.016] [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: 12/11/2022] [Revised: 02/14/2023] [Accepted: 03/28/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the outcome of pullout repair of medial meniscus posterior root tear during open-wedge high tibial osteotomy, including the bone tunnel position and the state of healing on second-look arthroscopy. METHODS The cohort comprised 22 patients (six men, 16 women) who underwent arthroscopic root fixation by the transtibial pullout technique for medial meniscus posterior root tear during open-wedge high tibial osteotomy. The mean patient age was 63.7 years. The location of the tibial tunnel was assessed using a percentage-dependent method, and the location of a critical point was determined by two coordinates on CT. We defined the distance between the tibial tunnel center and the medial meniscal posterior root anatomic center as the TC-AC distance. The healing state was classified as complete, partial, or failed on second-look arthroscopy. Patients were categorized into those with complete or partial healing (group H) and those with failed healing (group F). The differences in the outcomes and characteristics of groups H and F were evaluated. RESULTS Twelve and 10 knees were classified into groups H and F, respectively. The bone tunnel position was significantly more posterior in group H than in group F. The TC-AC distance was significantly shorter in group H than in group F. CONCLUSIONS In pullout repair of medial meniscus posterior root tear during open-wedge high tibial osteotomy, it was considered important to create a bone tunnel position more posterior to increase the healing rate on second-look arthroscopy. LEVEL OF EVIDENCE Level Ⅳ.
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Affiliation(s)
- Shinya Yanagisawa
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan.
| | - Masashi Kimura
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Keiichi Hagiwara
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Atsuko Ogoshi
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Takuya Omodaka
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Hiroaki Omae
- Zensyukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
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Srimongkolpitak S, Chernchujit B. Posterior Root Medial Meniscus Tear With Medial Opening Wedge High Tibial Osteotomy: A Step-By-Step Systematic Arthroscopic Repair Technique. Arthrosc Tech 2022; 11:e1515-e1523. [PMID: 36185116 PMCID: PMC9519790 DOI: 10.1016/j.eats.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/07/2022] [Indexed: 02/03/2023] Open
Abstract
Medial meniscus root repair is often combined with correction of knee varus alignment by performing an opening wedge high tibial osteotomy (HTO) in patients with varus knee malalignment, particularly in those with suspected long-term medial meniscus root tear (MRT). Before planning a corrective alignment treatment, radiographic imaging of the knee alignment is recommended to assess a medial joint space and the tibiofemoral axis. Because HTO can reduce pressure on the repair site, new alignment may promote healing in the attachment of the MR repair. When HTO is used with meniscus root repair (MRR), the tunnel convergence remains a major concern. We describe an arthroscopic technique for treating chronic MRT with knee malalignment using the technique of arthroscopic posterior MRR with HTO. This approach was used to enhance anatomic healing of the meniscus root, decrease the load to the medial knee compartment to achieve MRR, and stop progressive osteoarthritis of the medial knee compartment.
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Affiliation(s)
- Surasak Srimongkolpitak
- Address correspondence to Surasak Srimongkolpitak, M.D., Department of Orthopedics, Faculty of Medicine, Queen Savang Vadhana Memorial Hospital, 209 Jermjormpol Road, Si Racha District, Chon Buri Province, Thailand 20110.
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11
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Itou J, Kuwashima U, Itoh M, Okazaki K. High tibial osteotomy for medial meniscus posterior root tears in knees with moderate varus alignment can achieve favorable clinical outcomes. J Exp Orthop 2022; 9:65. [PMID: 35796797 PMCID: PMC9263016 DOI: 10.1186/s40634-022-00504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Favorable clinical results have been reported following high tibial osteotomy (HTO) for medial meniscus posterior root tear (MMPRT) in knees with varus alignment. However, the effect on the preoperative neutral alignment of the knee is not known. This study sought to evaluate the clinical outcomes of medial open-wedge HTO for MMPRT with neutral alignment. Methods We retrospectively reviewed 119 medial open-wedge HTOs and analyzed 22 knees with MMPRT. The knees were divided according to the preoperative hip-knee-ankle angle into a moderate varus alignment group (≤4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score-12 (FJS-12) values were evaluated preoperatively and at the latest follow-up. The healing status of MMPRT at the time of second-look arthroscopy, performed at a mean of 15.4 ± 4.2 months, was compared with that after the primary HTO. Results There were 11 knees in the moderate varus alignment group and 11 in the varus alignment group. In terms of perioperative patient-reported outcome measures, there was no significant difference in the preoperative or postoperative KOOS subscale score or FJS-12 score between the moderate varus and varus alignment groups. The healing rate was significantly higher in the moderate varus alignment group. Conclusion Favorable clinical results were obtained by medial open-wedge HTO in knees with MMPRT and moderate varus alignment in the short term. Surgeons should consider the indications for medial open-wedge HTO, even with moderate varus alignment, when planning treatment for MMPRT with persistent knee pain. Level of evidence IV Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00504-9.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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12
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Goes RA, Cruz RS, Pavão DM, Vivacqua TA, Campos ALS, Maia PAV, Salim R, Rocha de Faria JL. Posterior-Medial Meniscal Root Repair Through Lateral Tibial Tunnel Combined With Medial Opening Osteotomy and Homologous Graft. Arthrosc Tech 2022; 11:e1321-e1333. [PMID: 35936854 PMCID: PMC9353535 DOI: 10.1016/j.eats.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/10/2022] [Indexed: 02/03/2023] Open
Abstract
When there is a rupture in the meniscal roots or close to them, the menisci suddenly and considerably reduce their capacity to absorb the axial mechanical load that passes through the knee, quickly leading to the development of a process of chondral degeneration. The varus deformity of the lower limb (when the mechanical axis crosses the medial compartment of the knee) favors this type of injury owing to the overload in the medial compartment. When the patient has both varus deformity and medial meniscal posterior root injury, there is a clear indication for surgical realignment of the affected lower limb. There is still not a consensus regarding combining meniscal root repair with corrective osteotomy, although there is a tendency to perform both procedures aiming at long-term joint preservation. We present a safe alternative technique for simultaneous medial meniscal posterior root repair using a lateral tibial transosseous tunnel associated with a valgus-producing high tibial osteotomy with homologous bone grafting, allowing a full return to daily activities and sports.
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Affiliation(s)
- Rodrigo Araújo Goes
- Sports Medicine Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - Raphael Serra Cruz
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - Douglas Mello Pavão
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | | | | | | | - Rodrigo Salim
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José Leonardo Rocha de Faria
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil,Address correspondence to José Leonardo Rocha de Faria, M.D., M.Sc., Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Av Brasil, 500, São Cristovão, Rio de Janeiro, Brazil, CEP 20940-070.
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Banovetz MT, Roethke LC, Rodriguez AN, LaPrade RF. Meniscal Root Tears: A Decade of Research on their Relevant Anatomy, Biomechanics, Diagnosis, and Treatment. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:366-380. [PMID: 35755791 PMCID: PMC9194705 DOI: 10.22038/abjs.2021.60054.2958] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022]
Abstract
A foundational knowledge of the anatomy and biomechanics of meniscal root tears is warranted for proper repair of meniscal root tears and for preventing some of their commonly described iatrogenic causes. Meniscal root tears are defined as either a radial tear occurring within one cm of the root attachment site of the meniscus or a complete bony or soft tissue avulsion of the root attachment altogether. Meniscal root tears disrupt the protective biomechanical function of the native meniscus. Biomechanical analyses of the current techniques for meniscal root repair highlight the importance of restoring menisci to their correct anatomic orientation, thereby restoring their biomechanical function. A comprehensive understanding of the clinical and radiographic presentations of these injuries is critical to preventing their underdiagnosis. The poor long-term outcomes associated with conservative treatment measures, namely, ipsilateral compartment osteoarthritis, warrants the surgical repair of meniscal root tears whenever possible. While excellent patient-reported outcomes exist for the various surgical repair techniques, adherence to stringent post-operative rehabilitation protocols is critical for patients to avoid damaging the integrity of a repaired root. This review will focus on current concepts pertaining to the anatomy, biomechanics, diagnosis, treatment, and postoperative rehabilitation for meniscal root tears.
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Affiliation(s)
- Mark T. Banovetz
- Twin Cities Orthopedics, Edina-Crosstown, Edina, MN, USA,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lindsay C. Roethke
- Twin Cities Orthopedics, Edina-Crosstown, Edina, MN, USA,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ariel N. Rodriguez
- Twin Cities Orthopedics, Edina-Crosstown, Edina, MN, USA,Georgetown University School of Medicine, Washington, DC, USA
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Jin JW, Kim JG, Wang JH, Tae J, Kim JH, Lee BH, Park JY, Lee DK. How to Perform Concomitant Medial Meniscus Pull-Out Repair With Medial Open-Wedge High Tibial Osteotomy Without Technical Failure. Arthrosc Tech 2022; 11:e881-e888. [PMID: 35646577 PMCID: PMC9134484 DOI: 10.1016/j.eats.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/07/2022] [Indexed: 02/03/2023] Open
Abstract
Varus alignment of the knee joint (varus >5°) is known as a poor prognostic factor for medial meniscus root repair, and alignment correction is recommended in patients with varus deformity and medial meniscus root tears. However, simultaneous medial meniscus pull-out repair and high tibial osteotomy are technically demanding procedures due to the long surgical time, poor visualization, and breaking of the pull-out sutures during high tibial osteotomy procedures. In the present Technical Note, we will introduce a surgical method to perform 2 procedures simultaneously without technical difficulty. The main surgical techniques are as follows. (1) Release the superficial medial collateral ligament before arthroscopic medial meniscus pull-out repair, which secures sufficient working space and visualization. Therefore, the operation time could also be reduced by performing the arthroscopic procedure with the anterior portal. (2) Protect the pull-out sutures with an ENDOBUTTON reamer, which prevents pull-out sutures from breaking during the high tibial osteotomy procedure.
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Affiliation(s)
- Jin Woo Jin
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Myong Ji Hospital, Hanyang University School of Medicine, Seoul, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungyeun Tae
- Konyang University School of Medicine, Daejeon, Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Kyunghee University Hospital at Gangdong, Kyunghee University School of Medicine, Seoul, Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jun Yong Park
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Do Kyung Lee
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
- Konyang University Myunggok Medical Research Institute, Daejon, Korea
- Address correspondence to Do Kyung Lee, M.D., Ph.D., Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H, Inaba Y. Risk of interference between the tibial tunnel and locking screws in medial meniscus posterior root repair and open wedge high tibial osteotomy. J Exp Orthop 2022; 9:25. [PMID: 35292866 PMCID: PMC8924329 DOI: 10.1186/s40634-022-00464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate whether the frequency of interference between locking screws for the plate fixation and tibial tunnels differs depending on the tibial tunnel positions in a surgical simulation of the transtibial pull-out repair of medial meniscus posterior root tears (MMPRTs) in patients undergoing biplanar open wedge high tibial osteotomy (OWHTO). METHODS Sixty-five patients (75 knees) who underwent OWHTO with TomoFix small plate (Depuy Synthes, PA, USA) for medial knee osteoarthritis with varus malalignment were enrolled in this study. Surgical simulation of transtibial pull-out repair of MMPRTs was performed using postoperative computed tomography images. The tibial tunnel was created in the anatomical attachment area of the medial meniscus posterior root. Another aperture of the tibial tunnel was created on the anteromedial (AM) tibial cortex, the posteromedial (PM) tibial cortex, and the anterolateral (AL) tibial cortex in the proximal tibial fragment. The frequency of interference between the tibial tunnel and A-D locking screws was compared in the 3 tibial tunnel positions. In each tibial tunnel position, the locking plate position with and without interference between the tibial tunnel and at least one locking screw was compared. RESULTS For screw A, the frequency of interference with the tibial tunnel in the AL position was higher than that in the AM (P = 0.048) and PM positions (P < 0.001). For screws B and C, the frequency of interference with the tibial tunnel in the AM position was higher than that in the PM (P < 0.001, P = 0.007) and AL positions (P < 0.001, P = 0.001), respectively. For screw D, there was no difference in the frequency of interference with the tibial tunnel among the three positions. The frequency of interference between the tibial tunnel and at least one screw in the AM position was 100%, which was higher than that in the PM (P < 0.001) and AL positions (P < 0.001). In the PM position, the locking plate was placed more posteriorly in the group where the locking screw interfered with the tibial tunnel. In the AL position, the locking plate was placed more parallel to the medial/lateral axis of the tibial plateau in the interference group. CONCLUSION Making the tibial tunnel in the AM position should be avoided because interference with locking screws was inevitable. When the tibial tunnel is created in the PM position, interference between the tibial tunnel and screw C should be paid attention. Anterior placement of the locking plate could be useful to prevent interference between locking screws and the tibial tunnel in the PM position. In addition, when the tibial tunnel is created in the AL position, interference between the tibial tunnel and especially screw A among screws A-C should be paid attention. Placing the locking plate in an anteromedial direction could be useful to prevent interference between locking screws and the tibial tunnel in the AL position. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Dan Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hironori Yamane
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Chung KS, Ha JK, Ra HJ, Kim JG. Preoperative varus alignment and postoperative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:4122-4130. [PMID: 33730189 DOI: 10.1007/s00167-020-06405-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE No studies have been conducted to determine long-term predictors of clinical failure after surgical root repair. This study identified long-term prognostic factors of clinical failure after pull-out repair of medial meniscus posterior root tears (MMPRTs) at a minimum of 10 year follow-up. METHODS A total of 37 patients who underwent MMPRT pull-out repair and had been observed for more than 10 years were recruited for this study. The mean follow-up period was 125.9 ± 21.2 months. Clinical failure of the procedures was defined as conversion to total knee arthroplasty (TKA). Participants were categorized into two groups: non-failure and failure groups. Various factors, including demographic features and radiologic findings, were analyzed and compared between the two groups. Meniscus extrusion was assessed at coronal magnetic resonance imaging preoperatively and 1 year postoperatively. Independent risk factors were determined by univariate analysis and logistic regression analysis. To determine the cut-off value for risk factors, the receiver-operating characteristic curve analysis was performed. RESULTS In total, eight patients (22%) were converted to TKA during the follow-up period. With univariate analysis, statistically significant differences between two groups were observed in mechanical varus alignment (P = 0.018), rate of the number of patient with more meniscal extrusion values after surgery (P = 0.024), and the difference between the preoperative and 1-year postoperative value of meniscus extrusion (mm) (P = 0.010). In a logistic analysis, OR of mechanical varus alignment and differences in meniscus extrusion value before and 1 year after surgery was 1.5 (P = 0.048) and 3.7 (P = 0.034). The cut-off values of mechanical varus alignment and differences in meniscus extrusion values were 5 degrees and 0.7 mm. CONCLUSION Clinically, preoperative varus alignment and increased meniscal extrusion after surgery were found to be predictive for a clinical failure after meniscal root repair in a long-term perspective. Thus, these negative prognostic factors should be taken into consideration for performing root repair in MMPRTs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kyu Sung Chung
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Ho Jong Ra
- Department of Orthopedic Surgery, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery and Sports Center, Myong-Ji Hospital, 55, Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang-si, Seoul, 10475, Gyeonggi-do, Korea.
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Kim MS, Koh IJ, Sung YG, Park DC, Ha WJ, In Y. Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial. J Clin Med 2021; 10:3272. [PMID: 34362054 PMCID: PMC8347076 DOI: 10.3390/jcm10153272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: the purpose of this study was to investigate the efficacy and safety of intravenous (IV) administration of tranexamic acid (TXA) in patients undergoing medial opening wedge high tibial osteotomy (MOWHTO). (2) Methods: a total of 73 patients were randomly allocated into two groups (TXA group and control group). The primary outcome was total perioperative calculated blood loss after MOWHTO. Secondary outcomes included self-reported pain severity using a 10-point visual analog scale (VAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire. The postoperative allogeneic transfusion rate and wound complications were compared. Deep vein thrombosis (DVT) incidence was compared by conducting DVT computed tomography imaging. (3) Results: the total blood loss after surgery was 470.9 mL in the TXA group and 739.3 mL in the control group, showing a significant difference (p < 0.001). There were no differences in pain VAS scores between the two groups (all p > 0.05). No difference in preoperative EQ-5D scores for any items existed between the two groups. No transfusion was performed in either group. There was no difference in DVT incidence or the rate of wound complications between the two groups. (4) Conclusion: in patients undergoing MOWHTO, IV TXA reduces total blood loss and drainage amount. However, no additional benefits in clinical outcomes, transfusion rate, or wound complications were apparent, with similar DVT incidence rates.
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Affiliation(s)
- Man-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
| | - In-Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul 03312, Korea;
| | - Yong-Gyu Sung
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
| | - Dong-Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
| | - Won-Jun Ha
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
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Kyun-Ho S, Hyun-Jae R, Ki-Mo J, Seung-Beom H. Effect of concurrent repair of medial meniscal posterior root tears during high tibial osteotomy for medial osteoarthritis during short-term follow-up: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:623. [PMID: 34266424 PMCID: PMC8283898 DOI: 10.1186/s12891-021-04499-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Medial meniscal posterior root tears (MMPRTs) are frequently associated with medial compartment osteoarthritis, leading to loss of meniscal hoop tension. This study aimed to evaluate the efficacy of concurrent MMPRT repair during high tibial osteotomy (HTO) compared to HTO alone in patients with medial osteoarthritis and MMPRTs. METHODS The MEDLINE/PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting on concurrent MMPRT repair during HTO. Pre- and postoperative data were pooled to investigate the treatment effects of concurrent MMPRT repair during HTO, and compare postoperative clinical, radiological, and arthroscopic outcomes including cartilage status and healing event rates according to the arthroscopic classification of MMPRT healing (complete, partial [lax or scar tissue], or failed healing) between HTO patients with and without concurrent MMPRT repair. The random-effect model was used to pool the standardized mean differences, odds ratios (ORs), 95% confidence intervals (CIs), and event rates. RESULTS Seven patient subgroups in six articles divided according to meniscal repair techniques were included in the final analysis. Concurrent MMPRT repair during HTO significantly improved the Lysholm score, while no intergroup differences were observed in the postoperative Lysholm and WOMAC scores, as well as radiological and arthroscopic outcomes. Those who underwent concurrent MMPRT repair showed a higher rate of complete meniscal healing (OR: 4.792, 95% CI, 1.95-11.79), with a pooled rate of complete meniscal healing of 0.327 (95% CI, 0.19-0.46). CONCLUSION Concurrent MMPRT repair during HTO for medial osteoarthritis with MMPRTs has little benefits on the clinical, radiological, and arthroscopic outcomes during short-term follow-up. Further accumulation of evidence is needed for long-term effects.
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Affiliation(s)
- Shin Kyun-Ho
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Ryoo Hyun-Jae
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Jang Ki-Mo
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Han Seung-Beom
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea.
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Kim MS, Koh IJ, Choi KY, Sung YG, Park DC, Lee HJ, In Y. The Minimal Clinically Important Difference (MCID) for the WOMAC and Factors Related to Achievement of the MCID After Medial Opening Wedge High Tibial Osteotomy for Knee Osteoarthritis. Am J Sports Med 2021; 49:2406-2415. [PMID: 34115533 DOI: 10.1177/03635465211016853] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many approaches have been used to determine the minimal clinically important difference (MCID) in patients undergoing total knee arthroplasty, but the MCID for outcome measures after medial opening wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis (OA) has not been reported. PURPOSE To define the MCID for the Western Ontario and McMaster Universities Arthritis Index (WOMAC) after MOWHTO and to identify risk factors for not achieving the MCID. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Among patients with medial compartment knee OA who underwent MOWHTO, 174 patients who were followed for 2 years were included in the study. The MCID and substantial clinical benefit (SCB) for the WOMAC were determined using the anchor-based method with a 15-item questionnaire. Preoperative OA severity was measured by the Kellgren-Lawrence (K-L) grading system, and the acceptable range of the postoperative weightbearing line ratio was 50% to 70%. Patients were divided into 2 groups based on whether the MCID and SCB were achieved, and then factors related to failure to achieve the MCID and SCB were analyzed using multivariate logistic regression analysis. RESULTS The MCID for the WOMAC was 4.2 points for the pain subscale, 1.9 points for the stiffness subscale, 10.1 points for the function subscale, and 16.1 points for the total. Additionally, the SCB for the WOMAC was 6.4 for pain, 2.6 for stiffness, 16.4 for function, and 25.3 for the total. Overall, 116 (66.7%), 99 (56.9%), 127 (73.0%), and 128 (73.6%) patients achieved the MCID for the WOMAC pain, stiffness, function, and total, respectively, after MOWHTO. The odds of not achieving the MCID for the WOMAC total were 1.09 times greater (95% CI, 1.05-1.13; P < .001) in patients with a low preoperative WOMAC total score (cutoff values: 10.5 for pain, 3.5 for stiffness, 34.5 for function, and 51.0 for the total), 11.77 times greater (95% CI, 3.68-37.70; P < .001) in patients with K-L grade 4 OA compared with K-L grades 2 or 3 OA, and 8.39 times greater (95% CI, 2.98-23.63; P < .001) in patients with undercorrection or overcorrection. A low preoperative WOMAC score, K-L grade 4 OA, and undercorrection or overcorrection were also associated with not achieving the SCB for the WOMAC total (all P < .05). CONCLUSION Patients treated with a MOWHTO require a 16.1-point improvement in the WOMAC total score to achieve a MCID from the procedure. Low preoperative WOMAC scores, severe OA, and undercorrection or overcorrection were related to failure to achieve the MCID.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Gyu Sung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Chul Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kim MS, Koh IJ, Sung YG, Park DC, Han SB, In Y. Alignment adjustment using the Valgus stress technique can increase the surgical accuracy of novice surgeons during medial opening-wedge high Tibial osteotomy. BMC Musculoskelet Disord 2021; 22:585. [PMID: 34172033 PMCID: PMC8235825 DOI: 10.1186/s12891-021-04475-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO). Methods Forty-eight patients who underwent MOWHTO performed by an expert surgeon (expert group) and 29 by a novice surgeon (novice group) were enrolled in analysis. During surgery, lower-extremity alignment was corrected using the “alignment adjustment under valgus stress technique”. Normocorrection was defined as a weight-bearing line ratio between 55 and 70% and the correction accuracy was compared between expert and novice groups using the ratio of normocorrection to outliers. The clinical outcomes were also compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year after surgery. Results The undercorrection rate was 14.6% in the expert group and 13.8% in the novice group, while the overcorrection rate was 2.1% in the expert group and 3.4% in the novice group. In the ratio of normocorrection to outliers, no difference was found between the two groups at the one-year follow-up visit (83.3% in the expert group vs. 82.8% in the novice group; p > 0.05). Also, no significant differences were seen in WOMAC subscores immediately preoperatively and at 1 year after surgery (all p > 0.05). Conclusion Adhering to the “alignment adjustment under valgus stress technique” protocol enabled novice surgeons to achieve similar surgical accuracy as that of an expert surgeon in coronal alignment during MOWHTO. Level of evidence Level III.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yong Gyu Sung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung Bin Han
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc 2021; 29:1258-1268. [PMID: 32712682 DOI: 10.1007/s00167-020-06151-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/10/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the results of the remodified Mason-Allen suture technique concomitant with high tibial osteotomy (HTO) for medial meniscal posterior root tears (MMPRTs). The hypothesis was that this procedure would improve clinical results, prevent progression of knee osteoarthritis and increase the healing rate of the repaired root. METHODS Total 17 patients of mean 51.5 ± 4.4 years who were underwent this combined procedure for MMPRT completed this study. Lysholm and Hospital for Special Surgery (HSS) scores, Kellgren-Lawrence (KL) grade reflecting osteoarthritis progression were evaluated preoperatively and at the last follow-up. Medial meniscus extrusion (MME) was measured on magnetic resonance imaging preoperatively and at mean 26.1 ± 2.3 months postoperatively. Second-look arthroscopy was performed at mean 25.1 ± 5.3 months postoperatively. The healing status of the repaired root was classified as complete, partial and failed healing. The Outerbridge (OB) grade of the medial femoral condyle (MFC) was compared between index surgery and second-look arthroscopy. RESULTS Mean follow-up duration was 66.4 ± 6.5 months. Mean Lysholm and HSS mean scores improved significantly from preoperatively to the last follow-up: Lysholm: 56.9 ± 5.4 to 83.5 ± 6.0 (P < 0.001); HSS: 56.1 ± 6.0 to 81.7 ± 7.7 (P < 0.001). The mean mechanical alignment of the lower extremity was corrected from varus to the neutral range at the last follow-up. The preoperative KL grade was not significantly different from the KL grade at the last follow-up (P = 0.071). On MRI, mean MME increased from 3.0 ± 0.7 mm to 3.1 ± 0.7 mm (P = 0.046). Second-look arthroscopy showed 64.7% complete, 29.4% partial and 5.9% failed healing of the repaired root. The initial OB grade of the MFC showed no progression (P = 0.103). CONCLUSIONS The remodified Mason-Allen suture technique concomitant with HTO for MMPRTs significantly improved clinical outcomes and suppressed OA progression at 66.4 months. However, this procedure produced limited complete healing of the repaired roots in 64.7% of patients. LEVEL OF EVIDENCE IV.
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Moon HS, Choi CH, Yoo JH, Jung M, Lee TH, Jeon BH, Kim SH. Mild to Moderate Varus Alignment in Relation to Surgical Repair of a Medial Meniscus Root Tear: A Matched-Cohort Controlled Study With 2 Years of Follow-up. Am J Sports Med 2021; 49:1005-1016. [PMID: 33600226 DOI: 10.1177/0363546520988072] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased varus alignment of the lower extremity is known to be a poor prognostic factor for the surgical repair for a medial meniscus root tear (MMRT). However, given the concept of constitutional varus, which is present in a substantial portion of the normal population, the generally accepted surgical indication for MMRT concerning a varus alignment of 5° may be unnecessarily narrow. PURPOSE To compare the surgical outcomes of arthroscopic transtibial pullout repair of MMRT according to the degree of varus alignment of the lower extremity. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent isolated arthroscopic transtibial pullout repair of MMRT between January 2010 and July 2017 at one institution and had a minimum follow-up of 2 years were included in this study. Patients were classified into 1 of 2 groups: the experimental group (n = 22) included patients with a preoperative hip-knee-ankle angle between 5° and 10° varus (mild to moderate varus alignment) and the control group (n = 51) included those with a preoperative hip-knee-ankle angle <5° varus (neutral alignment). Clinical scores and radiographic parameters were compared between the groups to assess surgical outcomes, which were statistically matched for potential confounders (age, body mass index, the severity of cartilage lesion) by use of the inverse probability of treatment weighting. A noninferiority trial was performed comparing the experimental and control groups in terms of subjective outcomes (International Knee Documentation Committee subjective and Lysholm scores) and objective outcomes (postoperative medial meniscal extrusion and the rate of osteoarthritis progression). RESULTS There were no statistically significant differences in surgical outcomes between the groups in subjective and objective aspects, which were consistent before and after inverse probability of treatment weighting. Apart from the clinical improvement observed in both groups, overall degenerative changes in the knee were found, although progression rates did not differ between the groups. In terms of the noninferiority trial, the overall surgical outcomes in the experimental group were not inferior to those in the control group. CONCLUSION The short-term surgical outcomes of arthroscopic transtibial pullout repair for MMRT of patients with mild to moderate varus alignment were not inferior to but rather comparable with those with neutral alignment in terms of subjective and objective aspects. Therefore, it would be inappropriate to exclude patients with a diagnosis of MMRT from being indicated for the surgery simply because of mild to moderate varus alignment.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 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
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 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
| | - Tae-Ho Lee
- 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
| | - Byeong-Hun Jeon
- 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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23
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Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:955-965. [PMID: 32390120 DOI: 10.1007/s00167-020-06055-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE This prospective study aimed to investigate the clinical benefits of meniscal repair during open-wedge high tibial osteotomies (OWHTOs) in patients with medial meniscus posterior root tears (MMPRTs) and to identify potential risk factors for meniscal healing. METHODS Ninety patients with degenerative MMPRTs were included in the final cohort and randomized into three groups. The patients in Group A (n = 30) underwent OWHTO and arthroscopic all-inside meniscal repair concurrently, those in Group B (n = 34) underwent OWHTO only, and those in Group C (n = 26) underwent arthroscopic partial meniscectomy. Clinical and radiological outcomes were recorded, and meniscal healing was evaluated during second-look arthroscopy. Logistic regression analysis was performed to identify risk factors for meniscal healing. RESULTS After a minimum follow-up of 24 months, no significant differences between Groups A and B regarding the final Lysholm (p = 0.689) or Hospital for Special Surgery (HSS) scores (p = 0.256) were observed. There were significant differences among the three groups regarding the hip-knee-ankle angle (HKA), weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) (p < 0.001, respectively), but the differences between Groups A and B were not significant. During second-look arthroscopy, the healing rate of the MMPRTs was significantly higher in Group A (63.3%) than in Group B (35.3%). Concurrent meniscal repair and changes in the HKA, and MPTA were risk factors for meniscal healing. CONCLUSION Concurrent arthroscopic meniscal repair during OWHTO did not lead to significant clinical benefits in the treatment of MMPRTs, except for an increased rate of meniscal healing, which was not associated with clinical outcomes. LEVEL OF EVIDENCE II, prospective comparative study.
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Zhuo H, Pan L, Xu Y, Li J. Functional, Magnetic Resonance Imaging, and Second-Look Arthroscopic Outcomes After Pullout Repair for Avulsion Tears of the Posterior Lateral Meniscus Root. Am J Sports Med 2021; 49:450-458. [PMID: 33382344 DOI: 10.1177/0363546520976635] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little data exist in the literature regarding second-look arthroscopic outcomes after pullout repair for avulsion tears of the posterior lateral meniscus root. PURPOSE To (1) assess the functional, magnetic resonance imaging (MRI), and second-look arthroscopic outcomes after pullout repair for avulsion tears of the posterior lateral meniscus root; (2) determine which demographic and clinical factors influenced healing of the repaired posterior lateral meniscus root; and (3) compare outcomes between different meniscal healing status groups. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 31 patients underwent pullout repair for avulsion tears of the posterior lateral meniscus root and had a minimum 2-year follow-up. Functional outcomes were assessed using patient-reported scores (Lysholm, Tegner, and International Knee Documentation Committee [IKDC] scores). Lateral meniscal extrusion, cartilage degeneration of the lateral compartment, and healing of the repaired posterior lateral meniscus root were assessed via MRI. The healing status was also assessed using second-look arthroscopic surgery, and the patients were divided into different healing status groups. RESULTS The postoperative patient-reported scores improved significantly compared with the preoperative values (P = .001). Lateral meniscal extrusion was reduced significantly from 3.37 ± 0.82 mm preoperatively to 0.63 ± 0.80 mm at final follow-up (P = .001). The grade of cartilage degeneration of the lateral compartment progressed from 0.69 ± 0.67 preoperatively to 0.95 ± 0.83 at final follow-up (P = .213). MRI scans showed complete healing in 28 patients (90.3%) and partial healing in 3 patients (9.7%). Second-look arthroscopic surgery showed stable healing in 18 of 23 patients (78.3%) and lax healing in 5 of 23 patients (21.7%). Patients with stable healing had significantly higher Lysholm and IKDC scores, more reduction of meniscal extrusion, and less progression of cartilage degeneration than did patients with lax healing (P < .05). Concomitant anterior cruciate ligament reconstruction was found to significantly positively influence healing of the repaired posterior lateral meniscus root (P = .047). CONCLUSION Pullout repair for avulsion tears of the posterior lateral meniscus root yielded significantly improved patient-reported scores, reduced meniscal extrusion, and a satisfactory healing rate at final follow-up. Patients with stable healing had significantly better functional and MRI outcomes than did patients with lax healing.
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Affiliation(s)
- Hongwu Zhuo
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ling Pan
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yangkai Xu
- Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jian Li
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Ren YM, Tian MQ, Duan YH, Sun YB, Yang T, Hou WY, Xie SH. Was femoral nerve block effective for pain control of medial opening-wedge high tibial osteotomy?: A single blinded randomized controlled study. Medicine (Baltimore) 2021; 100:e23978. [PMID: 33545983 PMCID: PMC7837819 DOI: 10.1097/md.0000000000023978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/15/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Medial compartment femoro-tibial osteoarthritis (OA) is a common disease and opening-wedge high tibial osteotomy (OWHTO) is the common surgical procedure carried out for these patients. While most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the pain control effect of femoral nerve block (FNB) for OWHTO patients. METHODS In this prospective, single-center, randomized controlled trial (RCT) study, 41 patients were operated on by OWHTO for OA during 2017 to 2018. Twenty of them (group A) accepted epidural anesthesia with FNB and 21 patients (group B) only had their single epidural anesthesia. All blocks were successful and all the 41 patients recruited were included in the analysis and there was no loss to follow-up or withdrawal. Systematic records of visual analog scores (VAS), quadriceps strength, mean number of times of patient-controlled intravenous analgesia (PCIA), using of additional opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), and complications were done after hospitalization. The Student t test and Chi-Squared test was used and all P values ≤.05 were considered statistically significant. RESULTS VAS scores at rest (3.48 ± 1.0 vs 4.68 ± 1.1) and on movemment (4.51 ± 0.6 vs 4.97 ± 0.8) decreased more in group A than group B with significance at follow-up of 12 hours. The quadriceps strength, consumption of additional opioids or NSAID injections and mean number of times that the patients pushed the PCIA button didnot differ significantly within each group. CONCLUSION This RCT study shows that FNB in patients undergoing OWHTO for unicompartmental osteoarthritis of the knee could result in significant reduction in VAS scores at 12 hours postoperatively.Research registry, Researchregistry4792. Registered April 7, 2019 - Retrospectively registered, http://www.researchregistry.com.
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Affiliation(s)
- Yi-Ming Ren
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Meng-Qiang Tian
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Yuan-Hui Duan
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Yun-Bo Sun
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Tao Yang
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Wei-Yu Hou
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, PR China
| | - Shu-Hua Xie
- Department of Anesthesiology, Tianjin Union Medical Center, PR China
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Jing L, Liu K, Wang X, Wang X, Li Z, Zhang X, Wang S, Yang J. Second-look arthroscopic findings after medial open-wedge high tibial osteotomy combined with all-inside repair of medial meniscus posterior root tears. J Orthop Surg (Hong Kong) 2020; 28:2309499019888836. [PMID: 31829094 DOI: 10.1177/2309499019888836] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To examine the results of medial open-wedge high tibial osteotomy (MOWHTO) combined with all-inside repair focusing on medial meniscus posterior root tears (MMPRT) by second-look arthroscopy and determine the clinical relevance of the findings. METHODS From June 2015 to June 2017, 27 consecutive patients underwent MOWHTO and meniscal treatment for MMPRT using all-inside repair. All were available for second-look arthroscopy evaluation at the time of plate removal. Cartilage regeneration in the medial condyles and healing status of the MMPRT were assessed at the time of second-look arthroscopy. Clinical outcomes were evaluated by the Hospital for Special Surgery (HSS) scores and the Lysholm score scale. The potential factors affecting the healing of MMPRT, including age, body mass index (BMI), weight-bearing line rate (WBLR) and femorotibial angle (FTA) were discussed. RESULTS There were 11 (41%) cases with complete healing (group A) and 16 (59%) cases with lax healing (group B). A complete cartilage coverage of chondral lesions was observed at second-look arthroscopy. Improvements of HSS in both groups were 41.25 ± 6.18 and 38.82 ± 5.43, while improvements in Lysholm score seen in both groups were 30.40 ± 4.84 and 32.65 ± 4.11. There was no significant difference in the postoperative clinical results between the two groups. In group A, the age (months), BMI, WBLR, and FTA are 54.61 ± 2.53, 23.58 ± 2.39, 66.10 ± 2.86% and 169.00 ± 2.62°, respectively, while in group B, they are 55.16 ± 4.92, 29.58 ± 3.91, 57.51 ± 5.49% and 175.21 ± 2.87°, respectively. A significant difference has been identified between two groups except for age. CONCLUSION As seen in this retrospective study, a higher healing rate of MMPRT using all-inside repair and regeneration of degenerated articular cartilage in the medial condyles after MOWHTO can be expected. Healing of the MMPRT was not related to a better clinical outcome. Moreover, it can be inferred that BMI, WBLR and FTA may affect the healing status of MMPRT.
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Affiliation(s)
- Lizhong Jing
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kun Liu
- Department of Orthopedics, Penglai Traditional Chinese Medicine Hospital, Yantai, China
| | - Xiaole Wang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaotan Wang
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhen Li
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xia Zhang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shaoshan Wang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiushan Yang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, China
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Lee DW, Lee SH, Kim JG. Outcomes of Medial Meniscal Posterior Root Repair During Proximal Tibial Osteotomy: Is Root Repair Beneficial? Arthroscopy 2020; 36:2466-2475. [PMID: 32389775 DOI: 10.1016/j.arthro.2020.04.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical and radiologic outcomes and arthroscopic findings of proximal tibial osteotomy (PTO) alone versus PTO combined with medial meniscal posterior root repair (MMPRR). METHODS Between October 2010 and September 2016, patients who underwent PTO and second-look arthroscopy at a minimum of 24 months postoperatively were reviewed. Patients were divided into group I (isolated PTO), group P (PTO with MMPRR using the pull-out technique), and group F (PTO and MMPRR using the side-to-side repair method). The subjective knee scores were assessed. Radiologic evaluation was based on the Kellgren-Lawrence grade. Healing of medial meniscal posterior root tears (good/loose/scar tissue/failed) and cartilage regeneration (excellent/good/poor) were assessed by arthroscopic examination. RESULTS Mean clinical follow-up duration of group I (n = 22), P (n = 25), and F (n = 24) was 28.5 ± 5.7, 27.9 ± 6.2, and 26.3 ± 5.3 months, respectively. At final follow-up, Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale significantly improved in all groups (P < .001), and subjective scores did not differ among the groups. The Kellgren-Lawrence grade progression showed no significant differences among 3 groups (P = .461). Good healing of medial meniscal posterior root tears was found in 24% and 12.5% of patients in groups P and F, respectively, and 0 in group I; there were significant differences between groups I and P (P < .001) and groups I and F (P < .001). Excellent cartilage regeneration in the medial femoral condyle and medial tibial plateau was found in 13.6% and 9.1% in group I, 24% and 12% in group P, and 16.7% and 8.3% in group F, respectively, without significant differences. CONCLUSIONS Concurrent MMPRR during PTO appears to improve the arthroscopic appearance (healing of MMRPTs and cartilage regeneration) during second-look arthroscopy. However, concurrent MMPRR does not significantly improve clinical and radiologic outcomes at short-term follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Su Hyun Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Hanyang University Myongji Hospital, Goyang-si, Gyeonggi-do, Korea.
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Simple Medial Meniscus Posterior Horn Root Repair Using an All-Inside Meniscal Repair Device Combined with High Tibial Osteotomy to Maintain Joint-Space Width in a Patient with a Repairable Tear. Indian J Orthop 2020; 55:397-404. [PMID: 33927818 PMCID: PMC8046862 DOI: 10.1007/s43465-020-00234-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/13/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare the radiological and clinical outcomes using simple medial meniscus posterior horn (MMPH) root repair using an all-inside meniscal repair device combined with high tibial osteotomy (HTO) and HTO alone. METHODS Between November 2013 and December 2016, patients treated for MMPH root tear along with HTO were enrolled. Based on the tear gap, the participants were divided into repairable (< 2 mm) and unrepairable (> 2 mm) categories. The participants in each group were divided into those amenable to simple MMPH root repair using an all-inside meniscal repair device and those that required no procedure for meniscus. Radiological parameters including mechanical femorotibial alignment (MA), posterior tibial slope (PTS) and medial joint-space width (JSW) were evaluated preoperatively and postoperatively at 2 years. For clinical evaluation, the WOMAC score was determined at the 2-year visit postoperatively. RESULTS A total of 81 knees including 48 repairable (group R) and 33 unrepairable (group I) knees were enrolled. A total of 43 knees underwent simple MMPH root repair using an all-inside meniscal repair device (subgroup r), whereas the other 38 knees did not (subgroup n). The MA, PTS, and their postoperative changes as well as the WOMAC scores showed no differences. However, the JSW in group Rr increased from 3.1 to 3.6 mm, but decreased from 3.7 to 3.4 in group Rn, which was a statistically significant difference. CONCLUSION Simple MMPH root repair using an all-inside meniscal repair device combined with HTO was more effective for the maintenance of JSW compared with HTO without a meniscal procedure in patients with repairable MMPH root tear and varus alignment. However, other options are needed for unrepairable MMPH root tear.
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Kim MS, Koh IJ, Kim CK, Choi KY, Kang KH, In Y. Preoperative Medial Meniscal Extrusion Is Associated With Patient-Reported Outcomes After Medial Opening Wedge High Tibial Osteotomy. Am J Sports Med 2020; 48:2376-2386. [PMID: 32631156 DOI: 10.1177/0363546520933834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the medial compartment continues to sustain some loading after medial opening wedge high tibial osteotomy (MOWHTO) in varus-deformed knees, no studies have examined the relationship between medial meniscal extrusion (MME) and patient-reported outcome measures after MOWHTO. PURPOSE To examine whether compartmental baseline MME was associated with patient-reported outcome measures after MOWHTO. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective study was composed of 149 MOWHTOs in 147 patients with clinical and radiological assessments. Patients were grouped according to severity of MME in the medial compartment at the time of surgery. MME was categorized into 4 groups according to MOAKS (MRI [magnetic resonance imaging] Osteoarthritis Knee Score) criteria and relative value of MME. We compared preoperative characteristics, including Kellgren-Lawrence (KL) grading scale, meniscal tear pattern, and postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores. Associations between extent of MME and WOMAC subscores at postoperative 1 and 2 years were assessed with generalized linear models. RESULTS Pattern of meniscal tear (P < .05) and KL grade (P < .05) were associated with MME. Patients with KL grades 3 and 4 at the time of surgery had significantly greater MME than those with KL grade 2 (P < .05). When patients were divided into 4 groups according to MOAKS criteria at the time of surgery, there were significant differences in WOMAC pain scores among groups at 1 and 2 years after the operation (all P < .05). The WOMAC function score also differed among groups at postoperative 1 year (P < .05) but not postoperative 2 years (P > .05). When patients were divided into 4 groups according to relative MME at the time surgery, the WOMAC pain score differed significantly among groups at postoperative 1 and 2 years (all P < .05). Analysis of WOMAC pain score as the dependent variable in multivariate analyses revealed that severity of absolute and relative MME and KL grade were independent predictors of worse WOMAC pain score at postoperative 1 and 2 years (all P < .05). CONCLUSION Greater preoperative MME at the time of surgery was associated with inferior patient-reported outcomes, especially pain, in patients with MOWHTO at 1 and 2 years after surgery.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopedic Surgery, Eunpyeong St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Kyu Kim
- Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Ho Kang
- Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Chung KS, Ha JK, Ra HJ, Yu WJ, Kim JG. Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Long-term Survivorship and Clinical Outcomes at Minimum 10-Year Follow-up. Am J Sports Med 2020; 48:1937-1944. [PMID: 32437216 DOI: 10.1177/0363546520920561] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The importance of repair in medial meniscus posterior root tears (MMPRTs) has been increasingly recognized because it restores hoop tension. However, no study has compared the long-term outcomes between meniscectomy and repair. HYPOTHESIS Survivorship and clinical outcomes of repair would be better than those of meniscectomy after long-term follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Between 2005 and 2009, patients with MMPRTs who had been followed up for at least 10 years after partial meniscectomy (n = 18) or pullout repair (n = 37) were recruited. Clinical assessments, including the Lysholm score and International Knee Documentation Committee (IKDC) subjective score, were evaluated preoperatively and at the final follow-up. The final results in each group were compared with the preoperative results, and the final results of the groups were compared. Clinical failure was defined as conversion to total knee arthroplasty (TKA), and the final clinical scores were assessed just before TKA. Kaplan-Meier survival analysis was used to investigate the survival rates of surgical procedures. RESULTS Mean ± SD follow-up period was 101.4 ± 45.9 and 125.9 ± 21.2 months in the meniscectomy and repair groups, respectively (P = .140). The mean Lysholm and IKDC scores, respectively, in the meniscectomy group were 50.8 ± 7.7 and 37.6 ± 7.0 preoperatively and 58.2 ± 22.1 and 44.4 ± 19.0 postoperatively (P = .124; P = .240). In the repair group, the mean Lysholm score and IKDC score, respectively, significantly increased from 52.3 ± 10.9 and 41.0 ± 9.6 preoperatively to 77.1 ± 24.0 and 63.7 ± 20.6 postoperatively (P < .001; P < .001). The final Lysholm and IKDC scores in the repair group were significantly better than those in the meniscectomy group (P = .004; P = .003). In cases of clinical failure, 10 patients (56%) in the meniscectomy group and 8 patients (22%) in the repair group converted to TKA in the follow-up period (P = .016). According to Kaplan-Meier analysis, the 10-year survival rates for the meniscectomy and repair groups were 44.4% and 79.6%, respectively (P = .004). CONCLUSION In MMPRTs, root repair was superior to partial meniscectomy in terms of clinical results for at least 10 years of follow-up. From a long-term perspective, repair with restoration of hoop tension is more effective management than meniscectomy.
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Affiliation(s)
- Kyu Sung Chung
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Ho Jong Ra
- Department of Orthopedic Surgery, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Republic of Korea
| | - Woo Jin Yu
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery and Sports Center, Myong-Ji Hospital, Seoul, Republic of Korea
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High tibial osteotomy in obese patients: Is successful surgery enough for a good outcome? J Clin Orthop Trauma 2019; 10:S168-S173. [PMID: 31695277 PMCID: PMC6823675 DOI: 10.1016/j.jcot.2018.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/29/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis is the most common articular pathology. High tibial osteotomy (HTO) is a frequently used treatment procedure in medial osteoarthritis of the knee joint. We aimed to reveal factors that affect clinical and radiologic outcomes by evaluating the efficacy of HTO in patients with BMI ≥30 kg/m2 who were not appropriate for prostheses considering their activity, degree of pain, and age. MATERIAL AND METHOD HTO was performed using the medial open wedge technique who presented to the orthopedics polyclinic with symptoms of knee pain, whose BMI was over 30 kg/m2. All patients were diagnosed as having mechanical axis deviation and isolated medial compartmental arthrosis between 2013 and 2015.The clinical and radiologic follow-ups of patients were performed on day 45, at month 3, month 6, and after 1 year. The knee scoring system from the American Knee Society (AKS), and range of motion (ROM) were used in the functional evaluation of the patients. RESULT Eighteen patients were included in the study. Thirteen patients (72.2%) were women and 5 (27.8%) were men. Preop axis score was found significantly lower compared with the axis scores at postop month 6 and in final follow-up, the postoperative final follow-up axis score was found significantly lower than the axis score at month 6 (p < 0.05). CONCLUSION We anticipated in our study that the better outcomes obtained in the early period might be maintained for longer in parallel with weight loss and decreased BMI in the postoperative period. We believe that it is important to perform complication-free HTO with the correct technique, and by organizing a rapid and systematic weight loss process.
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Chung KS, Ha JK, Kim YS, Kim JH, Ra HJ, Kong DH, Wang PW, Choi CH, Kim JG. National Trends of Meniscectomy and Meniscus Repair in Korea. J Korean Med Sci 2019; 34:e206. [PMID: 31432650 PMCID: PMC6698454 DOI: 10.3346/jkms.2019.34.e206] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Meniscus surgeries are frequently performed in orthopaedics. However, their current status is not well known in many countries, including Korea. This study aimed to investigate the national trends of meniscus surgery in Korea. METHODS Information from the national database was acquired through the Korean Health Insurance Review and Assessment Service from 2010 to 2017. All cases coded as meniscectomy or meniscus repair were included. The total number and incidence of cases of meniscus surgery per 100,000 persons were determined, and the results were stratified by age and gender. The meniscus repair ratio for the total number of meniscus surgeries was evaluated. RESULTS The total number and incidence of meniscectomy cases were 65,752 and 137, respectively, in 2010, which increased to 74,088 and 154, respectively, in 2017. The number of meniscectomies increased by 12.67% in 8 years. The total number and incidence of meniscus repair cases were 9,055 and 18, respectively, in 2010, which increased to 14,947 and 31 in 2017. The number of meniscus repairs increased by 65.04%. The meniscus repair ratio was 12.1% in 2010, which increased to 16.8% in 2017. The highest peak was noted for patients who underwent meniscus surgeries in their 50s and 60s. Meniscectomy was performed more frequently in women (57%) than in men (43%), whereas repair was performed more frequently in men (54%) than in women (46%) over the study period. CONCLUSION The total number and incidence of meniscus surgeries increased from 2010 to 2017; the number and incidence of meniscus repair procedures increased more rapidly than those of meniscectomy, with the peak treatment age for both surgeries being in the 50s and 60s. The current study will contribute to understanding the epidemiology of meniscus surgery, its prevention, and cost-saving measures in Korea.
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Affiliation(s)
- Kyu Sung Chung
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jeong Ku Ha
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
| | - Yoon Seok Kim
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Sports and Exercise Medicine Lab, Korea Maritime and Ocean University, Busan, Korea
| | - Ho Jong Ra
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Doo Hwan Kong
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Pei Wei Wang
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Choong Hyeok Choi
- Department of Orthopaedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Sports Center, Myong-Ji Hospital, Seoul, Korea
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Abstract
RATIONALE Peroneal nerve injury is one of the major complications that may occur after closing wedge high tibial osteotomy (CWHTO). In contrast, the reduced risk of the peroneal nerve injury has been considered as one of the advantages of opening wedge HTO (OWHTO). PATIENT CONCERNS A 61-year-old male who underwent OWHTO showed a dropped big toe immediately after surgery. DIAGNOSIS Injury of deep peroneal nerve was confirmed by electrodiagnostic study. It was probably caused by a posterolaterally protruded screw. INTERVENTIONS The protruded screw was replaced with a shorter one 3 weeks after OWHTO. OUTCOMES The motor weakness and sensory reduction were completely recovered at 9 months after surgery. LESSONS OWHTO has been known to be safe from peroneal nerve injury. However, considering the anatomical course of deep peroneal nerve, great care should be taken to avoid damage to the deep peroneal nerve while drilling holes and inserting distal screws toward the posterolateral aspect of the proximal tibia.
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Affiliation(s)
- Jin Hwa Jeong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Moon Chong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Seung Ah Lee
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Seo SS, Nha KW, Kim TY, Shin YS. Survival of total knee arthroplasty after high tibial osteotomy versus primary total knee arthroplasty: A meta-analysis. Medicine (Baltimore) 2019; 98:e16609. [PMID: 31348307 PMCID: PMC6709048 DOI: 10.1097/md.0000000000016609] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Theoretical considerations suggest that total knee arthroplasty (TKA) is technically more challenging after high tibial osteotomy (HTO), resulting in inferior results compared to primary TKA. However, several studies on this issue have shown contradictory results. The purpose of this meta-analysis to compare survivorship and clinical outcomes between TKA with and without previous HTO. METHODS We reviewed studies that evaluated pain and function scores, range of motion (ROM), operation time, Insall-Salvati (IS) ratio, complications, and survival rates in patients treated with TKA with previous HTO or with primary TKA with short- to midterm (<10 years) or long-term (>10 years) follow-up. RESULTS Fifteen studies were included in the meta-analysis. There were no significant differences between TKA with and without previous HTO in pain score (95% CI: -0.27 to 0.29; P = .94), function score (95% CI: -0.08 to 0.24; P = .32), operation time (95% CI: -5.43 to 26.85; P = .19), IS ratio (95% CI: -0.03 to 0.08; P = .40), complication rates (TKA with previous HTO, 62/1717; primary TKA, 610/31386; OR 1.31, 95% CI: 0.97-1.77; P = .08), and short- to midterm survival rates (TKA with previous HTO, 1860/2009; primary TKA, 37848/38765; OR 0.55, 95% CI: 0.28-1.10; P = .09). Conversely, ROM (95% CI: -7.40 to -1.26; P = .006) and long-term survival rates (TKA with previous HTO, 1426/1523; primary TKA, 29810/31201; OR 0.71, 95% CI: 0.57-0.89; P = .003) were significantly different between the two groups. In addition, both groups had substantial proportions of knees exhibiting short- to midterm survivorship (92.6% by TKA with previous HTO and 97.6% by primary TKA) and long-term survivorship (93.6% by TKA with previous HTO and 95.5% by primary TKA). CONCLUSIONS This meta-analysis suggests that a previous HTO affected ROM or survival of TKA in the long-term even though both groups have equivalent clinical outcomes and complications. Thus, orthopedic surgeons should offer useful information regarding the advantages and disadvantages of both procedures to patients, and should provide advice on the generally higher risk of revision after TKA with previous HTO at long-term follow-up when counseling patients.
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Affiliation(s)
- Seung-Suk Seo
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan
| | - Kyung-Wook Nha
- Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Goyang
| | - Tae-Yeong Kim
- Department of Orthopedic Surgery, Hallym University School of Medicine, Chuncheon, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Hallym University School of Medicine, Chuncheon, Republic of Korea
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Drobnič M, Ercin E, Gamelas J, Papacostas ET, Slynarski K, Zdanowicz U, Spalding T, Verdonk P. Treatment options for the symptomatic post-meniscectomy knee. Knee Surg Sports Traumatol Arthrosc 2019; 27:1817-1824. [PMID: 30859265 DOI: 10.1007/s00167-019-05424-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/15/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. METHODS A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. RESULTS Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-meniscectomy OA. CONCLUSIONS Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, 1000, Ljubljana, Slovenia. .,Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Ersin Ercin
- Department of Orthopaedics and Traumatology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Joao Gamelas
- Department of Orthopaedics and Traumatology, Lusíadas Hospital, NOVA Medical School, Lisbon, Portugal
| | | | | | - Urszula Zdanowicz
- Carolina Medical Center, Warsaw, Poland.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Peter Verdonk
- Antwerp Orthopaedic Center, AZ Monica Hospitals, Antwerp, Belgium.,Antwerp University Hospital, Edegem, Belgium
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Yoon JR, Ko SN, Jung KY, Lee Y, Park JO, Shin YS. Risk of Revision Following Total Knee Arthroplasty or High Tibial Osteotomy: A Nationwide Propensity-Score-Matched Study. J Bone Joint Surg Am 2019; 101:771-778. [PMID: 31045664 DOI: 10.2106/jbjs.18.00980] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is often performed to postpone or avoid the need for subsequent total knee arthroplasty (TKA). We designed the present study to investigate the incidence rate and risk factors for subsequent revision in patients treated with HTO compared with those managed with TKA. METHODS In this retrospective nationwide cohort study, we reviewed the South Korean National Health Insurance claims database from January 1, 2009, to August 31, 2017. We evaluated patients ≥41 years old who had undergone TKA or HTO as the primary surgical procedure without a history of having undergone either procedure during the preceding 2 years. By including only new interventions without such prior surgery, we could eliminate the influence of previous TKA and HTO treatments. Multivariable logistic regression models were used to compare the risk of revision between the groups after propensity score matching with inverse probability of treatment weighting (IPTW). Revision was defined as conversion to revision TKA after primary TKA and conversion to TKA after HTO. RESULTS After applying the IPTW, a total of 436,538 patients with TKA and 452,724 patients with HTO were identified. The risk of revision during the entire study period was higher for patients with HTO than for patients with TKA (adjusted hazard ratio [HR], 2.47). The Kaplan-Meier 8-year survival was 97.8% in the TKA group and 91.5% in the HTO group. Compared with patients with TKA, patients with HTO had an increased risk of revision in cases of advanced age (HR of 1.85 for patients who were ≥61 to 69 years old and HR of 4.17 for those who were ≥70 years old), female sex (HR, 2.90), recipients of Medical Aid program benefits (HR, 4.77), the presence of hyperlipidemia (HR, 3.70), the presence of diabetes (HR, 4.86), and the presence of osteoporosis (HR, 3.53). However, younger patients with HTO (≤60 years old) had a lower risk of subsequent revision (HR, 0.64). CONCLUSIONS The risk of revision was higher for patients with HTO than for patients with TKA. The risk factors for subsequent revision in patients with HTO in our cohort of patients were advanced age (>60 years), female sex, receipt of Medical Aid, and the presence of comorbidities, such as diabetes, osteoporosis, and hyperlipidemia. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Seung-Nam Ko
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Kwang-Young Jung
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Young Lee
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Jae-Ok Park
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, South Korea
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Han SB, Choi JH, Mahajan A, Shin YS. Incidence and Predictors of Lateral Hinge Fractures Following Medial Opening-Wedge High Tibial Osteotomy Using Locking Plate System: Better Performance of Computed Tomography Scans. J Arthroplasty 2019; 34:846-851. [PMID: 30733072 DOI: 10.1016/j.arth.2019.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/25/2018] [Accepted: 01/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study compared the rates of plain radiographs and computed tomography (CT) for detecting lateral hinge fractures and to evaluate factors affecting lateral hinge fractures in patients following medial opening-wedge high tibial osteotomy (MOWHTO). METHODS This prospective study included 59 patients (65 knees) undergoing MOWHTO for primary medial compartment osteoarthritis with a 2-year follow-up between 2013 and 2016. Clinical and radiographic evaluations were performed using Knee Society Score and Western Ontario and McMaster Universities Arthritis Index, and we calculated the hip-knee-ankle angle, weight-bearing line ratio, lateral distal femoral angle, medial proximal tibial angle, posterior tibial slope, osteotomy gap height, and osteotomy gap filling rate. Immediate plain radiographs and CT were used to detect lateral hinge fractures according to Takeuchi's method. RESULTS Among 65 knees, the incidence of lateral hinge fractures was 13.8% (Type I: 7, Type II: 2). Only 6 knee fractures (9.2%) were detected on postoperative plain radiographs, including 5 Type I fractures and 1 Type II fracture. An additional 3 knees (4.6%) were detected on postoperative CT scans, including 2 Type I fractures and 1 Type II fracture. Furthermore, osteotomy gap height (adjusted odds ratio = 1.831, P = .016) was the only predictor of lateral hinge fractures. CONCLUSION The incidence of lateral hinge fractures after MOWHTO was 13.8%. CT (13.8%) afforded higher detection rates for lateral hinge fractures than did plain radiographs (9.2%) despite a marginal difference with uncertain significance. Osteotomy gap height was the only predictor of lateral hinge fractures. LEVEL OF EVIDENCE Prospective cohort study (Level II).
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Affiliation(s)
- Seung-Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyuk Choi
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Atul Mahajan
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Chuncheon Sacred Heart hospital, Hallym University School of Medicine, Chuncheon, Republic of Korea
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Lee SS, Celik H, Lee DH. Predictive Factors for and Detection of Lateral Hinge Fractures Following Open Wedge High Tibial Osteotomy: Plain Radiography Versus Computed Tomography. Arthroscopy 2018; 34:3073-3079. [PMID: 30292595 DOI: 10.1016/j.arthro.2018.06.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the accuracy of plain radiography and computed tomography (CT) in detecting lateral hinge fractures and to identify predictive factors of the lateral hinge fractures after open wedge high tibial osteotomy (HTO). METHODS This study included patients who underwent isolated primary open wedge HTO for medial compartment degenerative arthritis from 2015 to 2016 and were evaluated by postoperative CT scans and followed for a minimum of 1 year. This study involved 48 patients (48 knees) undergoing open wedge HTO for primary medial osteoarthritis. Lateral hinge fractures were evaluated on immediate plain radiographs and CT scans according to the Takeuchi classification. Predictive factors of plain radiograph-based hinge fracture and CT-based hinge fracture were investigated. RESULTS The detection rate of lateral hinge fracture was significantly higher on CT scans than on plain radiographs (50% vs 14.6%; P < .001). Seven knees (14.6%) showed lateral hinge fractures on postoperative plain radiographs, including 6 with type I and 1 with type III fractures; 24 (50.0%) showed lateral hinge fractures on postoperative CT scans, including 20 with type I, 2 with type II, and 2 with type III fractures. CT scans detected 14 type I, 2 type II, and 1 type III hinge fractures not detected by plain radiographs. The medial opening gap width was the only predictor of lateral hinge fracture on CT scans (adjusted odds ratio, 1.565; P =.034). CONCLUSIONS The incidence of lateral hinge fracture of the knee after open wedge HTO was higher on CT scans than on plain radiographs. The medial opening gap width was the only predictor of lateral hinge fractures, suggesting a need for care when spreading the gap to avoid lateral hinge fractures. LEVEL OF EVIDENCE Level III, cross-sectional study.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Haluk Celik
- Department of Orthopaedic Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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