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Loddo G, An JS, Claes S, Jacquet C, Kley K, Argenson JN, Sharma A, Ollivier M. CPAK classification cannot be used to determine segmental coronal extra-articular knee deformity. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38643399 DOI: 10.1002/ksa.12168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE While the coronal plane alignment of the knee (CPAK) classification serves as a useful guide in personalising total knee arthroplasty (TKA), the extent of its correlation with segmental coronal extra-articular knee deformities remains uncertain. This study aims to investigate the potential correlation between CPAK matrix groups and segmental coronal extra-articular deformities in prearthritic knees, shedding light on the relationship between these two factors that seems to be both essential to perform personalised TKA. MATERIALS AND METHODS A radiological assessment of 1240 nonarthritic knees was performed by evaluating lower limb measurements following the protocol established by Paley et al. Subsequently, all knees were classified into their respective CPAK matrix groups. In our quest to discern any correlation between the CPAK matrix groups and the presence of segmental coronal extra-articular knee deformities, nine potential coronal extra-articular deformity phenotype (CEDP) groupswere identified based on medial proximal tibial angle (MPTA) and mechanical lateral distal femoral angle (mLDFA). Neutral values for MPTA and mLDFA were set at 90.0° ± 3.0° and then at 87.0° ± 2.0°. Each CPAK matrix group underwent detailed coronal morphology analysis and then, segmental coronal extra-articular deformities were assessed by comparing them with the CEDP groups. RESULTS The study revealed a mean hip-knee-ankle angle (HKA) of 178.6° ± 4.4°, mLDFA of 86.9° ± 2.5°, MPTA of 85.4° ± 2.4°, arithmetic HKA of -1.4° ± 3.2° and joint line obliquity of 172.5° ± 3.7°. The varus CPAK groups (I/IV/VII) included 435 patients, the neutral groups (II/V/VIII) comprised 630 patients and the valgus groups (III/VI/IX) had 175 patients. Notably, CPAK matrix groups were not distinctly associated with specific coronal extra-articular deformity phenotype (CEDP) groups. Particularly among the most common CPAK matrix groups (I/II/III/IV/V), there was a significant variation in segmental coronal extra-articular deformity patterns. Moreover, when neutral MPTA/mLDFA values were set at 87.0° ± 2.0°, the CPAK matrix groups exhibited even greater variability in coronal extra-articular deformities. CONCLUSION The CPAK matrix groups do not exhibit a direct correlation with a specific extra-articular deformity pattern (CEDP), thus rendering them unsuitable for determining segmental coronal extra-articular knee deformities. LEVEL OF EVIDENCE Level III, retrospective diagnostic study.
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Affiliation(s)
- Glauco Loddo
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy
- Orthopedic Surgery Department, Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Jae-Sung An
- Orthopedic Surgery Department, Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals, Herentals, Belgium
| | - Christophe Jacquet
- Orthopedic Surgery Department, Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Kristian Kley
- Orthopedic Surgery Department, Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
- Orthopaedic Care Center, Harley Street Specialist Hospital, London, UK
| | - Jean-Noël Argenson
- Orthopedic Surgery Department, Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Akash Sharma
- Department of Orthopaedics and Traumatology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Matthieu Ollivier
- Orthopedic Surgery Department, Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
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Mabrouk A, Fernandes LR, Jacquet C, Kley K, Claes S, Ollivier M. The tipping point in medial opening wedge high tibial osteotomy relates to the shape of the proximal tibia more than to lower limb alignment correction. Knee Surg Sports Traumatol Arthrosc 2024; 32:1008-1015. [PMID: 38469922 DOI: 10.1002/ksa.12121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The tipping point (TP) of the knee joint is the centre of rotation of the joint in the coronal plane. This study aimed to define the TP in medial opening wedge high tibial osteotomy (MOWHTO). METHODS Data from 154 consecutive patients with varus knee malalignment, who underwent MOWHTO between 2017 and 2021, was retrospectively reviewed. The degree of preoperative osteoarthritis (OA), using the Kellgren-Lawrence (KL) grading system, was recorded. Long-leg standing radiographs were used to record the alignment parameters, including the hip-knee-ankle angle (HKA), the mechanical lateral distal femoral angle (mLDFA), the medial proximal tibial angle (MPTA), the joint line convergence angle (JLCA) and the joint line obliquity (JLO) angle. Postoperative Tegner activity scores, Western Ontario and McMaster University Scores and patients' satisfaction were recorded. To define the TP, the relationship of all variables to Δ JLCA (absolute difference between preoperative to postoperative JLCA values) was analysed. Linear regression was employed for Δ JLCA to preoperative JLCA and postoperative and Δ MPTA (absolute difference between preoperative and postoperative values). K-means clustering was used to partition observations into clusters, in which each observation belongs to the cluster with the nearest mean serving as a prototype of the cluster, and analysed if there was any specific threshold influencing Δ JLCA. After defining the TP, further subanalysis of the TP based on the preoperative KL OA grade and analysis of variance of this TP to the KL OA grade was performed. RESULTS A total of 154 patients (77.9% males and 22.1% females) were included. The mean age was 48.2 ± 11 years, and the mean body mass index was 27.1 ± 4 kg/m2. Preoperatively, 26 (16.9%) patients had KL grade IV OA. The mean preoperative and postoperative JLCA and the significance of their relation to Δ JLCA were 2.6° ± 1.8° (p < 0.0001) and 1.9° ± 1.8° (p = 0.6), respectively. The mean Δ JLCA was 1.4° ± 1.5°. The mean pre- and postoperative MPTA and the significance of their relation to Δ JLCA were 84.6 ± 2.2 (p = 0.005) and 91.8 ± 2.5 (p < 0.0007), respectively. The mean Δ MPTA was 7.2 ± 2.3 (p = 0.3). The mean preoperative and postoperative HKA and the significance of their relation to Δ JLCA were 174.6 ± 2.5 (p = 0.2) and 181.9 ± 2.4 (p = 0.7), respectively. The overall linear regression for Δ JLCA was statistically significant for preoperative JLCA (R2 = 0.3, p < 0.0001) and postoperative MPTA (R2 = 0.09, p = 0.0001) and statistically insignificant for Δ MPTA (R2 = 0.01, p = 0.2) and postoperative HKA (R2 = 0.04, p = 0.7). MPTA > 91.5° was the optimal threshold dividing this series data set between substantial and nonsignificant Δ JLCA. CONCLUSION In this study, the main predictive factors for intra-articular correction (Δ JLCA) after MOWHTO were the preoperative value of JLCA and the postoperative value of MPTA. A value of 92° for postoperative MPTA is potentially the optimal threshold to predict intra-articular correction. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Department of Trauma and Orthopaedics, Mid Yorkshire Teaching Hospitals, England
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
| | | | | | | | | | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
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Charre D, An JS, Khakha R, Kley K, Şahbat Y, Ollivier M. 'One millimetre equals one degree' is a major source of inaccuracy in planning osteotomies around the knee for metaphyseal deformities compared to the digital planning. Knee Surg Sports Traumatol Arthrosc 2024; 32:987-999. [PMID: 38431800 DOI: 10.1002/ksa.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The objective of this study was to compare the accuracy of virtually performed osteotomies around the knee. The comparison was made between the Miniaci method (method 1), considered the gold standard planning, with the widely held dogma that one degree of correction required equates to one millimetre of opening/closing (method 2). METHODS This retrospective cross-sectional study was conducted between December 2018 and September 2022 in patients aged at least 15 years with metaphyseal knee deformity. Osteotomy planning was performed in methods 1 and 2 utilising calibrated long-leg alignment X-rays in the frontal plane. In both methods, the desired correction was defined by the Fujisawa point. The error % in measurement (ratio method 1/method 2) and the difference in millimetres (method 1 - method 2) between the two methods were analysed. RESULTS A total of 107 osteotomies with 27 (25.2%) distal femoral osteotomies, 54 (50.5%) proximal tibial osteotomies and 26 (24.3%) double-level osteotomies were performed virtually with a mean hip-knee-ankle angle of 176.4 ± 6.6. In distal femur osteotomy, the mean error % between methods 1 and 2 was 38.9 ± 16.7% and 22.4 ± 16.8% for the opening and closing groups, respectively. In proximal tibial osteotomies, the mean error % was 22.7 ± 15.6% and 9 ± 10.8% for the opening and closing groups, respectively. In double-level osteotomy, the mean error % of femur-based corrections was 34.9 ± 19% and 19.5 ± 21% for the opening and closing groups, respectively, and the mean error of the tibial-based corrections was 26.4 ± 12.1% for the opening group and 10.8 ± 10% for the closing group, respectively. CONCLUSION Planning one millimeter per degree of desired correction for osteotomies around the knee in metaphyseal deformities is a major source of error when compared with digital planning using the Miniaci method. This was seen most frequently with osteotomies of the distal femur and all opening wedge osteotomies. LEVEL OF EVIDENCE Level Ⅲ, retrospective cross-sectional study.
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Affiliation(s)
- Dimitri Charre
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
| | - Jae-Sung An
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Kristian Kley
- Harley Street Specialist Hospital, London, UK
- Orthopädie Maximilium, Donauwörth, Germany
| | - Yavuz Şahbat
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
- Erzurum Regional Training and Research Hospital, Orthopaedic Surgery and Traumatology, Erzurum, Turkey
| | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
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Mabrouk A, An JS, Kley K, Tapasvi K, Tapasvi S, Ollivier M. Combined knee osteotomy and cartilage procedure for varus knees: friend or foe? A narrative review of the literature. EFORT Open Rev 2024; 9:173-180. [PMID: 38457915 PMCID: PMC10958248 DOI: 10.1530/eor-23-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Varus knees with associated cartilage pathologies are not uncommon scenarios that present to orthopaedic surgeons. There is no agreement on the ideal management of varus knees with concomitant cartilage pathology. Through a literature review, the authors tried to answer three main questions: On October 2022, OVID MEDLINE, EMBASE, and COCHRANE databases were searched. Clinical studies reporting on clinical, radiologic, or macroscopic cartilage regeneration following either isolated knee osteotomy or concomitant osteotomy and a cartilage procedure were reviewed. Despite controversies, the literature demonstrated favourable outcomes of combined knee osteotomy and a cartilage procedure in patients with substantial deformity and cartilage defects. Isolated high tibial osteotomy may induce cartilage regeneration in several scenarios and severities of concomitant malalignment and cartilage defects. There are recommendations that knee osteotomy should be added to a cartilage procedure when an extra-articular deformity of > 5° is detected. Some studies report good outcomes for combining a knee osteotomy with cartilage grafting, but they lack a control group of isolated osteotomy. There is still scarce of evidence on the influence of osteotomies on cartilage regeneration and the outcomes of concomitant osteotomy and different cartilage procedures vs isolated osteotomies. With advanced statistical evaluation (artificial intelligence, machine learning) of big datasets, more answers and better results will be delivered.
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Affiliation(s)
- Ahmed Mabrouk
- Mid Yorkshire Teaching Hospitals, Yorkshire, United Kingdom
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
| | - Jae-Sung An
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
| | | | | | | | - Matthieu Ollivier
- Institut du mouvement et de l’appareil locomoteur, Marseille, France
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Ferreira A, Jacquet C, Guy S, Khakha R, Kley K, Argenson JN, Ollivier M. Distal femoral osteotomy planning: Reversed Miniaci's method is more accurate than Dugdale and Paley methods. Orthop Traumatol Surg Res 2024; 110:103697. [PMID: 37783427 DOI: 10.1016/j.otsr.2023.103697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSES The purpose of this study was to validate the reversed Miniaci method for distal femoral osteotomies and to compare the accuracy with Dugdale and Paley methods. METHODS Between January 2019 and October 2021, 59 DFO were performed in a single center. Following application of the eligibility and exclusion criteria, radiographic measurements and analysis was performed for 24 patients by two independent observers, then repeated after one month. Medical planning software: PeekMed v2.3.7.6® was used. For all patients the following measurements were performed: Hip-Knee-Ankle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), joint line obliquity (JLO), width of the proximal tibia and the weight-bearing line (WBL). Each image was then analysed using the following planning methods for realignment surgery: Reversed Miniaci, Dugdale and Paley. Measurements were recorded post deformity correction. Difference between target and post-correction WBL was evaluated. This difference was adjusted by the objective in order to limit biases related to the different objectives according to the method. RESULTS Eighteen patients were managed for a varus osteotomy and 6 for a valgus osteotomy. Preoperative data was, HKA at 176.7±6.3, mLDFA at 90.6±5.4, MPTA 88.9±1.1, a WBL for valgus 80.9%±9.1 and for varus deformity 23.5%±11.7. Inter- and intra-rater reliability was>0.8 for every method. After normalizing reported precision on the amount of correction expected, reversed Miniaci method was the most accurate with a mean deviation from the target of 3%, compared to the Dugdale's method with 9% (p<0.001) and to Paley's method with 8.6% (p<0.001). CONCLUSION The reversed Miniaci method is effective and reliable for planning distal femoral osteotomies. Compared to other planning methods, it is the most accurate approach for achieving a correction goal. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Alexandre Ferreira
- Department of Orthopedics and Traumatology, Caen University Hospital, avenue Côte de Nacre, 14000 Caen, France.
| | - Christophe Jacquet
- Department of Orthopedics and Traumatology, Institute of movement and locomotion, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Sylvain Guy
- Department of Orthopedics and Traumatology, Institute of movement and locomotion, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Raghbir Khakha
- Harley Street Specialist Hospital, London, United Kingdom
| | - Kristian Kley
- Harley Street Specialist Hospital, London, United Kingdom; Orthoprofis Hannover Luisenstraße 10/11, 30539 Hannover, Germany
| | - Jean-Noël Argenson
- Department of Orthopedics and Traumatology, Institute of movement and locomotion, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France; Aix Marseille Unit, Department of Orthopedics and Traumatology, Institute for Locomotion, CNRS, ISM, Sainte-Marguerite Hospital, AP-HM, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of movement and locomotion, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France; Aix Marseille Unit, Department of Orthopedics and Traumatology, Institute for Locomotion, CNRS, ISM, Sainte-Marguerite Hospital, AP-HM, Marseille, France
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Mabrouk A, An JS, Glauco L, Jacque C, Kley K, Sharma A, Ollivier M. The joint line convergence angle (JLCA) correlates with intra-articular arthritis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5673-5680. [PMID: 37884727 DOI: 10.1007/s00167-023-07616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Knees with unicompartmental varus osteoarthritis (OA) usually display a combination of tibiofemoral bony deformity and increased joint line convergence angle (JLCA). The JLCA is a product of intra-articular deformity and lateral soft tissue laxity. This study aims to define the correlation between the JLCA and progression of OA. METHODS A retrospective radiological analysis of 501 patients, who underwent either high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA), was performed. The preoperative OA grade was reported based on the Ahlbäck and the Kellgren-Lawrence (KL). The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the mechanical lateral distal femoral angle (mLDFA) and the joint line convergence angle (JLCA) were recorded. The primary outcome was the relationship between the JLCA values and the OA grade. The secondary outcomes were comparing the JLCA and other alignment parameter values between HTO and UKA groups. RESULTS A total of 501 (59.3% females n = 297) cases were included, comprising 293 cases of HTO and 208 cases of UKA. Patients had a mean age of 57.63 ± 8.97 years, a mean BMI of 28.37 ± 7.39 kg/m2. Patients with Ahlbäck grade 2 represented 49.3% of all patients (n = 247) and patients with KL grade 3 represented 54.7% of all patients (n = 274). A high JLCA was observed in both groups. The reported mean JLCA in the UKA group was 3.69 ± 2.1°, and in the HTO group was 2.93 ± 1.82. There was a significant association between the increase in the JLCA and the progression of OA based on both the Ahlbäck and KL grades (both p values < 0.001). The mean JLCA in patients with Ahlbäck grades 1 and 4 was 1.48 ± 1.32°, and 7 ± 0.93°, respectively. The mean JLCA in patients with KL grades 1 and 4 was 1.77 ± 1.42°, and 4.89 ± 1.73°, respectively. The mean recorded preoperative HKA angle in the UKA group was 175.06 ± 3.08°, and in the HTO group was 173.26 ± 3.02°, whereas the mean MPTA was 88.63 ± 1.72° for the UKA group and 89.31 ± 2.29° for the HTO group. CONCLUSION The JLCA progressively increases with osteoarthritis progression in patients with unicompartmental varus knee osteoarthritis. The JLCA can potentially be used as a grading parameter for osteoarthritis progression akin to Ahlbäck and Kellgren-Lawrence grading systems.
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Affiliation(s)
- Ahmed Mabrouk
- Mid Yorkshire Teaching Hospitals, Yorkshire, UK
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Jae-Sung An
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Loddo Glauco
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Christophe Jacque
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | | | | | - Matthieu Ollivier
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France.
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Ollivier M, An JS, Kley K, Khakha R, Fernandes LR, Micicoi G. A significant rate of tibial overcorrection with an increased JLO occurred after isolated high tibial osteotomy without considering international consensus. Knee Surg Sports Traumatol Arthrosc 2023; 31:4927-4934. [PMID: 37597039 DOI: 10.1007/s00167-023-07518-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The recent ESSKA consensus recommendations defined indications and outlined parameters for osteotomies around a degenerative varus knee. The consensus collated these guidelines based on the published literature available to answer commonly asked questions including the importance of identifying the site and degree of the lower limb deformity. In the consensus, the authors suggest that a knee joint line obliquity (JLO) greater than 5° or a planned medial proximal tibial angle (MPTA) > 94° preferentially indicates a double level osteotomy (DLO) compared to an isolated opening wedge high tibial osteotomy (OWHTO). This study aimed to analyze the corrections performed on a cohort of isolated opening wedge high tibial osteotomies (OWHTOs) prior to the recent ESSKA recommendations, with a focus on the impact of knee joint line obliquity (JLO) and medial proximal tibial angle (MPTA) on the choice of osteotomy procedure. METHODS This monocentric, retrospective study included 129 patients undergoing medial OWHTO for symptomatic isolated medial knee osteoarthritis (Ahlbäck grade I or II) and a global varus malalignment (hip-knee-ankle angle ≤ 177°). An automated software trained to automatically detect lower limb deformity was implemented using patients preoperative long leg alignment X-rays to identify suitability for an isolated HTO in knee varus deformity. Based on the ESSKA recommendations, the site of the osteotomy was identified as well as the degree of correction required. The ESSKA consensus considers avoiding an isolated high tibial osteotomy if the planned resultant knee joint line orientation exceeds 5 ̊ or MPTA exceeds 94°. A preoperative abnormal MPTA was defined by a value lower than 85° and a preoperative abnormal LDFA by a value greater than 90°. The cases of DLO or DFO suggested by the software and the number of extra-tibial anomalies were collected. Multiple linear regression models were developed to establish a relationship between preoperative values and the risk of being outside of ESSKA recommendations postoperatively. RESULTS Based on ESSKA recommendations and on threshold values considered abnormal, the software suggested a DLO in 17.8% (n = 23/129) of cases, a distal femoral osteotomy in 27.9% (n = 36/129) of cases and advised against an osteotomy procedure in 24% (n = 31/129) of cases. The software detected a femoral anomaly in 34.9% (n = 45/129) of cases and an JLCA > 6° in 9.3% (n = 12/129). Postoperatively, the MPTA exceeds 94° in 41.1% (n = 53/129) and the JLO exceeds 5° in 29.4% (n = 38/129). On multivariate analysis, a high preoperative MPTA was associated with higher risk of postoperative MPTA > 94° (R2 = 0.36; p < 0.001). Similarly, the probability of the software advising a DLO or DFO was associated with the presence of an "normal" preoperative MPTA (R2 = 0.42; p < 0.001) or an abnormal preoperative LDFA (R2 = 0.48; p < 0.001) or a planned JLO > 5° (R2 = 0.27; p < 0.001). CONCLUSIONS Analysis of patients who underwent an isolated OWHTO prior to the ESSKA guidelines, demonstrated a significant rate of post-operative tibial overcorrection and a resultant increased JLO. Pre-operative planning that considers the ESSKA guidelines, allows for better identification of those patients requiring a DFO or DLO and avoidance of resultant post-operative deformities. LEVEL OF EVIDENCE IV, case-series.
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Affiliation(s)
- Matthieu Ollivier
- APHM, CNRS, ISM, Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Sainte-Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
| | - Jae-Sung An
- APHM, CNRS, ISM, Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Sainte-Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Kristian Kley
- Orthoprofis Hannover Luisenstraße, 10/11, 30539, Hannover, Germany
| | - Raghbir Khakha
- Guys and St. Thomas' Hospitals, Great Maze Pond, London, SE1 9RT, England
| | - Levi Reina Fernandes
- Department of Orthopedics and Traumatology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Grégoire Micicoi
- Institute for Locomotion and Sports, iULS-University, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, Nice, France
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Mabrouk A, Kley K, Jacquet C, Fayard JM, An JS, Ollivier M. Outcomes of Slope-Reducing Proximal Tibial Osteotomy Combined With a Third Anterior Cruciate Ligament Reconstruction Procedure With a Focus on Return to Impact Sports. Am J Sports Med 2023; 51:3454-3463. [PMID: 37885232 DOI: 10.1177/03635465231203016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND An increased posterior tibial slope (PTS) is a proven risk factor for both native anterior cruciate ligament (ACL) and ACL graft insufficiency. Anterior closing wedge high tibial osteotomy (ACW-HTO) for PTS correction is a validated procedure in revision ACL reconstruction (ACLR). PURPOSE/HYPOTHESIS The aim of this study was to evaluate the effect of combined ACW-HTO and at least a second revision ACLR procedure on knee stability, function, and sports performance in a large series of patients. The hypothesis was that patients would return to impact sports after ACW-HTO combined with a second or third revision ACLR procedure. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 64 patients who underwent a second (or more) revision ACLR procedure and ACW-HTO between June 1, 2015, and June 1, 2019, and had a PTS >12° were included. The mean age was 29.60 ± 6.31 years, and the mean preoperative PTS was 13.79°± 1.50°. The cases were analyzed at a mean follow-up of 2.96 ± 0.83 years (range, 2-5 years). At the last follow-up, the rate of patients returning to impact sports (based on the University of California, Los Angeles [UCLA], activity scale), ACL graft status (per magnetic resonance imaging), International Knee Documentation Committee (IKDC) scores, Lysholm scores, and laxity measurements using a knee arthrometer were recorded. RESULTS The total number of patients participating in impact sports and high-impact sports was as follows: 43 and 30, respectively, before the injury; 0 and 0, respectively, preoperatively; and 31 and 12, respectively, postoperatively. At the last follow-up, the UCLA score was ≥8 in 48.44% of the patients, and only 16 patients returned to their preinjury level of activity. At a minimum of 2 years of follow-up, there was clinical improvement in the IKDC score from 37.98 ± 12.48 preoperatively to 69.06 ± 12.30 postoperatively (P < .0001), in the Lysholm score from 51.94 ± 14.03 preoperatively to 74.45 ± 11.44 postoperatively (P < .001), and in the UCLA score. However, this clinical improvement did not equate to preinjury values for all outcome scores (P < .001). The preinjury IKDC and Lysholm scores were 76.98 ± 11.71 and 89.26 ± 8.91, respectively. The mean change in anterior knee laxity using a knee arthrometer at 134 and 250 N was -4.03 ± 0.18 mm and -3.63 ± 0.16, respectively. There were 3 cases of a rerupture with a severe pivot shift on the clinical examination. None of these patients underwent revision per the patient's preference. Increased knee recurvatum was observed in one-third of the patients, but all were asymptomatic. CONCLUSION In the setting of chronic ACL-deficient knees, PTS reduction (ACW-HTO) with revision ACLR restored knee stability and improved function with an acceptable rate of specific complications. Increased knee recurvatum was observed in one-third of the patients, but all were asymptomatic. Also, approximately half of the patients were able to return to impact sports.
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Affiliation(s)
- Ahmed Mabrouk
- Department of Trauma and Orthopaedic Surgery, Mid Yorkshire Teaching Hospitals, Yorkshire, UK
- Institute of Movement Sciences, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | | | - Christophe Jacquet
- Institute of Movement Sciences, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | | | - Jae-Sung An
- Institute of Movement Sciences, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement Sciences, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
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An JS, Mabrouk A, Khakha R, Kley K, Koga H, Jacquet C, Ollivier M. Assessment of return to sport and functional outcomes following distal femoral, double level and high tibial osteotomies for active patients with symptomatic varus malalignment. Knee Surg Sports Traumatol Arthrosc 2023; 31:4285-4291. [PMID: 37329369 DOI: 10.1007/s00167-023-07457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/13/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE This study indicated the outcomes of three surgical techniques for the treatment of symptomatic unicompartmental knee osteoarthritis (UKOA) with varus malalignment in younger, active patients: distal femoral osteotomy (DFO), double-level osteotomy (DLO) and high tibial osteotomy (HTO). The outcomes measured included the return to sport, sport activity and functional scores. METHODS A total of 103 patients (19 DFO, 43 DLO, 41 HTO) were enrolled in the study and were divided into three groups based on their oriented deformity, each undergoing one of the three surgical techniques. All patients underwent pre- and post-operative evaluations including X-rays, physical exams and functional assessments. RESULTS All three surgical techniques were effective in treating UKOA with constitutional malalignment. The average time to return to sport was similar among the three groups (DFO: 6.4 ± 0.3 [5.8-7] months, DLO: 4.9 ± 0.2 [4.5-5.3] months, HTO: 5.6 ± 0.2 [5.2-6] months). The sport activity and functional scores improved significantly for all three groups, with no significant differences observed among the groups. CONCLUSION Various knee osteotomy procedures, DFO, DLO, and HTO, result in high RTS rates and quick RTS times with satisfactory functional scores. Despite pre- to post-operative improvements in sport activities following DFO and DLO, pre-symptom levels were not reached following all evaluated procedures. LEVEL OF EVIDENCE Retrospective case-control study, Level III.
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Affiliation(s)
- Jae-Sung An
- Tokyo Medical and Dental University, Tokyo, Japan
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Ahmed Mabrouk
- Leeds Teaching Hospitals, Leeds, UK
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Raghbir Khakha
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
- Guys and St. Thomas' Hospitals, Great Maze Pond, London, UK
| | - Kristian Kley
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
- Harley Street Specialist Hospital, 18-22, Queen Anne Street, London, W1G8HU, UK
- Orthopädie Maximilium, Donauwörth, Germany
| | | | - Christophe Jacquet
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France.
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10
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Caubère A, Barbier O, Kley K, Hanak L, Jacquet C, Ollivier M. Double level osteotomy for genu varum: Is a return to sport possible? Orthop Traumatol Surg Res 2022; 109:103397. [PMID: 36087834 DOI: 10.1016/j.otsr.2022.103397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION A double level osteotomy (DLO) may be indicated in patients with genu varum when the deformity involves both the tibia and femur. These patients, who are often young and active, have a high functional demand and hope for a rapid return to sport. The purpose of our study was to assess return to sport and functional outcomes following DLO for symptomatic genu varum. MATERIALS AND METHODS A total of 40 patients (mean age 45.5±2 years) who underwent a DLO between 2018 and 2020, performed in 2 different hospitals, were reviewed after a minimum follow-up of 1-year. The mean initial varus was 11±2°. The type of sport and frequency of participation (UCLA activity score) as well as time to return to sport and level of activity recovered were defined as the primary endpoints. Functional scores were also assessed with the knee injury and osteoarthritis outcome score (KOOS). RESULTS At the last follow-up, 87.5% (n=35) of patients reported that they had returned to sport. The mean time to return to sport was 6±1 months with a significant difference (p<0.001) between the pre- and postoperative UCLA activity scores. There was a strong correlation between the presence of a joint line obliquity >3° and decreased functional outcomes (p<0.0001). The overall KOOS score improved (p<0.001) by a mean of 38.6 points after the correction. The 8 lateral cortical fractures (Takeuchi type I and II) and the 2 medial cortical fractures (Nakayama type 1) that were found had no impact on functional outcomes (p>0.05). CONCLUSION Our findings demonstrated that DLO provided rapid return to sport, thus making it possible to meet the functional demands and expectations of patients. LEVEL OF EVIDENCE IV; Retrospective study.
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Affiliation(s)
- Alexandre Caubère
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital d'Instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, France.
| | - Olivier Barbier
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital d'Instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, France
| | - Kristian Kley
- Harley Street Specialist Hospital, 18-22, Queen Anne Street, London, W1G8HU, United Kingdom
| | | | - Christophe Jacquet
- Service de Chirurgie Orthopédique et Traumatologie, Université Aix-Marseille, APHM, CNRS, ISM, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Marseille, France; Service de Chirurgie Orthopédique et Traumatologie, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Matthieu Ollivier
- Service de Chirurgie Orthopédique et Traumatologie, Université Aix-Marseille, APHM, CNRS, ISM, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Marseille, France; Service de Chirurgie Orthopédique et Traumatologie, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
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11
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Sautet P, Kley K, Khakha R, Ollivier M. Minimally Invasive Double Level Osteotomy in Severe Knee Varus: Pearls and Pitfalls. Arthrosc Tech 2022; 11:e1105-e1109. [PMID: 35782831 PMCID: PMC9244850 DOI: 10.1016/j.eats.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023] Open
Abstract
Minimally invasive double-level osteotomy (DLP) surgery is performed in severe knee varus, when extra-articular deformity is identified in both the distal femur and proximal tibia. The main advantage is to maintain a horizontal joint line and avoid creating secondary anatomic deformities. This article considers the pearls and pitfalls in performing minimally invasive DLO surgery.
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Affiliation(s)
- Pierre Sautet
- Institut du Mouvement et de l'Appareil Locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | | | - Raghbir Khakha
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, London, United Kingdom
| | - Matthieu Ollivier
- Institut du Mouvement et de l'Appareil Locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
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12
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Ollivier M, Fabre-Aubrespy M, Micicoi G, Ehlinger M, Hanak L, Kley K. Lateral femoral closing wedge osteotomy in genu varum. Orthop Traumatol Surg Res 2021; 107:102989. [PMID: 34144255 DOI: 10.1016/j.otsr.2021.102989] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 02/03/2023]
Abstract
The distal femoral valgisation osteotomy has a variety of indications due to enhanced understanding of segmental deformities of the lower limb. Historically, an overall varus deformity was corrected at the tibia, and a valgus deformity at the femur. This approach of performing an "all in the tibia" correction for an overall varus can nevertheless lead to abnormal postoperative morphology because it is non-anatomical; creating joint line obliquity, and potentially shear stress on the cartilage. An original lateral femoral closing wedge osteotomy technique is described, allowing the correction of a genu varum of femoral or mixed origin, in the event of an associated tibial valgisation osteotomy. The detailed technique minimizes the risk of a hinge fracture while improving post-operative outcomes.
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Affiliation(s)
- Matthieu Ollivier
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Institute of Movement and Locomotion, 270, Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
| | - Maxime Fabre-Aubrespy
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Institute of Movement and Locomotion, 270, Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - Grégoire Micicoi
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, UR2CA, University Côte d'Azur, Nice, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Hôpital de Hautepierre II, Hôpitaux Universitaires de Strasbourg, 67098 Strasbourg, France
| | | | - Kristian Kley
- Orthoprofis Hannover Luisenstraße 10/11, 30539 Hannover, Germany
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13
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Khakha RS, Bin Abd Razak HR, Kley K, van Heerwaarden R, Wilson AJ. Role of high tibial osteotomy in medial compartment osteoarthritis of the knee: Indications, surgical technique and outcomes. J Clin Orthop Trauma 2021; 23:101618. [PMID: 35070682 PMCID: PMC8758909 DOI: 10.1016/j.jcot.2021.101618] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022] Open
Abstract
Knee osteoarthritis (OA) is the most common joint disorder worldwide. In particular, primary knee OA often presents with a varus malalignment. This increases the loads going through the medial compartment resulting in cartilage degeneration and symptomatic arthritis. High tibial osteotomy (HTO) is the workhorse surgical procedure for treating medial knee OA. When performed precisely in the hands of an experienced surgeon, HTO can delay or avoid knee arthroplasty. Of note, outcomes of knee arthroplasty are at best unpredictable in patients of younger age. Hence, there is a growing need for joint preservation procedures for younger patients presenting with knee OA, of which HTO is one. Through this article, the authors of whom all are joint preservation surgeons with a special interest in osteotomy hope to share from their experience as well as the available literature on the indications, perioperative planning, surgical technique, outcomes as well as pearls and pitfalls of HTO.
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Affiliation(s)
- Raghbir S. Khakha
- London Knee Osteotomy Centre, Harley Street Specialist Hospital, 18-22 Queen Anne St, London W1G 8HU, UK,Department of Orthopaedics, Guys & St Thomas's Hospital, Great Maze Pond, SE1 9RT, UK,Corresponding author. London Knee Osteotomy Centre, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, UK.
| | - Hamid Rahmatullah Bin Abd Razak
- London Knee Osteotomy Centre, Harley Street Specialist Hospital, 18-22 Queen Anne St, London W1G 8HU, UK,Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
| | - Kristian Kley
- London Knee Osteotomy Centre, Harley Street Specialist Hospital, 18-22 Queen Anne St, London W1G 8HU, UK,Orthoprofis Hannover, Luisenstraße 10-11, 30159, Hannover, Germany
| | - Ronald van Heerwaarden
- London Knee Osteotomy Centre, Harley Street Specialist Hospital, 18-22 Queen Anne St, London W1G 8HU, UK,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
| | - Adrian J. Wilson
- London Knee Osteotomy Centre, Harley Street Specialist Hospital, 18-22 Queen Anne St, London W1G 8HU, UK,Department of Sports and Exercise, University of Winchester, Sparkford Rd, Winchester SO22 4NR, United Kingdom
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14
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Grasso F, Martz P, Micicoi G, Khakha R, Kley K, Hanak L, Ollivier M, Jacquet C. Double level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patients. Int Orthop 2021; 46:473-479. [PMID: 34536082 DOI: 10.1007/s00264-021-05194-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Double level osteotomy (DLO) (femoral and tibial) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO), and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of two years. METHODS A single-centre, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), lateral distal femoral angle (ΔLDFA), and posterior proximal tibial angle (ΔPPTA). Pre- and post-operative JLO was also evaluated. At two year follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables; the paired Student's t test was used to estimate evolution of functional outcomes. RESULTS The mean ΔHKA was 1.3 ± 0.5°; the mean ΔMPTA was 0.98 ± 0.3°; the mean ΔLDFA was 0.94 ± 0.2°; ΔPPTA was 0.45 ± 0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4 ± 0.2. At last follow-up, it was recorded a significant improvement in all KOOS scores, and 19 patients were enthusiastic, two satisfied, and one moderately satisfied. CONCLUSION Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at two year follow-up.
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Affiliation(s)
- Francesco Grasso
- IRCCS-Istituto Ortopedico Galeazzi, University of Milan, Milan, Italy
| | - Pierre Martz
- Service de Chirurgie Orthopédique, Centre-Hospitalo-Universitaire de Dijon, Dijon, France
| | - Grégoire Micicoi
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Raghbir Khakha
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Kristian Kley
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Lukas Hanak
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France.
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille Cedex 09, France.
| | - Christophe Jacquet
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille Cedex 09, France
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15
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Malavolta M, Kley K. [Kinematic alignment-management of deformities and flexion contractures]. Orthopade 2021; 50:173-178. [PMID: 32812069 DOI: 10.1007/s00132-020-03970-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Kinematic alignment (KA) total knee arthroplasty (TKA) has proven to be a viable alternative to mechanical alignment (MA) TKA. Like any technique, its validity has to encounter challenges. Two of these are flexion contracture and large deformities of the knee. FLEXION CONTRACTURE Flexion contracture is commonly treated with posterior capsular release. Often, however, this technique is not sufficient. Many surgeons accustomed to MA techniques and guided by traditional femoral instruments manage the problem by proximalizing the distal femoral cut. However, this has proven to be a surgical mistake that often leads to mid-flex knee instability. KA rules limit this mistake but leave the problem of flexion contracture. In these cases, the surgeon acts on the tibia distalizing the cut and, so as not to create instability in flexion, decreasing the slope. The technique is effective to obtain full extension but often leaves instability at 90° of knee flexion. To avoid this, it is useful to use the so-called "virtuous mistake" strategy, which strictly follows the KA guidelines but undercuts the posterior femoral condyles by 2 mm. DEFORMITIES Another problem that often limits the use of KA is large deformities. It is necessary to distinguish whether they are intra or extra-articular. In the first case, it is possible to decide whether to use the pure KA technique or to restrict the indication at the level of the tibial cut. In the latter, extraarticular osteotomies or combined procedures (osteotomy plus KA) have to be performed.
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Affiliation(s)
- M Malavolta
- Abteilung für Kniechirurgie, P. Pederzoli Privatkrankenhaus, Peschiera am Gardasee (Verona), Verona, Italien.
| | - K Kley
- Orthoprofis, Hannover, Deutschland
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16
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Micicoi G, Jacquet C, Sharma A, LiArno S, Faizan A, Kley K, Parratte S, Ollivier M. Neutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database. Knee Surg Sports Traumatol Arthrosc 2021; 29:849-858. [PMID: 32372282 DOI: 10.1007/s00167-020-06030-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagittal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype. METHODS A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype. RESULTS The mean HKA was 179.4° ± 2.6°, LDFA: 85.8° ± 2.0°, MPTA: 85.6° ± 2.4°, PDFA: 85.2° ± 1.5°, PPTA: 83.8° ± 2.9° and nwJLCA: 1.09° ± 0.9°. Gender was associated with higher LDFA and lower HKA for men. Ethnicity was associated with greater proximal tibial vara and distal femoral valgus for Asian patients. Patients with an overall global varus alignment had more tibia vara and less femoral valgus than patients with an overall valgus alignment. CONCLUSION Even if significant differences were found based on subgroup analysis (gender, ethnicity or phenotype), this study demonstrated that neutral alignment is the main morphological pattern in the healthy middle-aged population. This neutrality is the result from tibia vara compensated by an ipsilateral femoral valgus. LEVEL OF CLINICAL EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Grégoire Micicoi
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France.,Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Christophe Jacquet
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Akash Sharma
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | | | | | - Kristian Kley
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,The London clinic, 20 Devonshire Pl, Marylebone, London, W1G 6BW, UK
| | - Sébastien Parratte
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,Adult Reconstructive Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Matthieu Ollivier
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France. .,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
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Jacquet C, Pioger C, Khakha R, Steltzlen C, Kley K, Pujol N, Ollivier M. Evaluation of the "Minimal Clinically Important Difference" (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:820-826. [PMID: 32342141 DOI: 10.1007/s00167-020-06026-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Defining a Minimal Clinically Important Difference (MCID) value for Patient-Reported Outcome Measures (PROMs) is crucial for determining the effectiveness of a procedure and calculating the sample size for trial planning. The purpose of this study was to determine the MCID of several PROMs (Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and the SF-12) in patients who underwent medial opening-wedge High-Tibial Osteotomy (owHTO) with Patient-Specific Cutting Guides (PSCGs), using anchor-based methods. METHODS Patients undergoing isolated medial owHTO with PSCGs between January 2013 and January 2017 were enrolled in this single-center, prospective, observational study. Three outcome scores were collected pre-operatively and at the 2 years follow-up evaluation: KOOS, KSS and SF-12. The MCIDs were calculated using anchor-based method: at 2 years postoperatively: "Compared with before surgery, how would you rate operated joint now?" The responses were recorded using a five-point scale. Patients who answered "about the same" or "somewhat worse" were classified into the no change group, while those who answered "somewhat better" were classified into the minimal change group. A receiver operating characteristic (ROC) curve was used to define the cutoff point that best discriminated between the minimal change and no change groups for each PROMs RESULTS: 196 patients were included, 75 (somewhat better) and 24 patients (about the same and somewhat worse) were, respectively, assigned to the "no change" and "minimal change" groups. There was no significant difference between the two groups in terms of baseline characteristics and postoperative complications. At 24 months follow-up all the PROMs (KOOS, KSS and SF-12) were significantly better for the "minimal change" group compared to the "no change" group. MCID was 15.4 for KOOS pain, 15.1 for KOOS symptoms, 17 for KOOS ADL, 11.2 for KOOS sports/recreation, 16.5 for KOOS QQL, 3 for KSS symptoms, 5.6 for KSS activity, 7.2 for SF-12 physical component and 6.3 for PCS mental component. CONCLUSION This study determined the MCIDs of common used PROMs in patients undergoing owHTO. LEVEL OF EVIDENCE Prospective Cohort Study, Level II.
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Affiliation(s)
- Christophe Jacquet
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Charles Pioger
- Département de Chirurgie orthopédique de l'hopital Mignot, Le chesnay, France
| | - Raghbir Khakha
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,Guys and St Thomas' Hospital, London, UK
| | - Camille Steltzlen
- Département de Chirurgie orthopédique de l'hopital Mignot, Le chesnay, France
| | - Kristian Kley
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Nicolas Pujol
- Département de Chirurgie orthopédique de l'hopital Mignot, Le chesnay, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
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Kley K, Bin Abd Razak HR, Khakha RS, Wilson AJ, van Heerwaarden R, Ollivier M. Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy. Arthrosc Tech 2021; 10:e419-e422. [PMID: 33680774 PMCID: PMC7917090 DOI: 10.1016/j.eats.2020.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/17/2020] [Indexed: 02/03/2023] Open
Abstract
Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. Medial collateral ligament (MCL) release and posterior neurovascular structure protection during OW-HTO are steps that often induce stress and nervousness during surgery, especially for surgeons in the earlier stages of their learning curve. While is it well-known that the MCL should be released during OW-HTO, the standard retraction techniques pose challenges in visualization and instrument placement in the surgical field. We present our technique, which illustrates an alternative method to manage the MCL and safely protect the neurovascular structures using a second and more posterior surgical window during OW-HTO.
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Affiliation(s)
- Kristian Kley
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- Orthoprofis, Hannover, Germany
| | - Hamid Rahmatullah Bin Abd Razak
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Raghbir S. Khakha
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- Department of Orthopaedics, Guys & St Thomas’s Hospital, London, United Kingdom
| | - Adrian J. Wilson
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- Department of Sports and Exercise, University of Winchester, Winchester, United Kingdom
| | - Ronald van Heerwaarden
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Institute of Movement and Locomotion, Marseille, France
- Address correspondence to Dr. Matthieu Ollivier, M.D., Ph.D., Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Institute of Movement and Locomotion, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
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19
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Gulagaci F, Jacquet C, Ehlinger M, Sharma A, Kley K, Wilson A, Parratte S, Ollivier M. A protective hinge wire, intersecting the osteotomy plane, can reduce the occurrence of perioperative hinge fractures in medial opening wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:3173-3182. [PMID: 31773202 DOI: 10.1007/s00167-019-05806-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/12/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE A recent study reported that positioning a K-wire to intersect the cutting plane at the theoretical lateral hinge location increases the lateral hinge's resistance to fracture during the opening of opening wedge high tibial osteotomy (OWHTO). The purpose of this study was to evaluate the clinical relevance of the use of this K-wire and its benefits in terms of lateral hinge protection during OWHTO in daily practice. METHODS A retrospective comparative study identified 206 patients who underwent OWHTO from January 2014 to December 2017. Among these patients, 71 had an additional K-wire (HK + group), whereas 135 did not (HK- group). The subjects meeting the inclusion criteria were included in a matched pairing process, which identified 60 patients in the HK + group and 60 patients in the HK- group. Mean follow-up time was 2.3 ± 1.0 years (range 2-4.2). Radiographic outcomes were evaluated with intraoperative and postoperative fluoroscopic imaging and with CT imaging at 6 weeks post OWHTO surgery. The knee osteoarthritis outcomes score (KOOS) was used and time needed to return to work and any kind of sports was collected. RESULTS Thirty six patients (30%) were found to have a LHF. Among these patients, 26 (72%) did not have an additional K-wire positioned at their theoretical lateral hinge location (HK- group) during the procedure. LHF rate for patients without additional K-wire group (HK-) was 43.3%, whereas it was 16.7% for the patients with an additional K-wire (HK +) [Odd ratio 3.8 95% CI 1.6-8.3; p = 0.005]. The mean time to return to work, return to any kind of sports, and bone union was significantly shorter for HK + group (p < 0.05). CONCLUSION This study demonstrated that during OWHTO, positioning a K-wire intersecting the cutting plane at the theoretical lateral hinge location reduced the number of intraoperative lateral hinge fractures. LEVEL OF EVIDENCE III retrospective case-control study.
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Affiliation(s)
- Firat Gulagaci
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Christophe Jacquet
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - Akash Sharma
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Kristian Kley
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Adrian Wilson
- The Wellington Hospital, Wellington Place, St. John's Wood, London, UK
| | - Sebastien Parratte
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France. .,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France. .,The Institute for Locomotion, Aix-Marseille University, Marseille, France.
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20
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Jacquet C, Marret A, Myon R, Ehlinger M, Bahlouli N, Wilson A, Kley K, Rossi JM, Parratte S, Ollivier M. Adding a protective screw improves hinge's axial and torsional stability in High Tibial Osteotomy. Clin Biomech (Bristol, Avon) 2020; 74:96-102. [PMID: 32151903 DOI: 10.1016/j.clinbiomech.2020.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUNDS Despite the use of a locking plate a 30% incidence of lateral hinge fracture after Open-Wedge High Tibial Ostetomy was described in the literature. A finite element model was used to analyze if the presence of a hinge-securing screw in the osteotomy area, using Patient Specific Cutting Guides with a locking plate, decreases the stresses within the lateral hinge during compression and torsion. METHODS A 3D model of a tibial sawbone was used to simulate an opening wedge of 10°. To apply loads on the tibial plateau, two supports were modelled on each tibial plateau to simulate the femoral condyles forces. A two second model with a hinge-stabilizing was defined with two different screws (diameter 2 mm and 4 mm). Two cases of static charges were considered 1) compression test (2500 N) 2) Torsion test (along the tibial mechanical axis). FINDINGS During compression simulation, 17% of the total surface of lateral hinge was stressed between 41-50Mpa without hinge-securing screw while the amount of surface under stress between 41 and 50 MPa dropped significantly under screw stabilization (1% for the 2 mm and 3% for the 4 mm). During torsion stress simulation a decrease of the value of the maximal stress in the lateral hinge was also observed with the addition of a hinge-securing screw (37 MPa without screw, 27Mpa with a 2 mm screw and 25 Mpa with a 4 mm screw). INTERPRETATION Positioning a screw intersecting the cutting plane at the theoretical lateral hinge location associated with a locking plate reduces lateral hinge stress in both compression and torsion. Those findings need to be confirmed by further specimens' mechanical testing.
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Affiliation(s)
- Christophe Jacquet
- Institute of Movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Auriane Marret
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Robin Myon
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France
| | - Nadia Bahlouli
- Laboratoire ICube, IUT de Haguenau 2 rue Boussingault, FR-67000 Strasbourg, France
| | - Adrian Wilson
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Kristian Kley
- Institute of Movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France
| | - Jean-Marie Rossi
- Institute of Movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France; Centrale Marseille, 13451 Marseille Cedex 20, France
| | - Sebastien Parratte
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.
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Abstract
SummaryDuring the recent years, in vivo imaging of small animals using SPECT has become of growing relevance. Along with the development of dedicated high-resolution small animal SPECT cameras, an increasing number of conventional clinical scanners has been equipped with single or multipinhole collimators. This paper reviews the small animal tomographs, which are operating at present and compares their performance characteristics. Furthermore, we describe the in vivo imaging studies, which have been performed so far with the individual scanners and survey current approaches to optimize molecular imaging with small animal SPECT.
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22
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Lobenhoffer P, Kley K, Freiling D, van Heerwaarden R. Distale Femurosteotomie in schließender biplanarer Technik mit Stabilisierung durch spezifischen Plattenfixateur. Oper Orthop Traumatol 2017; 29:306-319. [DOI: 10.1007/s00064-017-0493-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/29/2017] [Accepted: 02/01/2017] [Indexed: 10/19/2022]
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23
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Becher C, Kley K, Lobenhoffer P, Ezechieli M, Smith T, Ostermeier S. Dynamic versus static reconstruction of the medial patellofemoral ligament for recurrent lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2014; 22:2452-7. [PMID: 24781275 DOI: 10.1007/s00167-014-3020-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/13/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare clinical and radiological outcomes of static and dynamic medial patellofemoral ligament (MPFL) reconstruction techniques. METHODS In a retrospective, matched-paired, cohort analysis, 30 patients surgically treated for recurrent lateral patellar dislocation were divided into two groups of 15 patients matched for inclusion and exclusion criteria. The static technique group underwent rigid fixation of the gracilis tendon at the anatomic femoral MPFL insertion and the superomedial border of the patella; the dynamic technique group underwent detachment of the gracilis tendon at the pes anserinus with fixation to the proximal medial patellar margin via tunnel transfer obliquely through the patella. Kujala, Lysholm, and Tegner scores; pain level; and pre- and postoperative radiographic changes of patellar height, patellar tilt, and bisect offset were compared. RESULTS No significant between-group differences were found in mean Kujala, Tegner, Lysholm, or visual analogue scale scores or radiographic parameters. One case of resubluxation was observed in the dynamic group. All but one patient in each group would have been willing to undergo the procedure again. CONCLUSIONS Both techniques provided satisfactory short-term outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christoph Becher
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany,
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24
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Schaarschmidt W, Richter J, Kley K, Kralisch S, Jank A, Ebert T, Lössner U, Jessnitzer B, Kratzsch J, Blüher M, Stumvoll M, Fasshauer M, Stepan H. Serum levels of growth arrest specific protein 6 are increased in preeclampsia. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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25
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Schaarschmidt W, Richter J, Kley K, Kralisch S, Jank A, Ebert T, Lössner U, Jessnitzer B, Kratzsch J, Blüher M, Stumvoll M, Fasshauer M, Stepan H. Serum levels of growth arrest specific protein 6 are increased in preeclampsia. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Schaarschmidt W, Richter J, Kley K, Kralisch S, Jank A, Ebert T, Lössner U, Jessnitzer B, Kratzsch J, Blüher M, Michael S, Fasshauer M, Stepan H. Serum levels of growth arrest specific protein 6 are increased in preeclampsia. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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27
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Richter J, Hindricks J, Hopf LM, Kley K, Kralisch S, Ebert T, Lößner U, Blüher M, Stumvoll M, Fasshauer M. Serum levels of the adipokine fibroblast growth factor-21 are increased in preeclampsia. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Heinzel A, Kley K, Mueller HW, Hautzel H. A comparison of rh-TSH and thyroid hormone withdrawal in patients with differentiated thyroid cancer: preliminary evidence for an influence of age on the subjective well-being in hypothyroidism. Horm Metab Res 2012; 44:54-9. [PMID: 22109678 DOI: 10.1055/s-0031-1295415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
We aimed to investigate the subjective well-being in patients with differentiated thyroid cancer after hormone withdrawal. Since this might be confounded by psycho-oncological processes unrelated to hypothyroidism we intended to minimize such factors by only including patients with a history of uneventful follow-up examinations for several years. We investigated 67 patients applying the General Health Questionnaire (GHQ-12) at 3 time points t1, t2, and t3. The time point t2 represented an intensified follow-up examination 5 years after thyroidectomy, which was performed either on hormone withdrawal (49 patients) or using rh-TSH (18 patients). The time points t1 and t3 took place during follow-up examinations 6 months before and after t2 in a euthyroid state. Additionally, we assessed the impact of age, gender, family status, and education on the GHQ-12 score at all 3 time points. Within the hormone withdrawal group the analyses demonstrated a significant difference between t1 and t2 as well as t3 and t2. Additionally, there was a significant negative correlation of age with GHQ-12 sum scores at t2, but not at t1 or t3. Subgroup analyses at t2 indicated that the subjective well-being in younger patients was more impaired compared to elderly patients. The between-group analysis showed no significant differences. However, concerning the age effect there was a significant difference between the subgroup of young hypothyroid patients and the total rh-TSH group at t2. We demonstrated preliminary evidence for an influence of age on the subjective well-being in hypothyroidism suggesting that younger subjects are subjectively more impaired by hypothyroidism than elderly ones.
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Affiliation(s)
- A Heinzel
- Department of Nuclear Medicine, Heinrich Heine-University of Düsseldorf, Düsseldorf, Germany.
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Selig L, Ebert T, Reiche M, Kley K, Lößner U, Kratzsch J, Blüher M, Stumvoll M, Bödeker H, Mössner J, Fasshauer M. Serum levels of the adipokine adipocyte fatty acid binding protein are decreased in chronic pancreatitis. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Nikolaus S, Wirrwar A, Antke C, Kley K, Müller HW. [State-of-the-art of small animal imaging with high-resolution SPECT]. Nuklearmedizin 2005; 44:257-66. [PMID: 16400386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
During the recent years, in vivo imaging of small animals using SPECT has become of growing relevance. Along with the development of dedicated high-resolution small animal SPECT cameras, an increasing number of conventional clinical scanners has been equipped with single or multipinhole collimators. This paper reviews the small animal tomographs, which are operating at present and compares their performance characteristics. Furthermore, we describe the in vivo imaging studies, which have been performed so far with the individual scanners and survey current approaches to optimize molecular imaging with small animal SPECT.
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Affiliation(s)
- S Nikolaus
- Nuklearmedizinische Klinik, Moorenstr. 5, 40225 Düsseldorf.
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31
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Abstract
Previous studies on hypothyroid subjects have indicated serious psychiatric symptoms affecting the patients' quality of life. The present prospective cross-sectional study's aim was to examine these symptoms in thyroid patients with different functional states. A total of 254 patients (age: 56 +/- 14 years [mean +/- standard deviation], 181 female, 73 male) referred to a hospital for radioiodine treatment of hyperthyroidism or for follow-up of differentiated thyroid cancer, respectively, were included. All patients underwent the twelve-item general health questionnaire, which is an instrument for detecting mood disturbances. Euthyroid and hyperthyroid patients did not differ significantly in their general health questionnaire score (11 +/- 5 vs. 11 +/- 7), nor did subclinical hyperthyroid (11 +/- 6) or subclinical hypothyroid subjects (12 +/- 5). In contrast, hypothyroid patients showed a significantly higher mean score (17 +/- 7, p < 0.001, ANOVA). Binary logistic regression revealed that hypothyroidism increases age and gender-adjusted risk for critical mood deterioration by seven-fold. Thus, hypothyroidism represents a widely underestimated functional condition that may severely affect mental health.
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Affiliation(s)
- R Larisch
- Department of Nuclear Medicine, Heinrich Heine University, Düsseldorf, Germany.
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