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Medial tibial "spackling" to lessen chronic medial tibial soft tissue irritation.

ABSTRACT: We describe a unique, utilitarian reconstructive treatment option known as tibial "spackling" for chronic, localized medial joint line pain corresponding with progressive radiographic peripheral medial tibial bone loss beneath a well-fixed revision total knee arthroplasty tibial baseplate. It is believed that this localized pain is due to chronic irritation of the medial capsule and collateral ligament from the prominent medial edge of the tibial component. In the setting of failed nonoperative treatment, our experience with utilizing bone cement to reconstruct the medial tibial bone defect and create a smooth medial tibial surface has been successful in eliminating chronic medial soft tissue irritation.

SUBMITTER: Martin JR

PROVIDER: S-EPMC5045467 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Medial tibial "spackling" to lessen chronic medial tibial soft tissue irritation.

Martin J Ryan JR Watters Tyler Steven TS Levy Daniel L DL Jennings Jason M JM Boyle James P JP Dennis Douglas A DA

Arthroplasty today 20160702 3

We describe a unique, utilitarian reconstructive treatment option known as tibial "spackling" for chronic, localized medial joint line pain corresponding with progressive radiographic peripheral medial tibial bone loss beneath a well-fixed revision total knee arthroplasty tibial baseplate. It is believed that this localized pain is due to chronic irritation of the medial capsule and collateral ligament from the prominent medial edge of the tibial component. In the setting of failed nonoperative ...[more]

PMID: 28326411

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Project description:Hallux valgus is one of the most common foot and ankle conditions faced by orthopaedic surgeons. Surgical correction of hallux valgus is frequently indicated for symptomatic deformity. Recently, the endoscopic technique of hallux valgus correction has been reported, which is basically an endoscopic approach to the classic distal soft tissue procedure. In this technical note, the technical details of the modified endoscopic distal soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation is described. In this modified technique, the intact intermetatarsal ligament, plantar capsule of the first metatarsophalangeal joint (including the sesamoid apparatus), and medial metatarsosesamoid ligament form a soft tissue envelop that can wrap around the first metatarsal head to stabilize the first metatarsal in the reduced position. Technique Video Video 1 Modified endoscopic lateral soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation of the left foot. The patient is in the supine position with the legs spread. The plantar portal is the viewing portal, and the toe web portal is the working portal. The adductor hallucis and lateral capsuloligamentous complex are released. Endoscopic bunionectomy is performed with the proximal bunion portal used as the viewing portal and the distal bunion portal used as the working portal. Two meniscal repair needles are inserted via the dorsal incision to the lateral side of the medial sesamoid. These bring back two PDS suture loops. The suture loops serve as suture retrievers and bring the minitape to the lateral side of the medial sesamoid. The minitape is passed through a bone tunnel at the first metatarsal neck, wrapped around the second metatarsal neck, and returned to the proximal bunion portal. The intermetatarsal space is closed up and transfixed by a basal intermetatarsal screw. The minitape is tensioned and fixed to the bone tunnel by a SwiveLock anchor.

Project description:BackgroundCorrect rotational alignment of the femoral and tibial component is an important factor for successful TKA. The transepicondylar axis is widely accepted as a reference for the femoral component. There is not a standard reference for the tibial component. CT scans were used in this study to measure which of 2 tibial landmarks most reliably reproduces a correct femoro-tibial rotational alignment in TKA.Methods80 patients received a cemented, unconstrained, cruciate-retaining TKA with a rotating platform. CT scans were performed 5-7 days postoperatively but before discharge. The rotational mismatch between the femoral and tibial components was measured. Furthermore, the rotational variance between the transepicondylar line, as a reference for the orientation of the femoral component and different tibial landmarks, was measured.ResultsThere was notable rotational mismatch between the femoral and tibial components. The median mismatch was 0 degrees (range: 16.2 degrees relative external to 14.4 degrees relative internal rotation of the femoral component).Using the transepicondylar line as a reference for femoral rotational alignment and the medial third of the tuberosity as a reference for tibial rotational alignment, 67.5% of all TKA had a femoro-tibial variance within +/- 5 degrees, 85% within +/- 10 degrees and 97.5% within +/- 20 degrees. Using the medial border of the tibial tubercle as a reference this variance was greater, only 3.8% had a femoro-tibial variance within +/- 5 degrees, 15% within +/- 10 degrees and 68.8% within +/- 20 degrees.ConclusionUsing fixed bone landmarks for rotational alignment leads to a notable variance between femoral and tibial components. Referencing the tibial rotation on a line from the medial third of the tibial tubercle to the center of the tibial tray resulted in a better femoro-tibial rotational alignment than using the medial border of tibial tubercle as a landmark. Surgeons using fixed bearings with a high rotational constraint between the inlay and the femoral component should be aware of this effect to avoid premature polyethylene wear.Trial registrationClinical trials registry NCT01022099.

Dataset Information

Medial tibial "spackling" to lessen chronic medial tibial soft tissue irritation.

Publications

Medial tibial "spackling" to lessen chronic medial tibial soft tissue irritation.

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