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Distal Tibial Tuberosity Focal Dome Osteotomy Combined With Intra-Articular Condylar Osteotomy (Focal Dome Condylar Osteotomy) for Medial Osteoarthritis of the Knee Joint.

ABSTRACT: High tibial osteotomy for medial-compartment knee osteoarthritis (OA) is an established biological knee reconstruction surgical procedure. In open- and closed-wedge high tibial osteotomy, the angulation correction axes are away from the center of rotation and angulation. This results in translation deformity, which alters the orientation of the adjacent joint and the length of the limb. In the present study, we combined the distal tibial tuberosity focal dome osteotomy centered on the center of rotation and angulation with the longitudinal condylar osteotomy (focal dome condylar osteotomy) for knee OA. The advantages of this procedure are as follows: physiological orientation of adjacent joint is achieved; limb length is maintained; joint stabilization in the coronal plane is achieved; patella infra is prevented; sufficient bone contact between the medial and posterior cortex is achieved; early weight-bearing walking is possible; and fibular osteotomy is not required. This study describes the details of the surgical procedure, including our compass cutter for accurate dome osteotomy and the postoperative rehabilitation program for patients with knee OA and moderate-to-severe varus deformity.

SUBMITTER: Igarashi K

PROVIDER: S-EPMC7451708 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:High tibial osteotomy is a common procedure to address unicompartment knee osteoarthritis and other conditions. Regarding the specific surgical methods, medial open wedge osteotomy and lateral close wedge osteotomy are the most used. Both methods have a common disadvantage in that they are not so suitable to correct a severe deformity. Thus, we would like to introduce an anterior proximal-to-posterior distal oblique proximal tibial osteotomy technique, which is especially suitable to correct severe tibial deformity. The most critical point of this technique is to create an osteotomy plane from the most proximal posterior site of the tibial tubercle posteriorly and distally to the posterior cortex of the tibia, with each horizontal osteotomy maneuver in the coronal plane. Combined fibular osteotomy is always needed, and better results can be obtained when it is combined with arthroscopic debridement of the knee. We consider the introduction of this technique will provide a useful option when tibial osteotomy is needed to preserve the knee, especially for a great deformity correction. Technique Video Video 1 Anterior proximal-to-posterior distal oblique proximal tibial osteotomy. This procedure is performed in the right knee. Arthroscopy is performed to confirm the osteoarthritis status of the medial compartment and the healthier status of the lateral compartment. Debridement and other indicated arthroscopic procedures are performed. A K-wire is drilled in the coronal plane from the medial to the lateral side of the tibia at a level approximately 1 cm distal to the joint line, parallels the joint line as far as possible, and is used as a proximal reference wire. Another K-wire is drilled into the tibia also in the coronal plane at a level in the distal one third of the leg and used as a distal reference wire. The angle between the 2 reference wires is controlled being equal to the to-be-corrected angle of the tibia as far as possible. A longitudinal incision is made over the midline of the medial surface of the tibia. The pes anserinus is peeled off from its tibial insertion. A K-wire is placed at the most proximal and posterior site of the tibial tubercle and an osteotomy line is marked posterodistally to the posteromedial ridge of the tibia with 30° angulation to the tibial axis. The posterior osteofascial compartments are opened at the distal end of the osteotomy line. A 2.5-mm K-wire is used to drill through the medial tibial cortex along the osteotomy line to make a line of holes with approximately 5 mm distance between the neighboring holes. An osteotome is used to cut the bone and connect the holes along the osteotomy line at the medial side of the tibia. The lateral tibial cortex is drilled through the medial tibial fissure with each drilling maneuver along the coronal plane, to create a line of holes on the lateral side of the tibia. The osteotome is put into the fissure at the medial side of the tibia to connect the holes on the lateral side of the tibia to create an osteotomy plane. The distal posterior tibial cortex is cut along the osteotomy plane. A K-wire is drilled perpendicular to the coronal plane through the middle of the osteotomy plane. A fibula osteotomy is performed at its middle point with a wire saw. Valgus stress is applied to correct the varus deformity of the tibia till the 2 reference wires parallel to each other. Two additional K-wires are placed across the osteotomy plane for temporary fixation of the fracture. A tibial condyle plate is placed at the medial side of the tibia. Four self-locking screws are placed in respectively at the proximal and distal segments of the tibia for fracture fixation. The K wires for temporary fixation and correction reference are removed. A suction drainage tube is placed to the osteotomy site. The wounds are closed.

Project description:BackgroundDistal tibia allograft reconstruction of the glenoid in shoulder instability has garnered significant attention over the last decade. Prior studies demonstrate significant improvement in all reported patient outcomes albeit the approach is through a subscapularis split. There have not been prior studies evaluating outcomes after lesser tuberosity osteotomy which provides excellent exposure to the anterior glenoid.We hypothesize there is significant improvement in functional outcomes and no deleterious effects after lesser tuberosity osteotomy for distal tibia allograft reconstruction of the glenoid for shoulder instability.MethodsA retrospective review was performed from 2016 of 2019 of patients undergoing distal tibia allograft reconstruction of the glenoid through a lesser tuberosity osteotomy. Patients were indicated if they had recurrent anterior shoulder instability with >20% glenoid bone loss and evidence of an off-track lesion. Clinical, imaging, and operative data were evaluated. Objective follow-up data evaluated at minimum 2 years included radiographs, range of motion, DASH, SANE, VAS, SST, ASES, and Constant scores.ResultsA total of 12 patients were available with average follow-up 28 months, average age 26 years old, and average glenoid bone loss of 33%. The patients demonstrated significant improvement in their clinical outcomes at final follow-up: DASH 42.9-8.9 (P = .004), SANE 32.2-85 (P = .00005), VAS 4.6-1.1 (P = .003), SST 7-11.4 (P = .01), ASES 50.2-90.5 (P = .001), and Constant 37.6-86.2 (P = .01). Range of motion at final follow-up was forward flexion to 161.4° (135-170°), external rotation 49.5° (40-65°), and internal rotation to T12-L1 (T7-L2) vertebral body.ConclusionThe present study demonstrates the effectiveness of a lesser tuberosity osteotomy in exposure of the glenoid for reconstruction with a distal tibia allograft. The functional integrity of the subscapularis is maintained and the patient-reported outcomes are comparable with current literature.

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Distal Tibial Tuberosity Focal Dome Osteotomy Combined With Intra-Articular Condylar Osteotomy (Focal Dome Condylar Osteotomy) for Medial Osteoarthritis of the Knee Joint.

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