Technique for Biplanar Lateral Opening Wedge Distal Femoral Osteotomy in the Valgus Knee.
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ABSTRACT:
SUBMITTER: Duerr RA
PROVIDER: S-EPMC7528581 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Coronal limb malalignment is a significant contributor to asymmetric joint wear, gait abnormalities, and the development and progression of degenerative joint disease. Osteotomies about the knee were developed to realign the mechanical axis of the limb to unload the affected compartment. Valgus malalignment is less common than varus malalignment, but can contribute to a variety of clinical conditions, including lateral compartment cartilage defects and arthritis, lateral patellofemoral instability, and medial collateral ligament laxity. In this article, we describe our preferred operative technique for a lateral opening wedge varus-producing distal femoral osteotomy to correct mild to moderate valgus malalignment.
| S-EPMC5039957 | biostudies-literature
Project description:Valgus knee alignment in excess of physiological valgus leads to excessive loading of the lateral compartment, which can potentially increase the risk of osteoarthritis and can place the medial knee structures at risk of chronic attenuation. Varus-producing distal femoral osteotomies have been proposed for correction of valgus malalignment, to relieve tension on medial-sided structures, as well as to off-load the lateral compartment. Understanding that symptomatic valgus deformity of the knee represents a complex problem that is magnified in the setting of lateral compartment arthritis or medial ligamentous incompetence, we present our preferred technique for a varus-producing distal femoral osteotomy using plate osteosynthesis and cancellous bone allograft.
| S-EPMC5040188 | biostudies-literature
Project description:Isolated lateral compartment arthritis or focal chondral defects in the setting of genu valgum in young, active individuals can be treated with a varus-producing distal femoral osteotomy with or without cartilage treatment. Both medial closing-wedge and lateral opening-wedge techniques have been described, with neither demonstrating clear superiority. The objective of this Technical Note is to describe a technique of biplanar medial opening-wedge with controlled reduction using an articulated tensioning device to achieve a safe, reproducible result.
| S-EPMC7823079 | biostudies-literature
Project description:BACKGROUND:The lateral opening wedge distal femoral osteotomy (LOWDFO) to reconstruct knee alignment in patients with genu valgum originating in the distal femur has gained importance within the last years. PURPOSE:To analyze clinical and radiographic outcome of patients treated with LOWDFO with respect to bone healing without grafting and patient age. MATERIAL AND METHODS:Twenty-two consecutive patients with genu valgum corrected with 23 LOWDFOs using a Tomofix-locking plate were retrospectively analyzed (mean age 23.7 years). Clinical evaluation was based on pre- and post-operative KOOS scores. A pre- and post-operative radiographic assessment, including MAD, mLDFA, LLD, bone healing, and patella parameters, was performed. Differences between subgroups (age, bone grafting) were analyzed. RESULTS:The restoration of MAD and mLDFA resulted in significantly improved post-operative KOOS5 scores in younger and older patients (p?=?0.001). Bone healing without bone grafting was reliable in all patients. The leg length was significantly increased post-operatively (p?=?0.001). The Blackburne-Peel ratio was significantly reduced to more normal values post-operatively (p?<?0.001). CONCLUSION:LOWDFO without bone grafting is a reliable procedure representing a promising treatment option particularly in young patients with genu valgum. Besides correction of the MAD, a significant leg length increase and additional patella stability can be expected.
| S-EPMC6787112 | biostudies-literature
Project description:Proximal tibial anterolateral opening-wedge osteotomies have been reported to achieve successful biplanar lower-extremity realignment. Indications for a proximal tibial anterolateral osteotomy include symptomatic genu recurvatum with genu valgus alignment, usually in patients with a flat sagittal-plane tibial slope. The biplanar approach is able to simultaneously address both components of a patient's malalignment with a single procedure. The correction amount is verified with spacers and intraoperative imaging, while correction of the patient's heel height is simultaneously measured. A plate is secured into the osteotomy site, and the site is filled with bone allograft. The anterolateral tibial osteotomy has been reported to be an effective surgical procedure for correcting concomitant genu recurvatum and genu valgus malalignment.
| S-EPMC5021538 | biostudies-other
Project description:Lateral patellofemoral instability is multifactorial in etiology, with bony and soft-tissue factors contributing. Coronal plane alignment, in particular genu valgum, is important to consider when evaluating lateral patellofemoral instability. When genu valgum is present and thought to be a significant contributing factor, we typically address this with an extra-articular, biplanar, medial closing-wedge distal femoral osteotomy (DFO). This can be combined with a medial patellofemoral ligament reconstruction using a partial-thickness quadriceps tendon graft via the same incision. A medial closing-wedge DFO with locking plate fixation affords a highly stable construct suitable for early weight-bearing. The locking plate is less prominent as compared with a lateral opening-wedge DFO, and it does not irritate the iliotibial band or cause tightening of the illiopatellar expansion. The biplanar nature of the osteotomy prevents extension of the osteotomy into the proximal trochlear, helps to control rotation in both axial and sagittal plane after wedge removal, and increases the bony surface area for healing. The quadriceps tendon medial patellofemoral ligament reconstruction allows a graft that can be tailored in terms of length and diameter, does not require an anchor on the patellar, and can be performed through the same incision as for the DFO.
| S-EPMC8322471 | biostudies-literature
Project description:Valgus malalignment can be corrected with a medial closing-wedge proximal tibia osteotomy in patients with symptomatic lateral compartment disease. Advantages of this technique include the inherent stability of the closing wedge with direct bone contact and reliable healing that enables early weight bearing and shorter recovery time. In addition, a tibial-based osteotomy alters joint contact forces in both flexion and extension versus femoral-based osteotomies. The purpose of this article is to present a reproducible technique for medial closing-wedge proximal tibia osteotomy and review the indications, preoperative planning, rationale, and clinical outcomes.
| S-EPMC7372308 | biostudies-literature
Project description:PurposeTo evaluate the postoperative change in patellar position after medial closed distal femoral osteotomy (DFO) performed for valgus osteoarthritic knees.MethodsThe study included 21 consecutive knees in 20 patients undergoing DFO. A minimum of 2-year follow-up data was obtained for all subjects with a mean follow-up period of 42?months (range 31–59?months). The patellar position was evaluated on plain radiographs preoperatively, 1-year postoperatively, and 2-year postoperatively. For patellar height, the modified Insall–Salvati Index (mISI), modified Caton–Deschamps Index (mCDI) and modified Blackburne–Peel Index (mBPI) were measured on the standing lateral radiographs. Patellofemoral alignment on the axial plane was assessed on skyline views with 30° flexion based on the measurements for lateral patellar tilt (LPT) and lateral patellar shift (LPS). Measured values at pre- and postoperative phases were statistically compared using a two-way analysis of variance.ResultsAll indices including mISI, mCDI, mBPI, LPT and LPS showed no statistically significant postoperative changes.ConclusionMedial closed-wedge DFO performed for valgus osteoarthritic knees did not significantly influence patellofemoral alignment either on the sagittal or axial plane. Therefore, to highlight the clinical relevance of our findings, medial closed-wedge DFO for the valgus knee does not adversely affect the patellofemoral joint.Level of evidenceLevel IV, case series.
| S-EPMC7219206 | biostudies-literature
Project description:BackgroundWhile proximal first metatarsal osteotomy combined with distal soft tissue realignment is accepted as standard treatment of moderate to severe hallux valgus with metatarsus primus varus, none of the described proximal metatarsal osteotomies address the hyper-obliquity of the first metatarsocuneiform joint. An opening-wedge osteotomy of the medial cuneiform can potentially correct the 1-2 intermetatarsal angle (IMA) in addition to normalizing the hyper-obliquity of the first tarsometatarsal (TMT) joint. The purpose of this study was to retrospectively review the early radiographic and clinical results of the use of a medial cuneiform opening-wedge osteotomy fixed with a low-profile wedge plate combined with distal soft tissue realignment for the treatment of hallux valgus.MethodsFourteen feet (13 patients; 2 male and 11 female, average age 56 years, range 22-75) with hallux valgus underwent an opening-wedge osteotomy of the medial cuneiform fixed with a low-profile nonlocking wedge plate combined with distal soft tissue realignment. The mean preoperative hallux valgus angle (HVA) was 32 degrees and the IMA was 16 degrees. HVA, 1-2 IMA, proximal first metatarsal inclination (PFMI), and presence of osteoarthritis of the first TMT joint were assessed on preoperative and final postoperative radiographs. Final postoperative radiographs were also evaluated for radiographic union and hardware failure at an average of 7 months (range, 3-19 months) postoperatively.ResultsA mean intraoperative correction of 19 degrees and 7 degrees was achieved for the HVA and IMA, respectively. The mean HVA was 22 degrees and the mean IMA was 11 degrees at the time of final follow-up. At final follow-up, a recurrence of the deformity was observed in 12/14 feet. There were 2 nonunions-one plate failure and one screw failure. No first TMT joint instability or arthritis was observed. All patients were ambulatory without assistive device in either fashionable or comfortable shoe wear.ConclusionMedial cuneiform opening-wedge osteotomy resulted in unreliable correction of HVA and IMA at short-term follow-up with a high rate of early recurrence of hallux valgus deformity and a complication rate similar to that of the Lapidus procedure. This procedure cannot be recommended for addressing hallux valgus in the setting of increased obliquity of the first TMT joint.Level of evidenceLevel IV, case series.
| S-EPMC8500382 | biostudies-literature
Project description:Lateral compartment disease combined with valgus alignment can lead to progressive knee joint degeneration. In the symptomatic patient with isolated lateral compartment disease, a varus-producing distal femoral osteotomy can unload the diseased lateral compartment. This osteotomy may be combined with other cartilage or meniscal restorative techniques to optimize knee joint preservation and pain relief. The osteotomy can be performed with a medial closing-wedge or lateral opening-wedge technique. Both techniques have been reported to improve knee-related quality of life in patients with lateral compartment disease. Advantages of the medial closing-wedge technique are direct bone apposition leading to inherent stability of the construct, as well as reliable bony healing, and less hardware irritation. Advantages of the lateral opening-wedge technique are a single bony cut and therefore more of an ability to adjust correction intraoperatively. However, this technique requires bone grafting and has a high rate of hardware irritation or removal. We present a surgical technique for the medial closing-wedge distal femoral osteotomy using an anteromedial-distal femoral locking plate.
| S-EPMC5263866 | biostudies-other