Kirschner Wire Reference Technique in Open-Wedge High Tibial Osteotomy.
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ABSTRACT:
SUBMITTER: Kwanyuang A
PROVIDER: S-EPMC8252815 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:High tibial osteotomy (HTO) is a useful alternative in the treatment of symptomatic varus malalignment. However, among its drawbacks is the tendency to decrease patellar height and increase the posterior tibial slope. The increased tibial slope increases anterior cruciate ligament tension and may compromise its function. On the other hand, patella baja often causes anterior knee pain and, over time, may favor degeneration of the patellofemoral joint. The aim of this study is to describe a technical modification of the standard open-wedge HTO. It consists of a double inverted L-shaped cut, which includes the anterior tibial tuberosity in the proximal fragment, to avoid any alteration of patellar height and control the eventual increase of the posterior tibial slope.
| S-EPMC5765526 | biostudies-literature
Project description:PurposeThis study aimed to demonstrate the application of orthotopic bone flap transplantation with a fibula transplantation (OBFT-FT) in open-wedge high tibial osteotomy (OW-HTO) and to assess the effect of OBFT-FT on gap healing.Patients and methodsFrom January to July 2020, 18 patients who underwent OW-HTO with OBFT-FT were reviewed for this study. Demographics, postoperative complications, and radiological and clinical outcomes of patients were collected. Finally, the clinical outcomes of patients were analyzed.ResultsA total of 14 patients were included in this study. The average age and body mass index were 59.6 ± 9.2 years and 28.1 ± 4.5 kg/m2, respectively. The average correction angle and gap width were 9.5 ± 1.8° and 10.2 ± 2.7 mm, respectively. The rates of radiological gap healing at sixth week, third month, and sixth month were 42.9%, 85.7%, and 100%, respectively. The mean Lysholm score, International Knee Documentation Committee score, and visual analog scale scores at sixth-month follow-up were significantly better than the preoperative scores (p < 0.001, p < 0.001, p = 0.001, respectively). And, no delayed union or non-union, collapse, loss of correction, or surgical site infection were found.ConclusionsAs a new technique for autologous bone graft, the OBFT-FT could be successfully applied in the treatment of gap healing after OW-HTO, and excellent radiological and clinical outcomes could be seen on patients' short-term follow-up.
| S-EPMC10948400 | biostudies-literature
Project description:Osteophytes are physiological bony outgrowths that develop at the margins of the articular surfaces during the progression of osteoarthritis; they are associated with active endochondral bone formation processes and expressions of various growth factors. We believe they could be a source of bone grafts as a result of a potentially strong osteoinductive effect. Moreover, osteophytes can be easily harvested by arthroscopy in patients undergoing open-wedge high tibial osteotomy (OW-HTO) for medial unicompartmental knee osteoarthritis. Therefore, we have been using osteophyte autografts for osteotomy gaps in OW-HTO with positive preliminary results indicating rapid bone healing of osteotomy sites. In this technical note, we introduce a technique for harvesting autologous osteophytes by arthroscopy and implanting them into the gap formed after OW-HTO. We expect that autologous osteophyte grafting can be a useful method for accelerating bone union and therefore enabling weight bearing from an early stage after surgery, which will lead to an early return to social activities.
| S-EPMC5124027 | biostudies-literature
Project description:PURPOSE:Although rotation of the distal portion of the tibia below the osteotomy site is considered an inevitable change in the axial plane in open wedge high tibial osteotomy (HTO), several studies on this issue have shown contradictory results. The purpose of this study was, therefore, to determine the direction and amount of distal tibial rotation following open wedge HTO using a three-dimensional reconstructed model. METHODS:This study involved 41 patients (42 knees) undergoing open wedge HTO for primary medial osteoarthritis. Distal tibial rotation was measured on the overlaid tibial plateau of a preoperative and postoperative 3-dimensional reconstructed model based on computed tomography. RESULTS:The mean distal tibial external rotation was 2.7° ± 2.3° (range, -0.9° to 9.9°), and the opening gap was larger in the group with > 3° distal tibial rotation than in the group with ? 3° distal tibial rotation (11.4 mm vs. 9.6 mm, P = 0.027). Multiple regression analysis showed that the opening gap was the only predictor of distal tibial rotation. On receiver operating characteristics analysis, an opening gap of 10 mm was found to be the optimal cutoff value for achieving greater than 3° of distal tibial rotation. CONCLUSIONS:Following medial opening wedge HTO, the distal tibial portion below the osteotomy site rotated approximately 3° externally. The magnitude of the external rotation of the distal tibia was affected by the opening gap width.
| S-EPMC6964860 | biostudies-literature
Project description:PURPOSE:This study evaluated the medial joint stability after high tibial osteotomy (HTO) releasing the superficial medial collateral ligament (sMCL) without cutting and repairing. METHODS:Twenty-one patients who performed HTO were enrolled. After an L-shaped incision was made in the pes anserinus, the sMCL was released from the distal portion during surgery. After plate fixation, the sMCL was reattached and the pes anserinus was repaired underneath the plate. Plate removal was performed after 31.1?±?14.2?months. Before HTO, a valgus force of 40?N was exerted at extension for reference values. Before and after plate removal, a valgus force of 40?N was exerted at extension and at a flexion position of 20°. Medial stability was evaluated by measuring the joint line convergence angle (JLCA). RESULTS:The JLCAs in the extension state before HTO and plate removal were 1.64°?±?1.15° and 1.83°?±?1.36°, respectively; there was no significant difference (p?=?0.198). There was also no significant difference in JLCA before HTO and after plate removal (p?=?0.835). There was also no significant difference in JLCA before and after plate removal both at a knee extension and flexion position of 20° (p?=?0.348 and p?=?0.456, respectively). CONCLUSIONS:Releasing the sMCL without cutting and repairing the pes anserinus underneath the plate during medial open wedge HTO could facilitate the maintenance of medial joint stability.
| S-EPMC7531106 | biostudies-literature
Project description:Open-wedge high tibial osteotomy (OW-HTO) is an effective surgical intervention for medial-compartment knee osteoarthritis. However, the osteotomized gap might be a disadvantage in OW-HTO because it can cause problems such as delayed bone union or loss of correction. These issues can be minimized by using autologous bone graft in the osteotomized gap, which is known to be the fastest and most clinically satisfactory gap filler. The primary mechanical stability of the osteotomy site in OW-HTO is essential for early weight bearing after surgery. Therefore, we introduce the combination of a cylindrical autologous bone grafting technique and a metallic block insertion for faster bone union and better primary stability of the site in OW-HTO. We expect that the described procedure will enable early postoperative weight bearing and, thereby, allow an early return to normal function.
| S-EPMC7917032 | biostudies-literature
Project description:The purpose of this study was to investigate the change in patellar position after open wedge high tibial osteotomy (OWHTO) with distal tubercle osteotomy (DTO), comparing outcomes of conventional OWHTO in young adults with proximal tibia varus deformity but no arthritic manifestations. Thirty-three patients (mean age, 31.8 years) subjected to OWHTO/DTO were matched with 30 patients (mean age, 33.5 years) undergoing conventional OWHTO. Patellar position, as measured in pre- and postoperative standing lateral radiographs, was compared. Patellar height was assessed via Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel (BP) index, Caton-Deschamps (CD) index, and modified Miura-Kawamura index. Computed tomography was used to measure lateral patellar tilt and shift. In the OWHTO group, all patellar height indices decreased significantly following surgery. Although mean values of BP and CD indices decreased significantly in the OWHTO/DTO group, other determinants of patellar height showed no significant postoperative differences. Significant postoperative declines in average lateral patellar tilt were also evident in both groups, but pre- and postoperative lateral patellar shift did not differ significantly. OWHTO/DTO can be performed without significant changes in patellar height. The results obtained support that OWHTO/DTO is suitable for relatively young patients with proximal tibia vara but no arthritic change.
| S-EPMC5540386 | biostudies-other
Project description:Open-wedge high tibial osteotomy is considered to be an effective surgical intervention for medial compartmental knee osteoarthritis. However, patella infra, which has been reported to be a result of tuberosity distalization after open-wedge high tibial osteotomy, changes the native patellofemoral biomechanics. This could raise abnormal patellofemoral contact stresses, which might be the trigger of patellofemoral arthrosis. To minimize the reduction in patellar height, we have developed a technique called open-wedge distal tuberosity tibial osteotomy. The benefits of this technique include increased bone-to-bone contact of the distal tuberosity cut surface after correction by cutting an arc osteotomy around the hinge position, which is the center of rotation. This technique also provides cortical support at the anterior osteotomy site without additional bone defect and, therefore, may be advantageous against weight-bearing stress on the osteotomy site. In all, open-wedge distal tuberosity tibial osteotomy could potentially be a unique open-wedge osteotomy that eliminates the risk for postoperative patellofemoral osteoarthritis and also could theoretically encourage rapid healing of the osteotomy, which could lead to early return to full physical activity.
| S-EPMC6624185 | biostudies-literature
Project description:BackgroundThe supplemental screw technique was introduced for salvage of lateral hinge fracture in medial open-wedge high tibial osteotomy (owHTO). The efficacy of its use in protection of lateral hinge fracture and corresponding biomechanical behaviors remained unclear. The current study was aimed to clarify if a supplemental screw can provide better protection to lateral hinge in biomechanical perspective.MaterialsAn in vitro biomechanical test was conducted. Tibial sawbones, commercial owHTO plates and a cannulated screw were utilized for preparing the intact, owHTO, and owHTO with cannulated screw insertion specimens. A "staircase" dynamic load protocol was adopted for axial compressive test with increasing load levels to determine structural strength and durability by using a material testing system, while a motion capture system was applied for determining the dynamic changes in varus angle and posterior slope of the tibia plateau with various specimen preparation conditions.ResultsType II lateral hinge fracture were the major failure pattern in all specimens prepared with owHTO. The insertion of a supplemental cannulated screw in medial owHTO specimens reinforced structural stability and durability in dynamic cyclic loading tests: the compressive stiffness increased to 58.9-62.2% of an intact specimen, whereas the owHTO specimens provided only 23.7-29.2% of stiffness of an intact specimen. In view of tibial plateau alignment, the insertion of a supplemental screw improved the structural deficiency caused by owHTO, and reduced the posterior slope increase and excessive varus deformity by 81.8% and 83.2%, respectively.ConclusionThe current study revealed that supplemental screw insertion is a simple and effective technique to improve the structural stability and durability in medial owHTO.
| S-EPMC7773260 | biostudies-literature
Project description:PurposeThe present study evaluated changes in bone tracer uptake (BTU) after medial open-wedge high tibial osteotomy (MOWHTO) and determined whether postoperative BTU correlates with clinical symptoms, radiologic parameters, or cartilage regeneration following MOWHTO.MethodsA total of 210 knees underwent MOWHTO for medial compartmental osteoarthritis (OA) were enrolled in this study. Mean follow-up period was 42.7 months. We assessed BTU for the medial compartment of the knee before MOWHTO and at the time of plate removal. Radiologic parameters included Kellgren-Lawrence (K-L) grade and Hip-Knee-Ankle angle (HKAA). Clinical evaluation included American Knee Society (AKS) score and cartilage status was graded at the time of MOWHTO and second-look arthroscopy according to the International Cartilage Repair Society (ICRS) grading system and articular cartilage regeneration stage. Statistical analysis performed to assess the relationships among postoperative BTU of the medial compartment, radiologic parameters, arthroscopic changes and clinical outcomes.ResultsBTU of medial femoral condyle and tibial plateau were significantly decreased at 2 years after MOWHTO (p<0.001). AKS scores and arthroscopic cartilage status were also significantly improved following MOWHTO. BMI and postoperative HKAA showed significant correlations with postoperative changes of BTU in uni- and multi-variable analysis. Meanwhile, postoperative changes of BTU did not show significant correlation with clinical outcomes or cartilage regeneration following MOWHTO.ConclusionLower BMI and postoperative valgus alignment were significant predictor for postoperative BTU decrease of the medial compartment following MOWHTO. However, postoperative changes of BTU did not reflect cartilage regeneration or clinical outcomes until the midterm follow-up.
| S-EPMC8439459 | biostudies-literature