Dataset Information

Restoration of the Knee Medial Collateral Ligament and Complete Soft-tissue Coverage After Medial Open-Wedge High Tibial Osteotomy.

ABSTRACT: High tibial osteotomy (HTO) is used in the treatment of knee osteoarthritis. This surgical procedure is indicated in patients with medial osteoarthritis who are relatively young and active and have a good range of motion. In most medial open-wedge HTO cases, the fascia, medial collateral ligament (MCL), and part of the knee joint capsule are carefully separated and moved to expose the osteotomy site, but many patients experience postoperative swelling and pain in the affected limb due to bleeding from the osteotomy site and MCL failure. We have developed a method of osteotomy followed by a restoration of the MCL to its anatomic position and complete soft-tissue coverage of the osteotomy. This Technical Note aims to provide a comprehensive description of the employment of a soft-tissue envelope for the MOW-HTO protection.

SUBMITTER: Handa M

PROVIDER: S-EPMC9596392 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Restoration of the Knee Medial Collateral Ligament and Complete Soft-tissue Coverage After Medial Open-Wedge High Tibial Osteotomy.

Handa Mikiko M Takahashi Tsuneari T Hayashi Yukinori Y Takeshita Katsushi K

Arthroscopy techniques 20220917 10

High tibial osteotomy (HTO) is used in the treatment of knee osteoarthritis. This surgical procedure is indicated in patients with medial osteoarthritis who are relatively young and active and have a good range of motion. In most medial open-wedge HTO cases, the fascia, medial collateral ligament (MCL), and part of the knee joint capsule are carefully separated and moved to expose the osteotomy site, but many patients experience postoperative swelling and pain in the affected limb due to bleedin ...[more]

PMID: 36311324

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Project description:PurposeTo quantify intraoperative joint space widening afforded by the outside-in, percutaneous release of the medial collateral ligament (MCL) and to evaluate its impact on medial compartment width and functional outcomes at 6-week follow-up for patients undergoing a partial medial meniscectomy without postoperative bracing.MethodsPatients with posteromedial meniscus tears and no evidence of ipsilateral knee pathology, undergoing partial medial meniscectomy, were enrolled. Intraoperatively, medial compartment width was quantified with fluoroscopy before and after the percutaneous MCL release with an 18-gauge spinal needle proximal to the joint line. At 6-week follow-up, valgus stress radiographs re-evaluated medial compartment width. International Knee Documentation Committee (IKDC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were completed preoperatively and at 6-week follow-up to evaluate functional outcomes. A paired sample t test performed at a 95% confidence interval (CI) was used to compare these variables.ResultsForty-two patients, mean (± standard deviation) age 55.3 ± 10.7 years, were available for analysis of intraoperative medial compartment widening. Medial compartment width increased from 5.95 ± 1.32 to 11.09 ± 1.74 mm intraoperatively after MCL release. At 6-week follow-up, radiographic assessment demonstrated a mean medial compartment width of 5.85 ± .99 mm, which represented an insignificant change compared with the preoperative value (CI -0.68 to .33, P = .474). PROMIS and IKDC scores significantly improved from baseline, with increases of 6.9 ± 12.4 (CI 2.0 to 11.8, P = .008) and 11.7 ± 17.8 (CI 4.7 to 18.8, P = .002), respectively.ConclusionsPercutaneous MCL release during knee arthroscopy improves visualization and facilitates instrumentation by providing an almost 2× wider working space within the medial tibiofemoral joint. In this study, the performance of percutaneous MCL release did not result in any complications. Radiographic and clinical resolution of iatrogenic laxity was demonstrated by 6-weeks postoperatively, without the use of postoperative bracing.Level of evidenceIV, therapeutic case series.

Dataset Information

Restoration of the Knee Medial Collateral Ligament and Complete Soft-tissue Coverage After Medial Open-Wedge High Tibial Osteotomy.

Publications

Restoration of the Knee Medial Collateral Ligament and Complete Soft-tissue Coverage After Medial Open-Wedge High Tibial Osteotomy.

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