Amin Moradi; Alireza Sadegpour; Akbar Khalilpour
Volume 8, Issue 4 , July 2020, , Pages 537-543
Abstract
Background: Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effectivesurgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varusdeformity is sometimes the femoral bone. No studies have reported concomitant ...
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Background: Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effectivesurgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varusdeformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoralosteotomy in ACL-deficient knees with femoral varus deformity and medial osteoarthritis till now. This prospectivestudy presents the technique and clinical outcome of a consecutive series of simultaneous lateral closed-wedge distalfemoral osteotomy and ACL reconstruction.Methods: Nineteen patients with confirmed ACL rupture and femoral varus deformity (mechanical lateral distal femoralangle ≥ 93°) associated with medial osteoarthritis (± lateral thrust) were included the study. The patients underwentsimultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction. At the end of one year followup, the final range of motion and stability of the knees and the last alignment of extremities were recorded. Surgicaloutcomes were assessed on 2000 IKDS subjective scores and KOOS subscales.Results: The mean preoperative varus knee was 10.6° (±2.2°) mostly from the femoral side. The mean union timewas 3.2 (±0.4) months. Regarding the radiological evaluation, the alignment of extremity and mLDFA were correctedsignificantly compared to the pre-operative findings. At the end of one year follow up, all patients were free of kneeinstability. Subjective assessment based on questionnaires showed a significant improvement in all aspects of kneefunction after surgery, however there was no considerable change in the knees range of motion.Conclusion: Simultaneous lateral closed- wedge distal femoral osteotomy and ACL reconstruction is a valuableprocedure in femoral varus knees with medial osteoarthritis and anterior knee instability. After one year follow up allaspects of knee function were improved without serious complications.Level of evidence: IV
Knee
Marco Cavallo; Sayyed-Hadi Sayyed-Hosseinian; Alessandro Parma; Roberto Buda; Massimiliano Mosca; Sandro Giannini
Volume 6, Issue 2 , March 2018, , Pages 112-118
Abstract
Purpose: high tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the result of HTO. In this prospective study we investigate safety and also results of HTO associated with bone marrow derived cells ...
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Purpose: high tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the result of HTO. In this prospective study we investigate safety and also results of HTO associated with bone marrow derived cells (BMDC) transplantation in relatively young and middle aged active individuals with early osteoarthritis of the knee and our hypothesis is combination of these procedures is safe and leads to better outcome. Methods: 24 patients (with mean age of 47.9 years) with varus knee and symptomatic medial compartment osteoarthritis were treated with medial opening-wedge high tibial osteotomy in conjunction with transplantation of bone marrow derived cells into the chondral lesions. Clinical outcome was assessed by IKDC score, KOOS score, VAS and Tegner scores and radiographic study was performed preoperatively and at follow-ups. Results: there were no major complications during operation and postoperative follow-ups.all the clinical scores significantly were improved for the IKDC score (from 32.7 +/-15 to 64+/- 21), KOOS score (from30 +/- 11 to 68 +/- 19), VAS (from7.5 to 3), and Tegner score (from 1.2 to 2.1). Conclusions: HTO in conjunction with BMDC transplantation is a safe and feasible treatment for early medial compartment osteoarthritis in varus knees and associated with good results in short term follow up.
Knee
Seyed Morteza Kazemi; Mohamad Qoreishi; Ehsan Behboudi; Alireza Manafi; Seyed Kamyar Kazemi
Volume 5, Issue 3 , May 2017, , Pages 149-152
Abstract
Background: There are limited studies regarding the effects of high tibial osteotomy (HTO) on other areas of lower extremity. In current study, we investigated the changes of tibiotalar joint following HTO. Methods: A total of 39 patients with genu varum requiring HTO were enrolled in this before and ...
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Background: There are limited studies regarding the effects of high tibial osteotomy (HTO) on other areas of lower extremity. In current study, we investigated the changes of tibiotalar joint following HTO. Methods: A total of 39 patients with genu varum requiring HTO were enrolled in this before and after study. The genu varus, joint diversion (JDA), lateral distal tibial (LDTA) and lateral distal tibial-ground surface (LDT-GSA) angles were measured before the operation and compared with 6 months after the surgery. Results: Twenty threeout of39 patients (59%) were females. The genu varus angle decreased significantly (130±1.70versus 0.60±10). No significant changes were seen in JDA (P=0.45) and LDTA (P=0.071). LDT-GSA changed significantly (P=0.011) from 8.10±10 in varus to -0.30±0.50 in valgus. Conclusion: Although HTO did not change the JDA and LDTA, however, significant change in LDT-GSAindicates that HTO can significantly decrease the shearing forces exerted on the ankle joint.
E. Carlos RODRIGUEZ-MERCHAN
Volume 4, Issue 4 , October 2016, , Pages 307-313
Abstract
Background: The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis. Methods: The search engine used was PubMed. The keywords were: "high tibial osteotomy versus ...
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Background: The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis. Methods: The search engine used was PubMed. The keywords were: "high tibial osteotomy versus unicompartmental knee arthroplasty". Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they strictly focused on the topic. Results: In a meta-analysis the ratio for an excellent outcome was higher in unicompartmental knee arthroplasty than high tibial osteotomy and the risks of revision and complications were lower in the former. A prospective comparative study showed that unicompartmental knee arthroplasty offers better long-term success (77% for unicompartmental knee arthroplasty and 60% for high tibial osteotomy at 7-10 years). However, a review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that unicompartmental knee osteoarthritis without constitutional deformity should be treated with unicompartmental knee arthroplasty while in cases with constitutional deformity high tibial osteotomy should be indicated. A case control study stated that unicompartmental knee arthroplasty offers a viable alternative to high tibial osteotomy if proper patient selection is done. Conclusion: The literature is still controversial regarding the best surgical treatment for unicompartmental knee osteoarthritis (high tibial osteotomy or unicompartmental knee arthroplasty). However, unicompartmental knee arthroplasty utilization is increasing, while high tibial osteotomy utilization is decreasing, and a meta-analysis has shown better outcomes and less risk of revision and complications in the former. A systematic review has found that with correct patient selection, both procedures show effective and reliable results. However, prospective randomized studies are needed in order to answer the question of this article.