Tibial Osteotomy Research Articles

Acellular Particulated Costal Allocartilage Improves Cartilage Regeneration in High Tibial Osteotomy: Data From a Randomized Controlled Trial.

This study aimed to compare short-term arthroscopic and clinical outcomes between microfractures with (treatment group) and without (control group) acellular particulated costal allocartilage in patients undergoing concurrent high tibial osteotomy (HTO). This retrospective cohort study enrolled 19 and 21 patients in the treatment and control groups, respectively, and reviewed them at a minimum 2-year follow-up after HTO. Cartilage regeneration status was evaluated according to the International Cartilage Repair Society-Cartilage Repair Assessment (ICRS-CRA) grading and Koshino's macroscopic staging systems during medial locked plate removal. Patient-reported measures, including the visual analog scale pain score, Knee Injury and Osteoarthritis Outcome Score, and International Knee Documentation Committee score, assessed clinical outcomes. The total points of the ICRS-CRA grading system were significantly higher in the treatment group than in the control group (7.7 ± 3.8 vs 4.2 ± 3.0, respectively; P = 0.007). Likewise, the cartilage status according to Koshino's macroscopic staging system was better in the treatment group (P = 0.022). Patient-reported functional outcomes significantly improved postoperatively but were equivalent between the study groups at the final follow-up. Microfractures augmented with acellular particulated costal allocartilage resulted in better repair quality than microfractures alone at a minimum 2-year follow-up after HTO, but functional outcomes improved similarly for both treatment approaches.

Hybrid closing-wedge DTO using PSI was selected for a patient wit severe deformity post-fracture malunion, which enable good alignment correction and patient satisfaction

BackgroundHigh tibial osteotomy (HTO) is an effective treatment option for deformity correction after fracture. However, performing precise corrective osteotomy for cases with a severe varus deformity and a significant posterior slope poses a significant challenge. Three-dimensional (3D) bone model construction and patient-specific instrumentation (PSI) created from preoperative Computed tomography (CT) may be useful tools in achieving successful outcome for such cases. The present technique describes a hybrid closing-wedge distal tuberosity tibial osteotomy (Hybrid CWDTO) using two PSIs.MethodsPreoperative planning was performed in 3D with reference to the contralateral normal lower extremity CT taken preoperatively, which was then mirrored for analysis. A full-scale bone model and two PSIs were constructed based on this plan to allow for complex correction. During surgery, osteotomy was performed using these sterilized PSIs as guides.ResultsRadiographic imaging showed that medial proximal tibial angle (MPTA) improved from 68 to 84 degrees and posterior tibial slope (PTS) improved from 19 to 6 degrees. The standing leg radiograph showed a mechanical varus alignment improvement from 12 to 3 degrees. The 2011 Knee Society Scoring system (2011 KSS) improved from 31 to 95 in objective knee indicators, from 10 to 24 in symptoms, from 14 to 40 in patient satisfaction and from 51 to 95 in activities.ConclusionHybrid CWDTO using PSIs is a useful surgical technique for alignment correction post-malunion while also achieving high patient satisfaction. This can assist surgeons in treating complex deformities that are otherwise difficult to treat.

Mid-term outcomes of distal tibial oblique osteotomy in patients with rheumatoid arthritis: a report of three cases.

Although distal tibial oblique osteotomy (DTOO) has usually been indicated for non-inflammatory diseases such as osteoarthritis, we encountered three patients with rheumatoid arthritis (RA) who underwent DTOO. We evaluated radiographic parameters and clinical scores, including self-reported scores for the foot and ankle (SAFE-Q) and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale. In all three cases, radiographic improvements were achieved along with improvements in SAFE-Q and JSSF scores after mid-term follow-up. Supramalleolar osteotomy including DTOO could be indicated even for inflammatory diseases such as RA, if erosive changes are not evident in the ankle joint.

Transtuberositary, Anterior Open Wedge High Tibial Osteotomy (TT-AOW-HTO) to Correct a Negative Slope

ZusammenfassungEin knöchernes Genu recurvatum tritt klinisch durch eine Überstreckbarkeit des Kniegelenks in Erscheinung. Neben den Problemen durch die Hyperextension kann es hierdurch langfristig außerdem zu einer Insuffizienz des hinteren Kreuzbandes (HKB) kommen. Kausale Therapie dieser Tibiakopfextensionsdeformität stellt eine Slope-erhöhende Tibiakopfosteotomie dar. Hierbei gibt es bisher nur wenige Publikationen zu klinischen Ergebnissen, insbesondere zur reinen Slope-Korrektur ohne Veränderung der Frontalachse. Im Folgenden wird die Technik der transtuberositären ventral öffnenden Tibiakopf-Flexions-Osteotomie (Transtuberositary Anterior Opening Wedge High Tibial Osteotomy, TT-AOW HTO) zur Erhöhung des tibialen Slope gezeigt (mit Ablösen und „Bioplating“ der Tuberositas tibiae). Nach vorgeschalteter Arthroskopie erfolgt nach der Osteotomie von ventral die Interposition eines autologen Beckenkammspans und die Osteosynthese mit 2 winkelstabilen Platten von medial und anteromedial.

Patellofemoral Instability in the Pediatric and Adolescent Population: From Causes to Treatments.

Patella instability is one of the most common knee injuries in the adolescent patient. There are several pathoanatomic risk factors which should be assessed via several modalities, including X-rays, magnetic resonance imaging (MRI), or even CT scan. We intend to review these risk factors along with the nonsurgical and surgical techniques used to prevent recurrent dislocations. We completed an extensive review of the recent literature concerning pediatric and adolescent patellar dislocation and subsequent treatment modalities. We review in detail the risk factors such as patella alta, trochlear dysplasia, lateralization of the tibial tubercle or medialization of the trochlear groove (increased tibial tubercle to trochlear groove (TT-TG) distance), lower limb malalignment, excessive femoral anteversion and/or tibial torsion, and hyperlaxity. There are classification systems for dislocators, and a natural progression of instability that patients often proceed through. Only after a patient has continued to dislocate after bracing and physical therapy is surgical treatment considered. Surgical techniques vary, with the workhorse being the medial patellofemoral ligament (MPFL) reconstruction. However, there are a variety of other techniques which add onto this procedure to address other anatomic risk factors. These include the tibial tubercle osteotomy to address a large TT-TG distance or trochleoplasty to address the lack of a trochlear groove. Nonsurgical and surgical treatments for patella dislocators are tailored to the pathoanatomic risk factors in each patient.

Medial Joint Opening in the Operated Knee After Unilateral High Tibial Osteotomy: Risk of Osteoarthritis and Future Surgery in the Operated and Nonoperated Knee.

High tibial osteotomy (HTO) modifies the mechanics of the affected knee but can also affect the nonoperated knee. However, no research has reported on the prognosis and risk factors related to the nonoperated knee after unilateral HTO. To assess the radiological parameters associated with osteoarthritis (OA) progression and the need for surgery in the nonoperated knee after unilateral HTO, with concurrent assessment of the operated knee. Case series; Level of evidence, 4. The medical charts of 197 patients with knee OA who underwent unilateral HTO between March 2007 and December 2020 were retrospectively investigated. Radiological parameters such as the Kellgren-Lawrence grade, weightbearing line ratio, joint line convergence angle (JLCA), and joint line obliquity angle were assessed preoperatively and 1 year postoperatively. The mean follow-up length for the 197 patients was 5.9 ± 3.2 years for the operated knee and 5.5 ± 3.2 years for the nonoperated knee. A smaller postoperative JLCA in the operated knee was a significant risk factor for OA progression (P = .027) and undergoing surgery (P = .006) in the nonoperated knee. Conversely, a larger postoperative JLCA in the operated knee was a significant risk factor for OA progression (P = .014) and conversion to arthroplasty (P = .027) in the operated knee. A postoperative JLCA >1.5° (P < .001) and <3.9° (P < .001) was needed to reduce the risk of undergoing surgery in the nonoperated knee and OA progression in the operated knee, respectively. Additionally, a pre- to postoperative change in the JLCA (ΔJLCA) between -5.6° and -1.7° (P = .021 and P = .004, respectively) was needed to reduce the risk of OA progression in both knees. A large medial joint opening (a small postoperative JLCA) in the operated knee after unilateral HTO was associated with a higher risk of OA progression and surgery in the nonoperated knee. Conversely, a small medial joint opening (a large postoperative JLCA) was associated with a higher risk of OA progression and conversion to arthroplasty in the operated knee. For a balanced medial joint opening, if the postoperative JLCA was between 1.5° and 3.9° or the ΔJLCA was between -5.6° and -1.7°, a favorable prognosis in both knees could be anticipated.

Changes and associations between synovial fluid and magnetic resonance imaging markers of osteoarthritis after high tibial osteotomy

BackgroundMechanobiological mechanisms of osteoarthritis (OA) are unclear. Our objectives were to explore: 1) changes in knee joint physiology using a large panel of synovial fluid biomarkers from before to one year after high tibial osteotomy (HTO) surgery, and 2) the association of changes in the synovial fluid biomarkers with the changes in MRI measures of knee effusion-synovitis and articular cartilage composition.MethodsTwenty-six patients with symptomatic knee OA and varus alignment underwent synovial fluid aspirations and 3 T MRI before and one year after medial opening wedge HTO. Cytokine and growth factor levels in synovial fluid were measured with multiplex assays. Ontology and pathway enrichment was assessed using data protein sets with gene set enrichment analysis (GSEA), and analyzed using linear mixed effects models. MRIs were analyzed for effusion-synovitis and T2 cartilage relaxation time using manual segmentations. Changes in biomarker concentrations were correlated to changes in MRI effusion-synovitis volume and articular cartilage T2 relaxation times.ResultsDecreased enrichment in Toll-like receptor and TNF-α signalling was detected one year after HTO. The leading contributors to this reduction included IL-6, TNF-α and IL-1β, whereas the highest contributors to positive enrichment were EGF, PDGF-BB and FGF-2. Effusion-synovitis volume decreased (mean [95%CI]) one year after HTO (-2811.58 [-5094.40, -528.76mm3]). Effusion-synovitis volume was moderately correlated (r [95% CI]) with decreased MMP-1 (0.44 [0.05; 0.71]), IL-7 (0.41 [0.00; 0.69]) and IL-1β (0.59 [0.25; 0.80]) and increased MIP-1β (0.47 [0.10; 0.73]). Medial tibiofemoral articular cartilage T2 relaxation time decreased (mean [95% CI]) one year after HTO (-0.33 [-2.69; 2.05]ms). Decreased T2 relaxation time was moderately correlated to decreased Flt-3L (0.61 [0.28; 0.81]), IL-10 (0.47 [0.09; 0.73]), IP-10 (0.42; 0.03–0.70) and increased MMP-9 (-0.41 [-0.7; -0.03]) and IL-18 (-0.48 [-0.73; -0.10]).ConclusionsDecreased aberrant knee mechanical loading in patients with OA is associated with decreased biological and imaging measures of inflammation (measured in synovial fluid and on MRI) and increased anabolic processes. These exploratory findings suggest that improvement in knee loading can produce long-term (one year) improvement in joint physiology.

Anterior Slope-Modifying Osteotomies Alter the Length Change Behavior of the Superficial Medial Collateral Ligament: A Biomechanical Study.

Increased tibial slope has been shown to lead to higher rates of anterior cruciate ligament graft failure. A slope-decreasing osteotomy can reduce in situ anterior cruciate ligament force and may mitigate this risk. However, how this procedure may affect the length change behavior of the medial ligamentous structures is unknown. The purpose of this study was to examine the effect of anterior slope-modifying osteotomies on the medial ligamentous structures. It was hypothesized that (1) decreasing the tibial slope would lead to shortening of the superficial medial collateral ligament (sMCL), (2) while the fibers of the posterior oblique ligament (POL) would be unaffected. Descriptive laboratory study. Eight fresh-frozen cadaveric knee specimens underwent anatomic dissection to precisely identify the medial ligamentous structures. The knees were mounted in a custom-made kinematics rig with the quadriceps muscle and iliotibial tract loaded. An anterior slope-modifying osteotomy was performed and fixed using an external fixator, which allowed modification of the wedge height between -15 and +10 mm in 5-mm increments. Threads were mounted between pins positioned at the anterior, middle, and posterior parts of the tibial and femoral attachments of the sMCL and POL. For different tibial slope modifications, length changes between the tibiofemoral pin combinations were recorded using a rotary encoder as the knee was flexed between 0° and 120°. All sMCL fiber regions shortened with slope reduction (P < .001) and lengthened with slope increase (P < .001), with the anterior sMCL fibers more affected than the posterior sMCL fibers. A 15-mm anterior closing-wedge high tibial osteotomy (ACWHTO) resulted in a 6.9% ± 3.0% decrease in the length of the anterior sMCL fibers compared with a 3.6% ± 2.3% decrease for the posterior sMCL fibers. A 10-mm anterior opening-wedge high tibial osteotomy (AOWHTO) increased anterior sMCL fiber length by 5.9% ± 2.3% and posterior sMCL fiber length by 1.6% ± 1.0%. The POL fibers were not significantly affected by a slope-modifying osteotomy. Tibial slope-modifying osteotomies changed the length change pattern of the sMCL such that an AOWHTO increased whereas an ACWHTO decreased the sMCL strain. This effect was most pronounced for the anterior fibers of the sMCL. The length change pattern of the POL remained unaffected by slope-modifying osteotomy. Surgeons should be aware that anterior tibial slope-modifying osteotomies affect the biomechanics of the sMCL. After an extensive ACWHTO, patients may develop a medial or anteromedial instability, while an AOWHTO may overconstrain the medial compartment.

Personalised High Tibial Osteotomy Surgery Is Accurate: An Assessment Using 3D Distance Mapping

Early-stage knee osteoarthritis is often suitable for treatment with high tibial osteotomy (HTO). This is an effective joint-preserving treatment, resulting in good postoperative outcomes. To overcome the limitations of traditional HTO, the surgical technique and correction accuracy can be enhanced by personalised procedures using three-dimensional digital planning and metal additive manufacturing, The purpose of this clinical trial study was to evaluate the three-dimensional accuracy of a new personalised HTO procedure, using modern imaging techniques, 3D modelling, and distance map analysis (DMA). Twenty-five patients were treated with the personalised HTO procedure. Before surgery and after 6 months, they underwent clinical evaluation scoring, radiographic imaging, and computed-tomography scanning to generate morphological models. Specifically, preoperative tibia models were used to plan the tibia correction and the design and position of the fixation plate. Preoperative, planned, and postoperative models were imported in computer-aided and designing software (Geomagic ControlTM 2014, 3D Systems, Rock Hill, SC, USA) for DMA implementation to assess geometrical differences between model surfaces. A very good reproduction of the planned tibia morphology was achieved postoperatively (average differences between −0.9 mm and 1.4 mm). DMA values associated with fixation-plate deformation were less than 1 mm, similar to those for plate-to-tibia surface-contour matching. Overall, personalised digitally planned HTO utilising three-dimensional printed surgical guides and plates enables accurate planned correction and plate placement.

Outcomes of Trochleoplasty vs Tibial Tubercle Osteotomy for Treatment of Patellar Instability Associated with Trochlear Dysplasia; A Systematic Review and Meta-analysis.

To compare the outcomes of tibial tubercle osteotomy (TTO) and trochleoplasty for the treatment of patellar instability associated with trochlear dysplasia Methods: This was a systematic review of the literature including published articles that describe either trochleoplasty or TTO in addition to medial patellofemoral ligament reconstruction for the surgical treatment of patellar instability associated with trochleoplasty. Main outcomes assessed were Kujala and international knee documentation committee (IKDC) scores, in addition to recurrent instability and complications. Outcome measures reported were provided in a table format and a subjective analysis was performed. Ten studies were included with a total of 362 knees including 132 in the trochleoplasty group and 230 in the TTO group. Mean follow up ranged from 27.6 to 61.3 months. At the final follow up, both Kujala and IKDC scores improved significantly in all studies that reported both preoperative and postoperative scores in both groups. There was a total of 3 instability events in the trochleoplasty group as opposed to 21 in the TTO group. Both procedures, trochleoplasty and TTO may provide satisfactory functional improvement in patients with patellar instability associated with trochlear dysplasia. However, trochleoplasty may be a better option to minimize the risk of recurrent instability.

Complications and Radiographic Outcomes of Tibial Tubercle Osteotomy at Minimum 5-Year Follow-up.

Tibial tubercle osteotomy (TTO) is a commonly utilized surgery in the treatment of patellofemoral instability and chondrosis. A number of case series studies have reported on the mid- and long-term outcomes with varying complication rates. To report the incidence of major complications after TTO and the rate of progression of knee osteoarthritis at midterm follow-up. Case series; Level of evidence, 4. All patients who underwent primary TTO between January 1, 2010 and December 31, 2015, and who had ≥5 years of clinical follow-up data were included. Patient demographics and clinical and radiographic outcomes were recorded. Risk factors for complications were identified using multivariate logistic regression analysis. A total of 72 patients were included. The mean follow-up period was 104.8 months (range, 67-138 months). The overall complication rate was 38.9% (28/72 patients), and the incidence of major complications was 6.9%. Univariate logistic regression analysis revealed that patients with a history of smoking were more likely to experience a complication (odds ratio = 4.33 [95% CI, 1.29-14.53]; P = .02). Multivariate analysis with TTO as the main predictor indicated that complication rates were not affected by TTO procedure (TTO vs TTO+other), number of screws, or distalization. There was also no difference between anteromedialization and medialization TTO techniques. The rate of patients with Kellgren-Lawrence grade 3 to 4 increased from 12.0% preoperatively to 23.9% at the final follow-up. New osteophyte formation was detected in 5.8% of patients on anteroposterior radiographs and in 9.1% of patients on lateral radiographs. In the current study, TTO was found to have a major complication rate of 6.9% at midterm follow-up. Smoking was a risk factor for major complications. Only 11.9% of patients had progression in tibiofemoral osteoarthritis at midterm follow-up.

Combination of closing-wedge distal femoral osteotomy and modified tibial plateau levelling osteotomy for the treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in dogs

Considering the prevalence of cranial cruciate ligament disease (CCLD) and concurrent medial patellar luxation (MPL) among dogs, and the concomitant bone deviations routinely identified, the aim of this study is to evaluate the efficacy of the combination between distal femoral osteotomy (DFO) and modified tibial plateau levelling osteotomy (mTPLO) for the treatment of MPL with distal femoral varus, tibial torsion, and CCLD. Dogs with concurrent MPL and CCLD that underwent DFO and mTPLO procedures were included. Subjective clinical evaluations of gait and pre-operative and immediate post-operative radiographic examinations were performed. Surgical data were documented. The anatomical lateral distal femoral angle (aLDFA), femoral varus angle, mechanical medial proximal tibial angle, and tibial plateau angle (TPA) were compared between the pre- and post-operative periods. A total of 12 dogs were included in this study. Closing-wedge DFO and mTPLO procedures were performed on 14 limbs. The mean pre-operative and post-operative aLDFA values were 104.8 ± 3.9° and 95.4 ± 2.4°, respectively. TPA values were 26.2 ± 3.7° pre-operatively and 6.3 ± 3.2° post-operatively. Bone healing was observed in 7.1 %, 71.3 %, and 85.5 % of patients at the first, second, and third follow-up, respectively. Lameness was resolved in 28.5 %, 78.5 %, and 100 % at 30, 60, and 90 days, respectively. No major peri- or post-operative complications were reported. The combination of mTPLO and DFO aligns the stifle extensor mechanism, promoting dynamic stabilization. It can be considered for the treatment of concurrent MPL and CCLD in dogs, performed as a single procedure, and is associated with favorable short-term outcomes.

Medial Tibial Condylar Valgus Osteotomy improve clinical outcomes and effectively corrects significant Tibial varus deformities without compromising joint line obliquity or patellar heigh

BackgroundTibial condylar valgus osteotomy (TCVO), or Chiba osteotomy, is a recognized procedure for treating advanced knee osteoarthritis in middle-aged individuals. Although its effectiveness is established, limited literature exists on its outcomes for specific conditions such as post-traumatic deformities, Blount disease (BD), and Pagoda-like proximal tibia varus deformities. HypothesisWe hypothesized that TCVO could improve both clinical and radiographic outcomes in patients with severe varus deformities, correcting lower-limb variances while preserving joint line obliquity (JLO) and patellar height in substantial varus deformities. Patients and methodsThis study included 33 patients who underwent TCVO, with etiologies including post-traumatic (26 patients, 78.8%), Blount disease (4 patients, 12.1%), and Pagoda deformities (3 patients, 9.1%). The average age was 32.5 years (standard deviation = 12.8 years). Techniques for deformity correction varied, including Patient Specific Instrumentation (PSI) for 10 patients (30.3%) and locking plate fixation for 13 patients (39.4%). We assessed several radiological parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), Caton-Deschamps index (CDI), and proximal posterior tibial angle (PPTA). Patient-reported outcomes, including the Knee injury and Osteoarthritis Outcome Score (KOOS) and simple knee value (SKV), were recorded both pre-operatively and two years post-operatively. ResultsStatistically significant improvements were observed in clinical scores and alignment changes two years post-operatively, including increases in HKA (from 166.1 to 178.4, p < .0001) and MPTA (from 72.4 to 85.1, p < .0001), and a decrease in JLO (from 9.8 to 3.2, p < .0001). No significant changes were noted in JLCA, PPTA, and CDI, with the patellar height remaining stable post-operatively. The achieved corrections closely matched the pre-operative plans. ConclusionTCVO offers significant improvements in radiological and clinical parameters for patients with substantial tibial varus deformities, effectively maintaining JLO and patellar height. Optimal outcomes from TCVO are dependent on careful patient selection and precise execution of surgical techniques. Level of evidenceIII.

Staged revision of the infected knee arthroplasty and endoprosthesis.

Periprosthetic joint infection (PJI) is a challenging complication of any arthroplasty procedure. We reviewed our use of static antibiotic-loaded cement spacers (ABLCSs) for staged management of PJI where segmental bone loss, ligamentous instability, or soft-tissue defects necessitate a static construct. We reviewed factors contributing to their failure and techniques to avoid these complications when using ABLCSs in this context. A retrospective analysis was conducted of 94 patients undergoing first-stage revision of an infected knee prosthesis between September 2007 and January 2020 at a single institution. Radiographs and clinical records were used to assess and classify the incidence and causes of static spacer failure. Of the 94 cases, there were 19 primary total knee arthroplasties (TKAs), ten revision TKAs (varus-valgus constraint), 20 hinged TKAs, one arthrodesis (nail), one failed spacer (performed elsewhere), 21 distal femoral endoprosthetic arthroplasties, and 22 proximal tibial arthroplasties. A total of 35/94 patients (37.2%) had spacer-related complications, of which 26/35 complications (74.3%) were because of mechanical failure of the spacer construct, while 9/35 (25.7%) were due to recurrence of infection. Risk factors for internal failure were a construct where the total intramedullary spacer length was less than twice the length of the central osseous defect (p = 0.009), where proximal or distal intraosseous spacer contact was < 10%, and after tibial tubercle osteotomy (p = 0.005). The incidence of spacer complications significantly increased the time to second stage: mean 157 days (42 to 458) in those without complications versus 227 days (11 to 528) with complications (p = 0.014). The failure rate of static antibiotic-loaded cement spacers is much higher than anticipated. Complications of the spacer significantly increased the time to second-stage revision. The risk of mechanical failure is significantly increased if the spacer is less than double the size of the segmental defect, or if inadequate reinforcement is inserted into the residual bone. These findings serve as a guide for surgeons to avoid mechanical complications with static spacers.

Canine sterile neutrophilic dermatosis (Sweet-like syndrome): A description of 3 cases

Three dogs were presented with a sudden onset of erythematous skin lesions, fever, and various extracutaneous signs, assigned to canine sterile neutrophilic dermatosis by clinical, laboratory, and histopathologic examination. This disease is very rare and comparable to Sweet syndrome in humans. According to the 4 forms of SS, the 1st and 3rd cases in this case report could be classified as classic/idiopathic SS. In this context, the respiratory signs may be a prodromal stage of SS preceding the skin lesions or possibly an infection of the respiratory tract was the trigger for SS. The 2nd case, on the other hand, shows a clear and the 3rd case a possible connection to pathergy as a consequence of a previous surgical treatment (case 2 a tibial plateau levelling osteotomy [TPLO] 20 days previously, case 3 a hemilaminectomy 90 days previously). This way, both may be assigned to the 4th form of SS. In all 3 cases, an adverse drug reaction as a trigger cannot be ruled out with certainty, as medication was used before the diagnosis was made in each case. Besides the most common extracutaneous signs such as fever and neutrophilia, immune-hemolytic anemia occurred in 2 of the patients. As therapeutic options, in addition to the established immunosuppressive drugs such as prednisolone, ciclosporin and azathioprine, oclacitinib is also included in the treatment regimen. In addition, administration of an antiplatelet agent (clopidogrel), which may be interpreted as a lesson learnt from the first of the presented cases, that died of pulmonary thromboembolism. In case 2, all drugs were tapered and eventually stopped over a period of 2.5 years and the patient has been without recurrence for 4 years. Case 3 is recurrence-free under therapy.

Distally Based Patella Tendon Shortening With Medial Patellotibial Ligament Reconstruction

Patella alta is a common pathoanatomic contributor to various knee pathologies, including patella instability, fat pad impingement, and patellar tendinopathy. The 2 most common surgical techniques used to treat patella alta include a distalizing tibial tubercle osteotomy and patella tendon imbrication. Although these 2 surgical techniques are effective, they are associated with significant surgical morbidity and a limiting postoperative course with prolonged rehabilitation. In this Technical Note, we propose a simple means of distalizing the patella and improving patella maltracking via the addition of a medial patellotibial ligament reconstruction. The described technique is easy to perform, has little postoperative morbidity, and is familiar to most knee surgeons who perform anterior cruciate ligament reconstruction.

Alignment rod and gap measurement methods achieve comparable alignment correction in opening wedge high tibial osteotomy for varus osteoarthritic knees.

To compare clinical and radiological outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using two different alignment methods: the alignment rod (AR) versus the gap measurement (GM) method. The primary outcome was to report the surgical accuracy of coronal plane corrections in each method. Patients who underwent MOWHTO with either AR or GM method between 2014 and 2022 at a single institution, with a minimum of 2 years of follow-up, were included. The opening gap was gradually spread with an AR under fluoroscopic control in the AR group, whereas the osteotomy site was opened to the value of the measured gap distance in addition to the thickness of the bone saw in the GM group. Radiological assessment of geometric characteristics included hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle and joint line convergence angle. Surgical accuracy, which is the deviation (Δ) between the intended and achieved correction, was compared between both methods. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Scores. A total of 110 patients (n = 110 knees) with a mean age of 54.1 ± 8.4 years were included in the study. Radiological parameters were significantly improved as reflected by HKA correction from 171.6° ± 2.0° to 181.1° ± 2.6° in the AR group and from 171.0° ± 2.3° to 181.1° ± 2.8° in the GM group at 2 years (Intergroup n.s). There was no significant intergroup difference for all radiological parameters and clinical outcomes. There was no intergroup difference in the surgical accuracy as evaluated by Δvalues and absolute Δvalues of both HKA and MPTA (n.s). Comparable correction accuracy was achieved in MOWHTO using either the AR or GM method. The GM method is simple and reliable in achieving the intended correction in MOWHTO. Ⅲ retrospective comparative study.

Evaluating the Effectiveness of a Structural Allograft in Medial Open Wedge High Tibial Osteotomy in Patients With and Without a Lateral Hinge Fracture.

A lateral hinge fracture is a common complication in medial open wedge high tibial osteotomy (MOWHTO) and is associated with delayed union or nonunion. A comparison of outcomes between patients with or without a lateral hinge fracture after MOWHTO with a structural allograft has not been investigated. To validate the outcomes of MOWHTO with a structural allograft, especially in the presence of a lateral hinge fracture. Case series; Level of evidence, 4. We conducted a single-surgeon cohort study at a tertiary referral hospital between April 2017 and August 2022 and included patients who had undergone MOWHTO with a structural allograft for isolated medial compartment osteoarthritis with genu varum. We compared the incidence of delayed union or nonunion events and functional scores between patients with a lateral hinge fracture and those without using the Fisher exact test and independent t test. A total of 88 MOWHTO procedures (77 patients) were analyzed. The overall incidence of lateral hinge fractures was 29.5% (n = 26), including type I (n = 20 [22.7%]) and type II (n = 6 [6.8%]). Notably, 42.3% (n = 11) of these fractures had not been detected intraoperatively but during the follow-up visits. The overall Knee Society Score (KSS), Knee Society Score-Function (KSS-F), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 90.0 ± 10.0, 93.4 ± 10.8, and 93.8 ± 7.1 points, respectively. None of the patients had delayed union or nonunion, and none underwent a reoperation because of bony union problems. The functional scores (KSS, KSS-F, and WOMAC) were not different between patients who had a lateral hinge fracture and those who did not (P > .05). The routine use of a structural allograft was associated with satisfactory outcomes after MOWHTO, regardless of whether there was a lateral hinge fracture.

Lateral closing wedge high-tibial osteotomy is a long-lasting option for patients under the age of 55 with medial compartment osteoarthritis.

Assess the survival of the closing wedge high tibial osteotomy (CWHTO) with failure defined as progression to total knee arthroplasty (TKA) and perioperative complications. Patients undergoing CWHTO in a single centre were included in this study. The patient's demographics, operative data and patient-reported outcome measures were collected from the medical records. The outcomes assessed were progression to TKA, complications and patient-reported outcome measures. The Australian joint registry was used to assess which patients progressed to TKA. A binary logistics regression is used to determine if any of the collected factors increase the likelihood of conversion to arthroplasty. Survival analysis is conducted using a Kaplan-Meier survivorship analysis with failure defined as progression to TKA. Three hundred and fifty-four (244 males and 110 females) patients were included in the study. The average age of the group was 51 years with an average follow-up of 18 years. Patients under the age of 55 had a lower rate of progression to TKA. At 15 years, the rate of progression to TKA was 64% and 85% for those under the age of 55 and over 55, respectively. The complication rate was 6% without any peroneal nerve palsies. CWHTO is a good surgical option particularly when indicated in patients under the age of 55. Additionally, this technique results in a low overall complication rate with an absence of the often-feared complication of peroneal nerve palsy. Level III, Retrospective study.

Superficial medial collateral ligament transection sufficiently increases joint space width for medial meniscal procedures during medial open-wedge high tibial osteotomy

Superficial medial collateral ligament transection sufficiently increases joint space width for medial meniscal procedures during medial open-wedge high tibial osteotomy