Precise Correction Research Articles

Prime editing: A gene precision editing tool from inception to present.

Genetic mutations significantly contribute to the onset of diseases, with over half of the cases caused by single-nucleotide mutations. Advances in gene editing technologies have enabled precise editing and correction of mutated genes, offering effective treatment methods for genetic disorders. CRISPR/Cas9, despite its power, poses risks of inducing gene mutations due to DNA double-strand breaks (DSB). The advent of base editing (BE) and prime editing (PE) has mitigated these risks by eliminating the hazards associated with DNA DSBs, allowing for more precise gene editing. This breakthrough lays a solid foundation for the clinical application of gene editing technologies. This review discusses the principles, development, and applications of PE gene editing technology in various genetic mutation-induced diseases.

The lateral approach for total knee arthroplasty in valgus osteoarthritis provides similar clinical and radiological results compared with the medial approach.

In total knee arthroplasty (TKA), valgus deformities require special approaches to achieve precise mechanical axis correction and joint stability. This study aimed to determine whether the lateral approach without tibial tubercle osteotomy allows mechanical axis correction in valgus knee osteoarthritis (OA), which is at least as effective as the medial approach, while also assessing whether it provides clinically comparable results and complications. A total of 204 patients undergoing TKA for valgus knee OA were included in this retrospective comparative study, with 131 patients in the lateral approach group and 73 patients in the medial approach group. The surgical goal was to achieve stability with a neutral axis based on mechanical alignment. Detailed pre- and postoperative clinical and radiographic data were obtained, including measurements of the hip-knee-ankle angle (HKAA) and patella tilt angle. Functional status was determined based on the Oxford Knee Score (OKS). Age, body mass index, sex and preoperative HKAA were adjusted between both groups using propensity score matching (n = 45 per group). In the propensity score-matched cohort, the postoperative HKAA did not show differences when comparing the lateral and the medial approach at a mean follow-up of 19.7 months (p = 0.385). The achieved correction of the patella tilt angle was higher in the lateral approach group in the overall (p < 0.001) and matched cohort (p < 0.001). No differences were detected regarding the postoperative OKS and complications. However, wound healing disorders showed a tendency to be more prevalent in patients who underwent the lateral approach in the overall cohort (6.1%, n = 8 vs. 0.0%, n = 0, p = 0.053) but not in the propensity score-matched cohort (p = 0.494). This study demonstrated that for pronounced valgus OA, the lateral approach achieves favourable results in HKAA correction, patellar tilt and complications comparable to the medial approach. However, the risk of wound healing disorders appears higher with severe valgus deformity. Level III therapeutic study.

Assessing the Impact of Environmental Conditions on Reflectance Values in Inland Waters Using Multispectral UAS Imagery

This study investigates the impact of environmental conditions on reflectance values obtained from multispectral Unmanned Aerial System (UAS) imagery in inland waters, focusing on sun glint, cloud glint, wind-generated waves, and cloud shading projections. Conducted in two reservoirs with differing water qualities, UAS platforms equipped with MicaSense Altum and DJI Phantom 4 Multispectral sensors were used to collect multispectral images. The results show that sun glint significantly increases reflectance variability as solar elevation rises, particularly beyond 54°, compromising data quality. Optimal flight operations should occur within a solar elevation angle range of 25° to 47° to minimize these effects. Cloud shading introduces complex variability, reducing median reflectance. Wind-generated waves enhance sun glint, increasing variability across all spectral bands, while cloud glints amplify reflectance non-uniformly, leading to inconsistent data variability. These findings underscore the need for precise correction techniques and strategic UAS deployment to mitigate environmental interferences. This study offers valuable insights for improving UAS-based monitoring and guiding future research in diverse aquatic environments.

U and Th zonation in apatite observed by synchrotron X-ray fluorescence tomography and implications for the (U–Th) ∕ He system

Abstract. Synchrotron X-ray fluorescence microtomography can non-destructively image the three-dimensional distribution of several trace elements in whole apatite crystals at the resolution of 1 µm3. This allows for precise determination of the physical geometry of a crystal and the quantification of the relative abundance of the radioactive parent nuclides uranium and thorium with high fidelity. We use these data to develop a more precise alpha ejection correction for (U–Th) / He thermochronology and high-resolution models of apatite crystals that are the foundation for a new generation of three-dimensional diffusion modeling. The application of synchrotron radiation to non-destructive imaging of minerals used for geochronology sheds light on causes of long-standing unresolved problems in the field that are rooted in previously unmeasurable parent nuclide zonation, especially the pervasive overdispersion of single-crystal ages.

Emerging gene therapy approaches for the treatment of severe combined immunodeficiency (SCID): a comprehensive review

Background. Severe Combined Immunodeficiency (SCID) is a life-threatening condition resulting from various genetic mutations that impair immune cell development. Traditional treatment via hematopoietic stem cell transplantation (HSCT) has limitations, prompting exploration into gene therapy as a promising alternative. Objectives. This review aims to evaluate emerging gene therapy approaches for SCID, emphasizing the use of lentiviral vectors and CRISPR/Cas9 technology, and to assess their efficacy and safety in comparison to traditional HSCT. Materials and Methods. A comprehensive literature search was conducted using PubMed and Google Scholar to identify peer-reviewed articles, clinical trials, and observational studies on gene therapy for SCID published in the last 10 years. Studies were included based on their relevance to gene therapy interventions, and outcomes related to efficacy and safety were analyzed. Discussions. Gene therapy has shown significant promise in SCID treatment, particularly through the use of lentiviral vectors and CRISPR/Cas9 for precise genetic correction. Clinical trials demonstrate improved immunological reconstitution and patient outcomes, with reduced side effects compared to HSCT. However, challenges such as optimizing protocols, ensuring long-term safety, and equitable access to treatments remain. Ongoing research and trials continue to advance our understanding, offering hope for more effective, personalized SCID therapies in the future.

High-fidelity PAMless base editing of hematopoietic stem cells to treat chronic granulomatous disease.

X-linked chronic granulomatous disease (X-CGD) is an inborn error of immunity (IEI) resulting from genetic mutations in the cytochrome b-245 beta chain (CYBB) gene. The applicability of base editors (BEs) to correct mutations that cause X-CGD is constrained by the requirement of Cas enzymes to recognize specific protospacer adjacent motifs (PAMs). Our recently engineered PAMless Cas enzyme, SpRY, can overcome the PAM limitation. However, the efficiency, specificity, and applicability of SpRY-based BEs to correct mutations in human hematopoietic stem and progenitor cells (HSPCs) have not been thoroughly examined. Here, we demonstrated that the adenine BE ABE8e-SpRY can access a range of target sites in HSPCs to correct mutations causative of X-CGD. For the prototypical X-CGD mutation CYBB c.676C>T, ABE8e-SpRY achieved up to 70% correction, reaching efficiencies greater than three-and-one-half times higher than previous CRISPR nuclease and donor template approaches. We profiled potential off-target DNA edits, transcriptome-wide RNA edits, and chromosomal perturbations in base-edited HSPCs, which together revealed minimal off-target or bystander edits. Edited alleles persisted after transplantation of the base-edited HSPCs into immunodeficient mice. Together, these investigational new drug-enabling studies demonstrated efficient and precise correction of an X-CGD mutation with PAMless BEs, supporting a first-in-human clinical trial (NCT06325709) and providing a potential blueprint for treatment of other IEI mutations.

Short-Term Visual and Refractive Outcomes of Single-Step Transepithelial Photorefractive Keratectomy with Amaris 750S and SmartSurfACE in Myopia and Astigmatism: A 6-Month Follow-Up Study.

Single-step transepithelial photorefractive keratectomy (TPRK) is a modern refractive surgery technique that offers a no-touch approach for correcting myopia and astigmatism. This study aims to evaluate the short-term visual and refractive outcomes of TPRK in patients with myopia and astigmatism over a 6-month follow-up period. This retrospective cohort study included patients who underwent single-step TPRK using the Amaris 750S laser platform with SmartSurfACE and SmartPulse® technologies, targeting a plano refraction. Procedures were performed with aspheric, non-wavefront-guided profiles, and outcomes were assessed postoperatively. 96% of eyes achieved 20/20 or better uncorrected distance visual acuity (UDVA), with 98% reaching 20/25 or better, and 100% achieving 20/32 or better. UDVA was the same or better than preoperative corrected distance visual acuity (CDVA) in 96% of eyes, and no eyes lost two or more Snellen lines. Refractive outcomes showed strong precision, with 93% of eyes within ±1.00 D of the target. Astigmatism correction was accurate, with 100% of eyes having ≤1.00 D of astigmatism, and 80% achieving a precise astigmatism angle of error between -5° and 5°. Single-step TPRK with SmartSurfACE and SmartPulse® technologies provides highly effective and predictable visual and refractive outcomes for myopia and astigmatism. The procedure consistently delivers precise corrections with minimal complications, making it a reliable option for refractive surgery.

Impact of teardrop angle correction on functional outcomes in die punch fractures of the distal radius: retrospective study

Background: Anatomic reduction of die punch fractures of the distal radius is crucial to optimize functional outcomes. The teardrop angle, formed by the volar cortex and articular surface, reflects distal radius alignment and articular congruity. This study evaluated the relationship between teardrop angle correction and clinical/functional results following surgical fixation of these injuries. Methods: This retrospective study included patients undergoing open reduction and internal fixation for die punch distal radius fractures between 2015-2020. Patients were divided into two groups based on teardrop angle correction: group 1 (≤10°) and group 2 (&gt;10°). Disabilities of the arm, shoulder and hand (DASH) scores, patient-rated wrist evaluation (PRWE) scores, range of motion, and grip strength were assessed at final follow-up (minimum 12 months). Multivariate analysis identified predictors of functional outcomes. Results: 60 patients were included (32 in group 1, 28 in group 2). Groups were similar in baseline demographics and injury characteristics. Group 2 (&gt;10° correction) had significantly better outcomes including lower DASH scores (14.5 versus 24.6, p=0.003), lower PRWE scores (21.6 versus 36.8, p=0.002), greater grip strength (84.6% versus 71.2%, p=0.005), increased flexion (62.5° versus 52.7°, p=0.004), and extension range of motion (55.8° versus 43.5°, p&lt;0.001). On multivariate analysis, greater teardrop angle correction was an independent predictor of improved DASH and PRWE scores. Conclusions: Obtaining &gt;10° of teardrop angle correction during surgical fixation of die punch distal radius fractures correlated with superior functional outcome scores, grip strength, and mobility compared to ≤10° of correction. These findings emphasize the importance of restoring distal radius anatomy and articular congruity in this injury pattern. Precise intraoperative correction of the teardrop angle deformity should be a key goal.

Synchronous measurement of wind pressure and flow field in wind tunnel: device, method and application

Accurate assessment of the relationship between flow field and surface wind pressure distribution around buildings in wind tunnel tests is crucial for understanding the interaction mechanism between wind and buildings. Despite notable technological advancements in dynamic pressure measurement and flow visualization, the acquirement of synchronous data on flow and wind pressure around buildings still faces challenges in terms of accuracy, cost, and operational complexity. Given this, a frame synchronization technique has been developed to collect flow field and wind pressure data based on particle image velocimetry and Scanivalve dynamic pressure measurement. Meanwhile, this study established a more precise correction method for the distortion effect of the synchronously measured wind pressure signal. Furthermore, the paper demonstrates the feasibility of synchronously measuring the flow field and the corrected wind pressure in time through the flow around triangular prism test. Experimental results indicate that the corrected wind pressure distribution on triangular prism surface is consistent with the temporal variations in instantaneous flow velocity and vorticity change, thereby verifying the reliability of the synchronous test system.

English Grammar Auto-Correction Robot based on Grammatical Error Generation Model

The traditional English grammar error correction system has problems such as poor error recognition precision and error correction success rate to be improved. Therefore, in this study, data augmentation techniques were used to transform and process error correcting English texts, and a rule-based and shallow neural network-based English text grammar correction model was constructed. The experimental results showed that the grammar error generation (GEG), rule-based (RB), classification-based (CB), and recurrent neural network (RNN) models achieved accuracy rates of 93.92%, 82.17%, 79.41%, and 88.09% in correcting grammar errors on 1702641 test sentences in the One Billion word corpus, respectively. The experimental results showed that the English grammar error correction model designed in this study had a strong error correction ability, but the computational efficiency was low. The research results significantly improved the accuracy and generalization ability of English grammar correction, optimized learning costs, and brought positive impacts to educational applications, providing strong support for the development of intelligent English grammar correction.

An Image Distortion Correction Method Based on Distortion Centre and Parameter Estimation

Abstract We propose a radial distortion correction method based on straight-line feature calibration to address the challenge of image radial distortion when measuring mechanical motion parameters using computer vision technology. This method first independently estimates the distortion center, and then transforms the distortion parameter estimation into an arc fitting problem. The least squares optimization algorithm is applied to quickly and accurately estimate the arc parameter of distorted lines, ultimately achieving precise correction of distortion in wide-angle camera images. This method can reduce lens distortion by 89% to 92%, laying a solid foundation for the application of computer vision technology in the field of mechanical motion parameter measurement.

The Legacy of Harrington's Rod and the Evolution of Long-Segment Constructs in Spine Surgery.

This paper delves into the historical evolution of spinal surgery, focusing on the pivotal role of the Harrington rod in treating spinal deformities. Introduced in 1955, the Harrington rod marked a significant breakthrough in neurosurgery, especially for scoliosis treatment, by offering a novel approach to spinal stabilization. Through a retrospective analysis, this study examines the development and impact of the Harrington rod, highlighting Dr. Paul Harrington's contributions to spinal surgery. His innovative technique revolutionized the management of spinal deformities, laying the groundwork for future advancements in spinal instrumentation. Despite initial skepticism, Harrington's methods gained acceptance, significantly influencing neurosurgical practices and patient outcomes. This study also explores subsequent advancements that built on Harrington's work, including the transition to long-segment spine constructs and the introduction of segmental pedicle screws, which allowed for more precise deformity correction. Reflecting on Harrington's legacy, this paper acknowledges the continuous evolution of spinal surgery, driven by the interplay between clinical challenges and technological innovations. Harrington's pioneering spirit exemplifies the ongoing pursuit of better surgical outcomes, underscoring the importance of innovation in the field of neurosurgery.

Research on the Wear State Detection and Identification Method of Huller Rollers Based on Point Cloud Data

Throughout the huller shelling process, the rubber rollers progressively deteriorate. The velocity of the rubber rollers decreases as the distance between the rollers rises. These modifications significantly influence the rate at which rice hulling occurs. Hence, the implementation of real-time online detection is crucial for maintaining the operational efficiency of the huller. Currently, the prevailing inspection methods include manual inspection, 2D vision inspection, deep learning methods, and machine vision methods. Nevertheless, these conventional techniques lack the ability to provide detailed information about the faulty components, making it challenging to conduct comprehensive defect identification in three dimensions. To address this issue, point cloud technology has been incorporated into the overall detection of the working condition of the huller. Specifically, the Random Sample Consensus segmentation algorithm and the adaptive boundary extraction algorithm have been developed to identify abnormal wear on the rubber rollers by analyzing the point cloud data on their surface. A solution technique has been developed for the huller to compensate for the speed of the rubber rollers and calculate the mean values of their radii. Additionally, a numerical simulation algorithm is proposed to address the dynamic change in the roller spacing detection. The results show that point cloud data can be utilized to achieve real-time and precise correction of anomalous wear patterns on the surface of rubber rollers.

Logarithmic Corrections to the Alexander–Orbach Conjecture for the Four-Dimensional Uniform Spanning Tree

We compute the precise logarithmic corrections to Alexander–Orbach behaviour for various quantities describing the geometric and spectral properties of the four-dimensional uniform spanning tree. In particular, we prove that the volume of an intrinsic n-ball in the tree is n2(logn)-1/3+o(1)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$n^2 (\\log n)^{-1/3+o(1)}$$\\end{document}, that the typical intrinsic displacement of an n-step random walk is n1/3(logn)1/9-o(1)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$n^{1/3} (\\log n)^{1/9-o(1)}$$\\end{document}, and that the n-step return probability of the walk decays as n-2/3(logn)1/9-o(1)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$n^{-2/3}(\\log n)^{1/9-o(1)}$$\\end{document}.

Illumination-aware divide-and-conquer network for improperly-exposed image enhancement

Improperly-exposed images often have unsatisfactory visual characteristics like inadequate illumination, low contrast, and the loss of small structures and details. The mapping relationship from an improperly-exposed condition to a well-exposed one may vary significantly due to the presence of multiple exposure conditions. Consequently, the enhancement methods that do not pay specific attention to this issue tend to yield inconsistent results when applied to the same scene under different exposure conditions. In order to obtain consistent enhancement results for various exposures while restoring rich details, we propose an illumination-aware divide-and-conquer network (IDNet). Specifically, to address the challenge of directly learning a sophisticated nonlinear mapping from an improperly-exposed condition to a well-exposed one, we utilize the discrete wavelet transform (DWT) to decompose the image into the low-frequency (LF) component, which primarily captures brightness and contrast, and the high-frequency (HF) components that depict fine-scale structures. To mitigate the inconsistency in correction across various exposures, we extract a conditional feature from the input that represents illumination-related global information. This feature is then utilized to modulate the dynamic convolution weights, enabling precise correction of the LF component. Furthermore, as the co-located positions of LF and HF components are highly correlated, we create a mask to distill useful knowledge from the corrected LF component, and integrate it into the HF component to support the restoration of fine-scale details. Extensive experimental results demonstrate that the proposed IDNet is superior to several state-of-the-art enhancement methods on two datasets with multiple exposures.

An improved method for developing the precipitable water vapor vertical correction global grid model

Precipitable Water Vapor (PWV) is a crucial parameter in climate research. However, obtaining high precision PWV data remains a problem. Discrepancies in water vapor elevation data from diverse observation sources pose challenges, emphasizing the need for precise vertical correction. In this paper, we proposed the precipitable water vapor model with systematic difference correction by using ERA5 (the fifth generation of European Centre for Medium-Range Weather Forecasts Reanalysis) data and GNSS (Global Navigation Satellite System) data. In this proposed method, two vertical correction models, employing cubic polynomial and exponential functions, were developed. The exponential function demonstrated superior overall performance with the RMS error of 0.96 mm, effectively capturing vertical characteristics across diverse regions, while the cubic polynomial function had the RMS (Root Mean Square) error of 2.77 mm validated by ERA5 PWV. The cubic polynomial function was found more suitable for low-elevation regions, while the exponential function excelled in high-elevation regions. Validated by radiosonde PWV, the cubic polynomial function and the exponential function show a strong correlation with latitude. Both functions exhibit smaller RMS values at higher latitudes and larger RMS values at lower latitudes. Validated by GNSS PWV, the cubic polynomial function exhibits superior accuracy, with the RMS of 2.39 mm, compared to the exponential function, particularly in specific regions. Analyzing six years of data reveals significant systematic differences between ERA5 and GNSS PWV. This discrepancy exhibits a noticeable annual periodic variation. The global GNSS stations were organized into grids, with stations within the same region grouped together for correction. Models considering systematic differences exhibited substantial RMS reductions and better accuracy. These findings can provide reference in atmospheric correction and the study of extreme weather events.

KNEE DEFORMITIES AND KNEE REPLACEMENTS IN SAUDI POPULATION: OUR EXPERIENCE AND LITERATURE REVIEW

It takes precise alignment, adequate balance, and deformity correction to accomplish a successful total knee arthroplasty (TKA). In main TKA, this can be successfully achieved with a posterior stabilized (PS) design, either with or without sub-periosteal release. However, severe abnormalities with a major bone defect, stiffness, and instability are often associated with these disorders in some circumstances, such as knee osteoarthritis. Additional restrictive prostheses are required since it is extremely difficult to balance these anomalies with soft tissue release alone, even after main TKA. In this situation, the constrained condylar knee (CCK) design is the optimum choice. This studys primary objectives were to characterize the clinical outcomes, function recovery, and complications of patients who underwent primary CCK-TKA for severe knee osteoarthritis related knee deformity. The secondary aim was to find out the mid-term prostheses survival. Methods: Between March 2021 and March 2022, 36 consecutive patients with knee osteoarthritis had cemented primary CCK-TKA. Twenty-Eight women and eight men, totaling 36 patients, had at least a 6 month follow-up for this retrospective analysis. We used the Knee Society Score (KSS), the Hospital for Special Surgery (HSS) score, and the roentgenographic evaluation form to assess the patients. The survival of prosthesis was assessed using Kaplan-Meiers survival analysis. The patients follow-up periods averaged 12 month. The KSS knee score rose from 44 points (23–68) to 91 points (76–100) following surgery [P &lt; 0.001]. Following the procedure, the mean KSS functional score rose from 20–75 points to 91 points (65–100) [P &lt; 0.001]. The average HSS score rose from 51 points (27–83) to 91 points (75–100) following surgery [P &lt; 0.001]. The average range of motion (ROM) also increased after surgery, going from 68.09° ± 35.99° (0°–120°) to 113.68° ± 8.90° (100°–130°) [P &lt; 0.001]. The average hip-knee-ankle (HKA) angle was 180.24° ± 1.77° (175°–184°) following surgery, compared to 176.88° ± 14.48° (135°–199°) before to surgery. Radiolucencies were seen in thirteen knees, mostly on the tibial side. After an average follow-up of 12 month, 94.7% of prosthesis were still in use. Despite severe deformity, instability, and stiffness at a relatively young age, the mid-term follow-up of primary CCK-TKA in knee osteoarthritis gives satisfactory clinical and functional outcomes with 94.7% prosthesis survival. However, there are a few issues.

Real-time uncombined PPP using BDS-3 PPP-B2b products with different multi-frequency integrations and refined stochastic model

BDS-3 geostationary orbit (GEO) satellites broadcast PPP-B2b real-time precise products to support real-time precise point positioning (RT-PPP) without dependence on the ground network communication. Since all BDS-3 satellites can provide multi-frequency signals, we investigate the effect of different multi-frequency integrations and the refinement of multi-frequency stochastic model for PPP-B2b RT-PPP. Given that the retrieval of PPP-B2b real-time precise corrections relies on the B1C and B2b frequencies, this study first investigates the kinematic uncombined (UC) RT-PPP performance of the B1C/B2b integration with a comparison to the conventional B1I/B3I integration. The results indicate that the convergence time (with a convergence threshold of 20 cm) of the RT-PPP with the B1C/B2b integration is shortened by 16 %, 15 %, and 12 % over the B1I/B3I integration in the east, north, and up directions, respectively. Further, this study compares the kinematic UC RT-PPP performance of the B1C/B2b dual-frequency integration, B1C/B2b/B3I triple-frequency integration, and B1C/B2b/B3I/B1I/B2a five-frequency integration. Compared with the dual-frequency integration, the positioning performance of the triple-frequency integration is slightly improved. By contrast, the performance improvement of the five-frequency integration is more significant, which can reach 6 %, 32 %, and 9 % for the convergence time, and 11 %, 9 %, and 6 % for the positioning accuracy in three directions, respectively. To further enhance the multi-frequency PPP performance, a refined stochastic model for the BDS-3 five-frequency integrated PPP-B2b RT-PPP is proposed by taking the inconsistency of signal quality among multi-frequency signals into account. After applying the refined stochastic model, the convergence time of the five-frequency kinematic RT-PPP is shortened by 10 %, 14 %, and 9 % to 32, 7, and 19 min in east, north, and up directions, respectively. The positioning accuracy (the root mean square of all the positioning errors excluding the first two hours) of the five-frequency RT-PPP with the refined stochastic model can reach the optimal level, which is 9.9, 6.5, and 14.0 cm in three directions, respectively.

Optimizing Outcomes in Distal Tibial Deformity Correction: The Role of Supramalleolar Osteotomy with Computer-assisted Hexapod External Fixator.

Distal tibial deformities can significantly impact patients if left uncorrected, often leading to pain, alterations in gait, and the eventual development of post-traumatic arthritis. The criteria for surgical correction in these patients continues to be a subject of debate, while supramalleolar osteotomy (SMO) is an effective method for correcting distal tibial deformities. The purpose of this study was to evaluate and compare the clinical results of SMO using internal fixation or using computer-assisted hexapod external fixator in the treatment of distal tibial deformity. A retrospective study was conducted on 290 patients who underwent SMO between June 2015 and January 2023. Forty-four patients met the inclusion and exclusion criteria. Among the participants, 19 underwent SMO combined with a computer-assisted hexapod external fixator, while 25 received SMO with plate and screw internal fixation. The tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle, the tibiotalar (TT) angle and the talocrural (TC) angle were assessed on weight-bearing X-ray films. Functional assessments were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. The study followed patients for an average duration of 31.7 ± 15.3 months, with a range from 12 to 67 months. Successful bone union was achieved in all cases. For patients treated with the computer-assisted hexapod external fixator, significant improvements were observed: the mean deviation in sagittal plane deformity parameters decreased from 14.3 ± 10.4 degrees preoperatively to 2.8 ± 3.8 degrees postoperatively (p < 0.05). Similarly, coronal plane deformity parameters showed a reduction from 25.9 ± 22.5 degrees preoperatively to 5.9 ± 11.0 degrees postoperatively (p < 0.05). The AOFAS ankle-hindfoot score improved markedly from 66.0 ± 14.9 to 86.1 ± 11.7 points (p < 0.05). For patients undergoing internal fixation, the absolute difference in coronal plane parameters improved from 15.4 ± 12.6 degrees preoperatively to 3.7 ± 3.4 degrees postoperatively (p < 0.05). A significant enhancement in AOFAS ankle-hindfoot score was also noted, increasing from 68.3 ± 14.3 points to 79.4 ± 13.5 points (p < 0.05). There were no significant differences in gender, side, follow-up time, postoperative deviation of deformity, pre- or postoperative AOFAS between the two groups. In conclusion, comprehensive preoperative planning of SMO combined with either internal fixation or a hexapod external fixator for treating distal tibial deformities can achieve satisfactory outcomes. The utilization of a computer-assisted hexapod external fixator facilitates a gradual and precise correction process, which proved to be an effective and relatively safe method.

Infratubercle Anterior Closing Wedge Osteotomy Corrects Sagittal Alignment without Affecting Coronal Alignment or Patellar Height.

Background: Excessive posterior tibial slope (PTS) has been associated with a higher risk of graft failure after anterior cruciate ligament reconstruction (ACLR). Although anterior closing wedge osteotomy (ACWO) can reduce the PTS, it may also change the coronal alignment and patellar height. Purpose: To elucidate the radiological outcomes after infratubercle ACWO, specifically to evaluate its influence on perioperative changes in patellar height. Methods: Patients who underwent infratubercle ACWO with combined ACLR with a minimum follow-up of 3 months were included. Surgery was indicated when the PTS was greater than 12°. Radiological evaluation included measurements of the hip-knee-ankle angle (HKA), PTS, femoral patellar height index (FPHI), and Caton-Deschamps index (CDI) preoperatively and 3 months postoperatively. Patellar height was classified as patella baja, normal, or alta based on CDI values. Knee recurvatum was measured preoperatively and at final follow-up. Results: A total of 21 patients with a mean age of 21.6 ± 3.0 years were included. Although HKA did not significantly change, significant corrections were achieved in the PTS from 14.5° ± 1.6° to 5.7° ± 1.0° (p < 0.001). No significant change in FPHI was found (preoperative: 1.33 ± 0.11 vs postoperative: 1.30 ± 0.09). Patellar height categories showed no significant differences pre- and postoperatively, while three patients (14.3%) changed their patellar height category (all moved up one category). Knee recurvatum increased significantly from 4.9° ± 2.9° preoperatively to 7.8° ± 3.1° at the final follow-up (p < 0.001). Conclusions: Precise sagittal correction was achieved after infratubercle ACWO without altering the coronal alignment and patella height. Level of Evidence: IV, Case series.