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Herman ZJ, Keeling LE, Fox MA, Dadoo S, Musahl V. The Role of Osteotomy in Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:383-398. [PMID: 38811117 DOI: 10.1016/j.csm.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Coronal and sagittal plane knee malalignments have been shown to increase the forces on anterior cruciate ligament (ACL) grafts after ACL reconstruction (ACLR). Studies have shown the benefit of high tibial osteotomy to address coronal and sagittal imbalance in revision ACLR. The purpose of this article is to further describe the use of osteotomy by reviewing preoperative planning, indications, techniques, and outcomes of high tibial opening and closing wedge as well as anterior tibial closing wedge osteotomies in the setting of ACLR.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Laura E Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Michael A Fox
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
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Lott A, James MG, Kaarre J, Höger S, Kayaalp ME, Ollivier M, Getgood A, Hughes JD, Musahl V. Around-the-knee osteotomies part II: Surgical indications, techniques and outcomes - State of the art. J ISAKOS 2024:S2059-7754(24)00072-5. [PMID: 38604568 DOI: 10.1016/j.jisako.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
Recent advances in surgical techniques and planning for knee-based osteotomies have led to improvements in addressing lower extremity malalignment. Part 1 of this review presented the biomechanical and clinical rationale of osteotomies, emphasizing the importance of osteotomies for restoring normal knee kinematics. In Part 2 of this review, indications, surgical technique and outcomes of osteotomies to correct coronal, sagittal and axial plane deformities will be examined. Traditional high tibial and distal femoral osteotomies will be discussed in addition to more recent advanced techniques including biplanar corrections and double-level osteotomies, as well as slope-correcting osteotomies. Patient-specific instrumentation and its use in more complex corrections will also be addressed.
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Affiliation(s)
- Ariana Lott
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael G James
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Svenja Höger
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Enes Kayaalp
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedics and Traumatology, Istanbul Kartal Training and Research Hospital, Istanbul, Turkey
| | | | - Al Getgood
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA.
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Zaffagnini S, Romandini I, Filardo G, Dal Fabbro G, Grassi A. Meniscal allograft transplantation, anterior cruciate ligament reconstruction, and valgus high tibial osteotomy for meniscal-deficient, unstable, and varus knees: surgical technique and clinical outcomes. INTERNATIONAL ORTHOPAEDICS 2023; 47:2523-2535. [PMID: 37316682 DOI: 10.1007/s00264-023-05846-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 05/17/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of this study was to determine the clinical and functional outcome of a salvage surgical approach with the combined procedures meniscal allograft transplantation (MAT), anterior cruciate ligament reconstruction (ACLR), and high tibial osteotomy (HTO), in a cohort of patients treated for complex knee lesions evaluated up to a mid-term follow-up. METHODS Eight patients (38.8 ± 4.6 years, 88% males) were treated arthroscopically with MAT without bone plugs combined with primary or revision ACLR and HTO and evaluated at basal, at a minimum of two years (short follow-up), and at a mean follow-up of 5.1 years (mid-term follow-up) with the VAS score for pain, Lysholm score, IKDC subjective score, WOMAC Osteoarthritis index, and Tegner score. Physical examination (Lachman and pivot-shift tests, arthrometer assessment) and radiographic evaluation (pre- and post-operative x-rays) were obtained. Complications and failures were also recorded. RESULTS A statistically significant improvement was observed from baseline to five years in all clinical scores. In particular, the IKDC subjective score improved from 33.3 ± 20.7 to 73.1 ± 18.4 at short follow-up (p < 0.05), up to 78.3 ± 9.8 at the final follow-up (p < 0.05). A similar trend was demonstrated with the Lysholm, VAS, WOMAC, and Tegner score, even though only one patient reached the pre-injury activity level. Two patients had a worsening of the Kellgren-Lawrence (KL) grade from preoperative (grade 1) to final follow-up (grade 2). No major complications and surgical failures were documented. CONCLUSION The combined procedure of MAT, ACLR, and HTO presents few complications and failures and showed to be a valid option to reduce pain, recover knee function, and slow down the osteoarthritis process even in complex patients, with good and stable results up to a mid-term follow-up.
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Affiliation(s)
- Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
| | - Iacopo Romandini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy.
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
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Agostinone P, Lucidi GA, Dal Fabbro G, Di Paolo S, Pagano A, Viotto M, Neri MP, Grassi A, Zaffagnini S. Satisfactory long-term outcomes for combined anterior cruciate ligament reconstruction and lateral closing wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4399-4406. [PMID: 37386198 DOI: 10.1007/s00167-023-07496-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE A combined anterior cruciate ligament (ACL) reconstruction and high tibial osteotomy (HTO) is considered a valuable treatment in young patients affected by symptomatic medial osteoarthritis and ACL deficiency. However, only a few studies have investigated the outcomes of this procedure, especially in the long term. Therefore, the aim of this study is to report clinical and radiographic outcomes of ACL reconstruction and lateral closing wedge HTO at a mean of 14 years of follow-up. METHODS Patients were prospectively evaluated pre-operatively, after 6.5 ± 2.7 years and 14.3 ± 2.2 years. Patient-reported outcome measures (PROMs) were collected, knee laxity was assessed through KT-1000 arthrometer, and limb alignment and knee osteoarthritis were evaluated on long-cassette radiographs. Survivorship of the surgical procedure was calculated through the Kaplan-Meier method. RESULTS 32 patients were initially enrolled and completed the mid-term evaluation (6.5 ± 2.7 years), and 23 patients (72%) were available for the final evaluation at 14.3 ± 2.2 years after surgery. Statistically significant improvement was found for all the clinical scores (VAS, WOMAC, Tegner, subjective IKDC, objective IKDC) between the pre-operative status and the mid-term follow-up (p < .001). VAS, subjective IKDC and objective IKDC showed no statistically significant differences (p > .05) between the mid-term and the final follow-up; a significant decrease of WOMAC (p < .05) and Tegner (p < .001) was found from mid-term to final follow-up. Significant progression of osteoarthritis was found for all the knee compartments. The survivorship was 95.7% at 5 years, 82.6% at 10 years, and 72.8% at 15 years. CONCLUSIONS Combined ACL reconstruction and lateral closing wedge HTO showed satisfactory clinical outcomes and survivorship at a mean of 14 years follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy.
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy
| | - Stefano Di Paolo
- Dipartimento di Scienze per la Qualità. della Vita QUVI, Università di Bologna, Bologna, Italy
| | - Anna Pagano
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy
| | - Marianna Viotto
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy
| | - Maria Pia Neri
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
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Takahashi T, Watanabe S, Hino M, Takeda H, Ito T. Excellent short-term results of dome-shaped high tibial osteotomy combined with all-inside anterior cruciate ligament reconstruction. J Exp Orthop 2023; 10:69. [PMID: 37428298 DOI: 10.1186/s40634-023-00632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023] Open
Abstract
PURPOSE This study aimed to evaluate short-term outcomes at least 2 years after dome-shaped high tibial osteotomy (HTO) combined with all-inside anterior cruciate ligament reconstruction (ACL) in patients with persistent ACL insufficiency accompanied by pain due to varus deformity. METHODS The study enrolled 19 knees of 18 patients. The mean age was 58.4 ± 13.4 years and the mean postoperative follow-up period was 31.4 ± 6.6 months (24-49 months). JOA(Japanese Orthopaedic Association)-OA(osteoarthritis) score, Lysholm score, radiographic outcomes such as femoro-tibia angle (FTA) in a standing position, side-to-side difference in KT-1000 measurements were evaluated at pre op. and post operative final follow up. And arthroscopic evaluation was evaluated at the time of the HTO plate-removal procedure. RESULTS Before surgery, the mean JOA-OA score was 65.0 ± 13.5, the mean Lysholm score was 47.2 ± 16.2, the mean femoro-tibia angle (FTA) in a standing position was 183.8 ± 3.4° (range;180-190°), and the mean side-to-side difference in KT-1000 measurements was 4.1 ± 1.3 mm. After surgery, the mean JOA-OA score, Lysholm score, and side-to-side difference in KT-1000 measurements improved to 93.1 ± 6.0 (P < 0.00001), 94.2 ± 5.9 (P < 0.00001), and -0.2 ± 0.8 mm (P < 0.00001), respectively. The mean FTA decreased to 168.0 ± 3.3 (P < 0.00001), and the mean posterior tibial slope angle decreased to 5.0 ± 3.6° from 6.9 ± 2.6° preoperatively (P = 0.024). Arthroscopic evaluation during the HTO plate-removal procedure of 17 knees were performed at a mean of 16 months after the surgery. The reconstructed ACL graft in 13 knees were successful, a cyclops lesion in one knee, and looseness of the graft in three knees. CONCLUSIONS Dome-shaped HTO allows for a relatively high degree of varus correction and decreases the steep posterior tibial slope that causes excessive load on the ACL. Therefore, its use in combination with ACL reconstruction seems to be effective.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Faculty of Collaborating Regional Innovation, Ehime University, 3 Bunkyo-Cho, Matsuyama, Ehime, 790-8577, Japan.
| | - Seiji Watanabe
- Department of Orthopaedic Surgery, Watanabe Hospital, Matsuyama, Ehime, 791-0054, Japan
| | - Masanori Hino
- Department of Orthopaedic Surgery, Saijo Central Hospital, Saijo, Ehime, 793-0027, Japan
| | - Haruhiko Takeda
- Department of Orthopaedic Surgery, Saijo Central Hospital, Saijo, Ehime, 793-0027, Japan
| | - Toshio Ito
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Saijo, Ehime, 793-0030, Japan
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Grassi A, Cialdella S, Costa G, Pizza N, Macchiarola L, Dal Fabbro G, Lo Presti M, Zaffagnini S. Good stability and mid-term subjective outcomes after repeated anterior cruciate ligament (ACL) revision surgery using allografts. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07399-8. [PMID: 37014417 DOI: 10.1007/s00167-023-07399-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE To evaluate the mid-term clinical outcomes of a cohort of patients who underwent multiple ACL revision reconstructions. The hypothesis was that patients with pre-existing meniscal deficiency conditions, malalignment and cartilage degeneration would have obtained lower results. METHODS All cases of multiple ACL revisions performed with allograft tissue at one single sport-medicine institution were extracted and patients with a minimum 2 years of follow-up were included. WOMAC, Lhysolm, IKDC, and Tegner activity level before the injury and at last follow-up was collected and laxity evaluated with KT-1000 arthrometer and KiRA triaxial accelerometer. RESULTS From a cohort of 241 ACL revisions, 28 patients (12%) with Repeated ACL Revision reconstructions were included. Fourteen cases (50%) were considered "Complex" due to the addition of meniscal allograft transplantation (8) or meniscal scaffold (3) or high tibial osteotomy (3). The remaining 14 cases (50%) were considered as "Isolate". The mean WOMAC score was 84.6 ± 11.4, Lysholm 81.7 ± 12.3, subjective IKDC 77.2 ± 12.1, and median Tegner score 6 (IQR 5-6) at pre-injury and at final follow-up. Statistically significant inferior values of WOMAC (p = 0.008), Lysholm (p = 0.02) and Subjective IKDC (p = 0.0193) were detected between "Complex" and "Isolate" revision groups. Higher average values of anterior translation at KT-1000 at both 125 N (p = 0.03) and manual maximum displacement test (p = 0.03) were reported in "Complex" with respect to "Isolate" revisions. Four patients were considered as failures and occurred in patients with "Complex" revisions, none occurred in the "Isolate" (30% vs 0%; p = 0.04). CONCLUSION Good mid-term clinical results can be obtained after repeated ACL revision with allograft in patients who experienced multiple failures; however, those who need additional procedure due to malalignment or post-meniscectomy syndrome reported lower objective and subjective results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Sergio Cialdella
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Gianluca Costa
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Nicola Pizza
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy.
| | - Luca Macchiarola
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Mirco Lo Presti
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
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Zaffagnini S, Lucidi GA, Macchiarola L, Agostinone P, Neri MP, Marcacci M, Grassi A. The 25-year experience of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: the story so far. J Exp Orthop 2023; 10:36. [PMID: 37005946 PMCID: PMC10067780 DOI: 10.1186/s40634-023-00599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
This article presents with an evidence based approach, the kinematical rationale, biological evidence and the long term results of the "Over-The-Top" anterior cruciate ligament reconstruction with lateral plasty technique. This surgery was developed more than 25 years ago at the Rizzoli Institute by professor Marcacci and Zaffagnini and it is still widely performed in many orthopedic center worldwide.
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Affiliation(s)
- Stefano Zaffagnini
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy
| | - Luca Macchiarola
- Ortopedia E Traumatologia, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Piero Agostinone
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy.
| | - Maria Pia Neri
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy
| | - Maurilio Marcacci
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Clinical and Research Center, Milan, Italy
| | - Alberto Grassi
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, Italy
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Goodell PB, Johansen PM, Bartels DW, Sherman SL, Amanatullah DF. Comparing Unicompartmental Knee Arthroplasty and High Tibial Osteotomy for Isolated Medial Compartment Knee Osteoarthritis. JBJS Rev 2023; 11:01874474-202303000-00004. [PMID: 36930742 DOI: 10.2106/jbjs.rvw.22.00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
» Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) allow for compartment-specific intervention on an arthritic knee joint that preserves bone stock and native soft tissue compared to a total knee arthroplasty (TKA). Both operations give a more natural feeling with native proprioception compared with a TKA. » HTO is better suited in patients who are younger (<55 years-of-age), have a body mass index (BMI) <30 kg/m2, high activity requirements, mechanical malalignment, asymmetric varus, isolated anterior cruciate ligament insufficiency, need for multiplanar correction, and a preference for joint preserving interventions. Recent data suggest that age (>55 years-of-age) should not solely contraindicate a HTO. » UKA may be chosen in patients who are older (>55 years-of-age), low activity requirements, have a BMI <40 kg/m2, severe osteoarthritis with significant joint space narrowing, acceptable coronal alignment, symmetric varus, and patient preference for arthroplasty.
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Affiliation(s)
- Parker B Goodell
- Department of Orthopaedic Surgery, University of California San Francisco, Fresno, California
| | - Phillip M Johansen
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Douglas W Bartels
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
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Toofan H, Tabatabaei Irani P, Ghadimi E, Ayati Firoozabadi M, Mortazavi SMJ. Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction Using Double Suspensory Technique and Medial Open-Wedge, High Tibial Osteotomy. Arthrosc Tech 2022; 11:e2357-e2364. [PMID: 36632396 PMCID: PMC9827118 DOI: 10.1016/j.eats.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) is generally performed regardless of knee malalignments. However, there are some indications for either staged or simultaneous ACL reconstruction and realignment procedures, such as high tibial osteotomy (HTO). Simultaneous HTO-ACL reconstruction has the apparent benefit of a single surgical procedure with a faster recovery than a staged procedure, and it produces good clinical outcomes. Several techniques have been described for simultaneous ACLR and medial open wedge HTO. The tibial tunnel preparation and graft fixation are the most challenging part of the procedure. Recent studies on comparison of fixation of tibial tunnel graft using suspensory fixation versus bioabsorbable screws have shown superior results of more bone preservation and less graft rupture. We assumed suspensory fixation on the tibial side with bone preservation might be more reliable in patients who received ACLR and open wedge HTO at the same time. Therefore, we described our technique of simultaneous open-wedge HTO and ACLR using double suspensory graft fixation.
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Affiliation(s)
- Hesam Toofan
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya Tabatabaei Irani
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ghadimi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran,Address correspondence to Javad Mortazavi, M.D., Joint Reconstruction Research Center, Tehran University of Medical Sciences, 1419733141, Tehran, Iran.
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Aman ZS, DePhillipo NN, Peebles LA, Familiari F, LaPrade RF, Dekker TJ. Improved Accuracy of Coronal Alignment Can Be Attained Using 3D-Printed Patient-Specific Instrumentation for Knee Osteotomies: A Systematic Review of Level III and IV Studies. Arthroscopy 2022; 38:2741-2758. [PMID: 35247513 DOI: 10.1016/j.arthro.2022.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the accuracy and precision of postoperative coronal plane alignment using 3D-printed patient-specific instrumentation (PSI) in the setting of proximal tibial or distal femoral osteotomies. METHODS A systematic review evaluating the accuracy of 3D-printed PSI for coronal plane alignment correcting knee osteotomies was performed. The primary outcomes were accuracy of coronal plane limb alignment correction and number of correction outliers. Secondary variables were duration of surgery, number of intraoperative fluoroscopic images, complications, cost, and clinical outcomes (as applicable). RESULTS Ninety-three studies were identified, and 14 were included in the final analysis. Overall, mean postoperative deviation from target correction ranged from 0.3° to 1° for all studies using hip-knee angle measurements and 2.3% to 4.9% for all studies using weight-bearing line measurements. The incidence of correction outliers was assessed in 8 total studies and ranged from 0 to 25% (total n = 10 knees) of patients corrected with 3D-printed PSI. Osteotomies performed with 3D-printed cutting guides or wedges demonstrated significantly shorter operative times (P < .05) and fewer intraoperative fluoroscopic images (P < .05) than control groups in four case control studies. CONCLUSION Patients undergoing distal femoral osteotomy or proximal tibial osteotomy procedures with 3D-printed patient-specific cutting guides and wedges had highly accurate coronal plane alignment with a low rate of outliers. Patients treated with 3D printed PSI also demonstrated significantly shorter operative times and decreased intraoperative fluoroscopy when compared to conventional techniques. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Zachary S Aman
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | | | - Liam A Peebles
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Filippo Familiari
- Department of Orthopaedics and Trauma Surgery, Magna Graecia University, Catanzaro, Italy
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Vermue H, Winnock de Grave P, Ryckaert A, Luyckx T. Equal bony resection of distal and posterior femur will lead to flexion/extension gap inequality in robot-assisted cruciate-retaining TKA. Knee Surg Sports Traumatol Arthrosc 2022; 30:2617-2623. [PMID: 34287654 DOI: 10.1007/s00167-021-06672-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/14/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Joint imbalance has become one of the main reasons for early revision after total knee arthroplasty (TKA) and it is directly related to the surgical technique. Therefore, a better understanding of how much bone has to be removed to obtain a balanced flexion/extension gap could improve current practice. The primary objective of this study was to analyse the amount of bone that needed to be removed from the distal and posterior femoral joint surfaces to obtain an equal flexion/extension gap in robot-assisted TKA. The second objective of this study was to evaluate whether the size of the knee joint influenced the amount of bony resection needed to achieve an equal flexion/extension gap in robot-assisted TKA. METHODS A retrospective analysis was performed on all patients receiving a robot-assisted TKA (Cruciate Retaining (n = 268)) by six surgeons from April 2018 to September 2019. The robot was used consecutively when available in all patients receiving Cruciate Retaining TKA. Gap assessment, bony resections, femoral implant size and hip-knee-ankle angle were evaluated with the robot. Femoral implant size was categorized into small (size 1-2), medium (size 3-5) and large (size 6-8). RESULTS The difference between the posterior and distal resection needed to obtain equal flexion and extension gap was on average 2.0 mm (SD 1.6) and 1.5 mm (SD 2.2) for the medial and lateral compartment, respectively. The discrepancy was smaller in the large implant group compared to the small implant group (p < .05 medial and lateral) and medium implant group (p < .05 medial). Varus knees required a larger differential resection compared to neutral and valgus knees (only laterally) (medial compartment: p < .05 (varus-neutral), p = .051 (varus-valgus); lateral compartment: p < .05 (varus-neutral and varus-valgus). CONCLUSION Removing an equal amount of bone from the distal and posterior femur will lead to flexion/extension gap imbalance in TKA. It was required to remove 1.5-2 mm more bone from the posterior femur compared to the distal femur to equalize flexion and extension gap. This effect was size dependent: in larger knees, the discrepancy between the distal and posterior resections was smaller. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hannes Vermue
- Department of Orthopedic Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | | | | | - Thomas Luyckx
- Department of Orthopedic Surgery, AZ Delta, 8800, Roeselare, Belgium
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12
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Is there any benefit in the combined ligament reconstruction with osteotomy compared to ligament reconstruction or osteotomy alone?: Comparative outcome analysis according to the degree of medial compartment osteoarthritis with anterior or posterior cruciate ligament insufficiency. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04544-9. [PMID: 35857119 DOI: 10.1007/s00402-022-04544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/05/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the outcomes of middle-aged patients with anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) insufficiency by assessing different groups: high tibial osteotomy (HTO), HTO with combined ligament reconstruction, and isolated ligament reconstruction according to the alignment change and medial compartment osteoarthritis (OA). MATERIALS AND METHODS From 2014 to 2019, middle-aged (40-65 years) patients with knee instability were enrolled in this retrospective study. They were categorized into three groups: group I, HTO; group II, HTO with combined ACL or PCL reconstruction; and group III, isolated ligament reconstruction. Radiological outcomes, including Kellgren-Lawrence grade, mechanical femorotibial angle (mFTA), weight-bearing line (WBL) ratio, and posterior tibial slope were compared. Knee stability and clinical outcomes were also compared. RESULTS Seventy-nine patients completed the final assessment. Group I was older than other two groups (p = 0.006). Groups I and II had a higher body mass index (p = 0.043) and more preoperative varus alignment than group III (p < 0.001). OA severity was ranked in the order of group I, II, and III (p < 0.001). Group I showed more valgus alignment than group II after HTO (p = 0.024 for mFTA and 0.044 for WBL ratio, respectively). Compared to their preoperative status, all three groups showed significant improvement in knee stability (p < 0.001); however, group I showed inferior knee stability regardless of ACL or PCL reconstruction (p < 0.001 and 0.043, respectively). All clinical scores significantly improved in the three groups (p < 0.001), and they showed comparable clinical outcomes in the final assessment. CONCLUSIONS Our strategy in managing middle-aged patients with knee instability according to the varus alignment and medial degeneration showed favorable stability and clinical outcomes. Middle-aged patients with knee instability should be managed with different strategies depending on their status. LEVEL OF EVIDENCE Case-control study; Level-III.
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13
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Nazzal EM, Zsidai B, Pujol O, Kaarre J, Curley AJ, Musahl V. Considerations of the Posterior Tibial Slope in Anterior Cruciate Ligament Reconstruction: a Scoping Review. Curr Rev Musculoskelet Med 2022; 15:291-299. [PMID: 35653051 DOI: 10.1007/s12178-022-09767-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW The significance of posterior tibial slope (PTS) in the setting of anterior cruciate ligament (ACL) injury and reconstruction has been increasingly recognized in recent years. The purpose of this article is to review the biomechanical and clinical studies of PTS in conjunction with ACL injuries, providing an evidence-based approach for the evaluation and management of this patient population. RECENT FINDINGS Several biomechanical and clinical studies suggest that PTS > 12° may be considered with increased strain on the native ACL fibers (or reconstructed graft) and greater anterior tibial translation, predisposing patients to a recurrent ACL injury. The increased rates of ACL injury and graft failure seen in those with increased PTS have garnered attention to diagnose and surgically address increased PTS in the revision ACL setting; however, the role of a slope-reducing high tibial osteotomy (HTO) in primary ACL reconstruction (ACL-R) has yet to be defined. Various HTO techniques to decrease PTS during revision ACL-R have demonstrated promising outcomes, though conclusions are limited by the multifactorial nature of revision surgery and concomitant procedures performed. Recent evidence suggests that increased PTS is a risk factor for failure following ACL-R, which may be mitigated by a slope-reducing HTO. Further investigation is needed to elucidate abnormal PTS values and to determine appropriate indications for a slope-reducing HTO in primary ACL-R.
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Affiliation(s)
- Ehab M Nazzal
- UPMC Freddie Fu Sports Medicine Center, 3200 S Water St., Pittsburgh, PA, 15203, USA.
| | - Bálint Zsidai
- UPMC Freddie Fu Sports Medicine Center, 3200 S Water St., Pittsburgh, PA, 15203, USA.,Department of Orthopaedics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oriol Pujol
- UPMC Freddie Fu Sports Medicine Center, 3200 S Water St., Pittsburgh, PA, 15203, USA.,Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Janina Kaarre
- UPMC Freddie Fu Sports Medicine Center, 3200 S Water St., Pittsburgh, PA, 15203, USA.,Department of Orthopaedics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Curley
- UPMC Freddie Fu Sports Medicine Center, 3200 S Water St., Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, 3200 S Water St., Pittsburgh, PA, 15203, USA
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14
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Sabnis BM. A review of role of osteotomy in knee ligament injuries. J Clin Orthop Trauma 2022; 29:101891. [PMID: 35601508 PMCID: PMC9115312 DOI: 10.1016/j.jcot.2022.101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Realignment osteotomies around the knee joint are used primarily for management of arthritis. Traditionally, an unstable knee has been considered a contraindication for osteotomy. But with a better understanding of biomechanics of osteotomies and their effect on ligament instabilities, the beneficial role of osteotomies in managing an unstable knee is becoming clearer. This review looks at recent literature on this subject to help in formulating a management plan especially in failed ligament reconstruction patients.
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15
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Kim JH, Ryu DJ, Lee SS, Jang SP, Park JS, Kim WJ, Kim IS, Wang JH. Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability? [Formula: see text]. Am J Sports Med 2022; 50:142-151. [PMID: 34850639 DOI: 10.1177/03635465211059162] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon's preference. However, it is still unclear whether transection of sMCL increases valgus laxity. PURPOSE We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. RESULTS All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment (P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, -3.5°± 2.0°; 6 months, -3.2°± 2.3°; 1 year, -3.1°± 2.3°; 2 years, -2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, -0.1°± 2.1°; 3 months, -0.2°± 2.4°; 6 months, -0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). CONCLUSION Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.
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Affiliation(s)
- Joo-Hwan Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Ryu
- Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea. Department of Orthopedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Republic of Korea
| | - Seung Pil Jang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Sung Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Jae Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Il-Su Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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16
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Femur originated genu varum in a patient with symptomatic ACL deficiency: a case report and review of literature. BMC Musculoskelet Disord 2021; 22:437. [PMID: 33985470 PMCID: PMC8120728 DOI: 10.1186/s12891-021-04274-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) injury may be associated with genu varum. There are a few indications in which the varus deformity can be corrected at the time of ACL reconstruction. However, as the genu varum originates mostly from the tibia and the simultaneous presence of ACL deficiency and femur originated genu varum is uncommon, only a few papers have described their management for ACL deficient patients with femur originated genu varum. Case presentation A young patient visited our clinic with a complaint of right knee pain and giving way. Further work up revealed a full mid substance ACL tear, mild medial knee osteoarthritis and femur originated genu varum of his right knee. He was managed with simultaneous ACL reconstruction and distal femoral valgus osteotomy. Conclusions Any corrective osteotomy for genu varum should be performed at center of rotation angle. Isolated ACL reconstruction in patients with simultaneous ACL deficiency and genu varum may hasten the knee degeneration. Level of evidence IV
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17
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Vajapey SP, Alvarez PM, Greco NJ, Chonko DJ. Medial Osteoarthritis in an ACL-Deficient Knee: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202103000-00005. [PMID: 33735156 DOI: 10.2106/jbjs.rvw.20.00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» In anterior cruciate ligament (ACL)-deficient knees, treatment of medial compartment osteoarthritis (OA) that is refractory to nonoperative modalities is a controversial subject. » Currently available treatment options include unicompartmental knee arthroplasty (UKA) with or without ACL reconstruction (ACLR), high tibial osteotomy (HTO) with or without ACLR, and total knee arthroplasty (TKA). » Each treatment option has its own risks and benefits, and the evidence that is reviewed in this article suggests that patient characteristics guide treatment selection. » Future high-quality prospective studies that directly compare all 3 of the modalities are necessary to determine the best treatment option for different patient populations.
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Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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18
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Grimm NL, Levy BJ, Jimenez AE, Arciero RA. Osteotomies for the Management of Medial Compartment Defects of the Knee. J Knee Surg 2020; 33:1164-1171. [PMID: 32583399 DOI: 10.1055/s-0040-1712985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For nearly three-quarters of a century the proximal tibia osteotomy has been used as an effective treatment for cartilage injuries of the knee. Over this same timeframe several advancements have been made in our diagnostic, preoperative planning, and technical execution of this procedure. As such, good-to-excellent short-, mid-, and long-term outcomes have been reported. Since its inception, the most important step in deciding on this procedure is identifying the ideal candidate. This candidate should be a young patient (<55 years old), active, with isolated medial compartment arthrosis without significant comorbidities. With appropriate patient selection and careful preoperative planning, the patient should achieve excellent results and high satisfaction.
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Affiliation(s)
- Nathan L Grimm
- Pediatric & Adult Sports Medicine Surgeon, Idaho Sports Medicine Institute, Boise, Idaho.,Division of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Benjamin J Levy
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Andrew E Jimenez
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Robert A Arciero
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
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19
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Lateral meniscal slope negatively affects post-operative anterior tibial translation at 1 year after primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:3524-3531. [PMID: 32347343 DOI: 10.1007/s00167-020-06021-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/21/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this study was to assess the correlation between posterior tibial slope and meniscal slope over postoperative anterior tibial translation during the first 18 months after primary anterior cruciate ligament (ACL) reconstruction. The main hypothesis was that PTS and MS would be positively correlated with post-operative ATT-SSD after ACL reconstruction. METHODS Patients (28 males and 15 females) with confirmed ACL tears were selected from an in-house registry and included if they were over 16 years old, had primary ACL-reconstruction and healthy contralateral knee. Patients meeting one of the following criteria were excluded: previous knee surgeries, intraarticular fractures, associated ligamentous lesions, previous or concomitant meniscectomy or extraarticular procedures. Lateral posterior tibial slope, medial posterior tibial slope, lateral meniscal slope and medial meniscal slope were measured using preoperative MRIs. The side-to-side-difference in anterior tibial translation was evaluated 9-18 months postoperatively. RESULTS Forty-three patients were included, (28 males/15 females; mean age 25 ± 8 years). Mean postoperative anterior tibial translation was 1.0 ± 1.1 mm at a mean time of 12 ± 1 months. Mean slope values were: lateral posterior tibial slope 4.7° ± 2.2°, medial posterior tibial slope 4.0° ± 2.8°, lateral meniscal slope 3.0° ± 2.2° and medial meniscal slope 2.0° ± 2.8°. The anterior tibial translation was significantly correlated with lateral meniscal slope (r = 0.63; p < 0.01). For each 1° increase in lateral meniscal slope, a 0.3 mm 95% CI [0.2, 0.4] (p < 0.01) increase in anterior tibial translation was observed. A lateral meniscal slope greater or equal to 4.0° was estimated as optimal threshold for increased risk of abnormal side-to-side difference in postoperative anterior tibial translation (≥ 1.2 mm). CONCLUSION The lateral meniscal slope was positively correlated to side-to-side difference in anterior tibial translation after primary ACL reconstruction. A lateral meniscal slope greater or equal to 4.0° was detected as threshold for an increased risk of abnormal side-to-side difference in postoperative anterior tibial translation in patients who underwent primary ACL reconstruction. This confirms that soft tissue slopes have an impact on the outcomes after reconstructive surgery. Level of evidence III.
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20
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Hoch A, Jud L, Roth T, Vlachopoulos L, Fürnstahl P, Fucentese SF. A real 3D measurement technique for the tibial slope: differentiation between different articular surfaces and comparison to radiographic slope measurement. BMC Musculoskelet Disord 2020; 21:635. [PMID: 32979919 PMCID: PMC7520019 DOI: 10.1186/s12891-020-03657-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/18/2020] [Indexed: 01/29/2023] Open
Abstract
Background The tibial slope plays an important role in knee surgery. However, standard radiographic measurement techniques have a low reproducibility and do not allow differentiation between medial and lateral articular surfaces. Despite availability of three-dimensional imaging, so far, no real 3D measurement technique was introduced and compared to radiographic measurement, which were the purposes of this study. Methods Computed tomography scans of 54 knees in 51 patients (41 males and 10 females) with a mean age of 46 years (range 22–67 years) were included. A novel 3D measurement technique was applied by two readers to measure the tibial slope of medial and lateral tibial plateau and rim. A statistical analysis was conducted to determine the intraclass correlation coefficient (ICC) for the new technique and compare it to a standard radiographic measurement. Results The mean 3D tibial slope for the medial plateau and rim was 7.4° and 7.6°, for the lateral plateau and rim 7.5° and 8.1°, respectively. The mean radiographic slope was 6.0°. Statistical analysis showed an ICC between both readers of 0.909, 0.987, 0.918, 0.893, for the 3D measurement of medial plateau, medial rim, lateral plateau and lateral rim, respectively, whereas the radiographic technique showed an ICC of 0.733. Conclusions The proposed novel measurement technique shows a high intraclass agreement and offers an applicable opportunity to assess the tibial slope three-dimensionally. Furthermore, the medial and lateral articular surfaces can be measured separately and one can differentiate the slope from the plateau and from the rim. As three-dimensional planning becomes successively more important, our measurement technique might deliver a useful supplement to the standard radiographic assessment in slope related knee surgery. Level of evidence Level III, diagnostic study.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tabitha Roth
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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21
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Lin LJ, Akpinar B, Meislin RJ. Tibial Slope and Anterior Cruciate Ligament Reconstruction Outcomes. JBJS Rev 2020; 8:e0184. [DOI: 10.2106/jbjs.rvw.19.00184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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22
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Excellent long-term results in combined high tibial osteotomy, anterior cruciate ligament reconstruction and chondral resurfacing in patients with severe osteoarthritis and varus alignment. Knee Surg Sports Traumatol Arthrosc 2020; 28:1085-1091. [PMID: 31428822 DOI: 10.1007/s00167-019-05671-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/08/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine survivorship and functional results of medial open-wedge high tibial osteotomy (HTO) combined with anterior cruciate ligament reconstruction (ACLR) and a chondral resurfacing (CR) procedure (abrasion/microfracture) in patients with Kellgren-Lawrence grade 3 and 4 osteoarthritis with full thickness-cartilage defects, ACL-insufficiency and varus alignment. METHODS A cohort of 23 patients undergoing a combined procedure of HTO (fixation with angular stable internal fixator, Tomofix®), ACLR and CR for the treatment of severe symptomatic medial osteoarthritis, ACL insufficiency and varus alignment (> 4°) between 2005 and 2009 was prospectively surveyed with a minimum follow-up of 10 years with regard to survival (not requiring arthroplasty), functional outcome (subjective IKDC score), pain level (numeric rating scale), Oxford Knee Score (OKS) and subjective satisfaction. The Wilcoxon signed-rank-test was used for statistical evaluation of non-parametric data in these related samples. RESULTS Twenty-one cases were included, one case with incomplete follow-up data and another case excluded. The follow-up rate was 91% at 12.0 ± 1.0 years (10.0-13.4). Mean age at time of surgery was 47.3 ± 5.9 years (37.8-57.7). At final follow-up, no arthroplasty was performed in any of the cases (survival: 100%). Subjective IKDC score improved from 47 ± 11 to 75 ± 15 at 1, 72 ± 15 at 3, 73 ± 17 at 6 years and 70 ± 16 at final follow-up (p < 0.001), respectively. At final follow-up the OKS was 40 ± 7 (17-48) and pain-level significantly decreased from 7.5 ± 1.0 preoperatively to 2.9 ± 2.3 (p < 0.001) at final follow-up. All patients were satisfied with the result and stated that they would retrospectively undergo the procedure again. CONCLUSION A combined approach of HTO, ACLR and a CR shows excellent results in a long-term follow-up in selected young patients even in severe osteoarthritis. However, the role and potential benefit of the ACLR and CR compared to HTO alone remains unclear. LEVEL OF EVIDENCE Therapeutic case series, Level IV.
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23
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Schneider A, Gaillard R, Gunst S, Batailler C, Neyret P, Lustig S, Servien E. Combined ACL reconstruction and opening wedge high tibial osteotomy at 10-year follow-up: excellent laxity control but uncertain return to high level sport. Knee Surg Sports Traumatol Arthrosc 2020; 28:960-968. [PMID: 31312875 DOI: 10.1007/s00167-019-05592-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to report the long-term outcomes of a continuous series of patients who underwent simultaneous anterior cruciate ligament (ACL) reconstruction and opening wedge high tibial osteotomy (HTO) for varus-related early medial tibio-femoral osteoarthritis. It was hypothesized that this combined surgery sustainably allowed return to sport with efficient clinical and radiological results. METHODS From 1995 to 2015, all combined ACL reconstruction (bone-patellar tendon-bone graft) and opening wedge HTO for anterior laxity and early medial arthritis were included. Clinical evaluation at final follow-up used Tegner activity score, Lysholm score, subjective and objective IKDC scores. Radiologic evaluation consisted in full-length, standing, hip-to-ankle X-rays, monopodal weight-bearing X-rays and skyline views. AP laxity assessment used Telos™ at 150 N load. Student's t test was performed for matched parametric data, Wilcoxon for nonparametric variables and Friedman test was used to compare small cohorts, with p < 0.05. RESULTS 35 Patients (36 knees) were reviewed with a mean follow-up of 10 ± 5.2 years. The mean age at surgery was 39 ± 9. At final follow-up 28 patients (80%) returned to sport (IKDC ≥ B): 11 patients (31%) returned to sport at the same level and 6 (17%) to competitive sports. Mean subjective IKDC and Lysholm scores were 71.8 ± 14.9 and 82 ± 14.1, respectively. The mean decrease of the Tegner activity level from preinjury state to follow-up was 0.8 (p < 0.01). Mean side-to-side difference in anterior tibial translation was 5.1 ± 3.8 mm. Three patients were considered as failures. The mean preoperative mechanical axis was 4.2° ± 2.6° varus and 0.8° ± 2.7° valgus at follow-up. Osteoarthritis progression for medial, lateral, and femoro-patellar compartments was recorded for 12 (33%, p < 0.05), 6 (17%, p < 0.001), and 8 (22%, p < 0.05) knees, respectively. No femoro-tibial osteoarthritis progression was observed in 22 knees (61%). CONCLUSIONS Combined ACL reconstruction and opening wedge HTO allowed sustainable stabilization of the knee at 10-year follow-up. However, return to sport at the same level was possible just for one-third of patients, with femoro-tibial osteoarthritis progression in 39% of cases. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A Schneider
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, University Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - R Gaillard
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, University Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
| | - S Gunst
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, University Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - C Batailler
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, University Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - P Neyret
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, University Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - S Lustig
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, University Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.,Univ Lyon, IFSTTAR, LBMC, UMR_T9406, Université Claude Bernard Lyon 1, 69622, Lyon, France
| | - E Servien
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, University Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.,Univ Lyon, LIBM, Université Claude Bernard Lyon 1, Lyon, France
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Grassi A, Zicaro JP, Costa-Paz M, Samuelsson K, Wilson A, Zaffagnini S, Condello V. Good mid-term outcomes and low rates of residual rotatory laxity, complications and failures after revision anterior cruciate ligament reconstruction (ACL) and lateral extra-articular tenodesis (LET). Knee Surg Sports Traumatol Arthrosc 2020; 28:418-431. [PMID: 31324964 DOI: 10.1007/s00167-019-05625-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/10/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Residual rotational instability remains a controversial factor when analysing failure rates of anterior cruciate ligament (ACL) reconstruction. Anatomical and biomechanical studies have demonstrated a very important role of anterolateral structures for rotational control. Revision ACL is considered one of the main indications for a lateral extra-articular tenodesis (LET). Yet, few series evaluating these procedures are published. PURPOSE To perform a systematic review of studies that assessed outcomes in patients treated with revision ACL surgery associated with a lateral extra-articular procedure. STUDY DESIGN Systematic review. METHODS A comprehensive literature search was performed in February 2018 using PubMed, Scopus, Web of Search and Cochrane. Inclusion criteria were series of ACL revision reconstructions associated with lateral extra-articular procedures. Clinical outcomes (Lysholm, subjective IKDC, KOOS, Cincinnati and WOMAC), joint stability measures (Lachman test, pivot-shift, arthrometer assessment and navigation assessment), graft type, reported chondral and meniscal injury, radiographic outcomes, complications and failures were recorded. Articles were assessed for level of evidence and methodology using a modification of the ACL Methodology Score (AMS) system. RESULTS Twelve studies met the inclusion criteria out of the 231 abstracts; 9 retrospective evaluations, two prospective cohorts and one combination of two populations (a retrospective and prospective series). A total of 851 patients evaluated with a mean age of 28.8 years (range 16-68 years) and a weighted mean follow-up of 4.9 years (range 1-10 years). The mean time from primary ACL reconstruction to revision was 5.3 years (reported in 7 studies, including 710 patients). The Lysholm, IKDC, and KOOS scores indicated favorable results in studies that reported these outcomes. Objective evaluations reported 86% objective A and B IKDC results, 2.6 mm mean side-to-side arthrometric difference and 80% negative pivot-shift. About 74% of patients returned to their previous sport (evaluated in six studies). Few studies reported radiological evaluation. Fifty-nine complications (8.0%) and 24 failures (3.6%) were reported. The mean modified ACL Methodology Score was 55.5 (range 32-72). CONCLUSION Good mid-term results were obtained for combined revision ACL reconstruction and lateral extra-articular procedures. Despite the fact that in clinical practice LET are a common indication associated with revision ACL, there are no high-level studies supporting this technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1/10, 40136, Bologna, Italy.
| | - Juan Pablo Zicaro
- Department of Knee Arthroscopy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Matias Costa-Paz
- Department of Knee Arthroscopy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adrian Wilson
- Department of Orthopaedic Surgery, Basingstoke and North Hampshire Hospitals, NHS Foundation Trust, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1/10, 40136, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
| | - Vincenzo Condello
- Joint Preservation and Reconstructive Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Italy
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Sherman SL, Raines BT, Burch MB, Ray T, Shubin Stein BE. Patellofemoral Imaging and Analysis. OPER TECHN SPORT MED 2019. [DOI: 10.1016/j.otsm.2019.150684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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26
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Marcheggiani Muccioli GM, Fratini S, Cammisa E, Vaccari V, Grassi A, Bragonzoni L, Zaffagnini S. Lateral Closing Wedge High Tibial Osteotomy for Medial Compartment Arthrosis or Overload. Clin Sports Med 2019; 38:375-386. [DOI: 10.1016/j.csm.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Gupta A, Tejpal T, Shanmugaraj A, Horner NS, Simunovic N, Duong A, Ayeni OR. Surgical Techniques, Outcomes, Indications, and Complications of Simultaneous High Tibial Osteotomy and Anterior Cruciate Ligament Revision Surgery: A Systematic Review. HSS J 2019; 15:176-184. [PMID: 31327950 PMCID: PMC6609638 DOI: 10.1007/s11420-018-9630-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of primary anterior cruciate ligament reconstruction (ACLR) failure ranges from 10 to 20% in the USA. Many patient and surgical factors may lead to re-rupture after ACLR. Some authors have suggested that not correcting excessive posterior tibial slope may be a significant contributing factor to ACLR failure. PURPOSES We sought to systematically review the literature on outcomes, indications, and complications in patients undergoing simultaneous high tibial osteotomy (HTO) and ACLR revision. METHODS PubMed, Medline, and Embase were searched in February 2018 for articles addressing simultaneous HTO and ACLR revision in skeletally mature patients. Major orthopedic conferences were screened in duplicate to find gray literature. All studies were assessed using the Methodological Index for Non-Randomized Studies. Descriptive statistics are presented where applicable. RESULTS Seven studies satisfied inclusion. Seventy-seven patients underwent combined HTO and ACLR revision. The main indications were a posterior slope of more than 12° or severe varus malalignment. Graft types included hamstring tendon autograft (58.4%; n = 45) and quadriceps tendon graft (16.9%; n = 13). Mean delay between primary and revision surgery was 9 years. Rehabilitation protocol dictated return to running at 4 months and return to sport at 4 to 9 months. Visual analog scale pain scores reduced on average by 30 points. Subjective International Knee Documentation Committee, Tegner-Lysholm, and Tegner activity scores also improved. Fifty-eight percent (35/60) of patients showed osteoarthritis signs post-operatively. One patient (1.3%) received an arthroscopic arthrolysis of adhesions for stiffness. There were no reported incidences of graft re-rupture. CONCLUSION This systematic review found that the use of HTO for ACLR revision produces good post-operative functional outcomes, low complication rates, and no reported re-ruptures. The main indications for combined HTO with ACLR revision was a posterior slope of more than 12° or severe varus malalignment. Future studies with large sample sizes and long-term follow-up are required to corroborate these results.
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Affiliation(s)
- Arnav Gupta
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | - Tushar Tejpal
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | | | - Nolan S. Horner
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, Ontario L8N 3Z5 Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Andrew Duong
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, Ontario L8N 3Z5 Canada
| | - Olufemi R. Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, Ontario L8N 3Z5 Canada
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Cantivalli A, Rosso F, Bonasia DE, Rossi R. High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction/Revision. Clin Sports Med 2019; 38:417-433. [PMID: 31079772 DOI: 10.1016/j.csm.2019.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
High tibial osteotomy (HTO) may be performed in association with anterior cruciate ligament (ACL) reconstruction/revision in patients with medial osteoarthritis, varus malalignment, and anterior instability. Furthermore, it may be performed in patients with varus alignment and increased posterior tibial slope (exceeding 12°), because it is related to an increased risk for ACL failure. There are different techniques to perform HTO, and consequently, a concomitant HTO and ACL reconstruction/revision. This article describes the indication, surgical techniques, and outcomes of concomitant HTO and ACL reconstruction/revision.
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Affiliation(s)
| | - Federica Rosso
- Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, Turin 10128, Italy.
| | - Davide Edoardo Bonasia
- Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, Turin 10128, Italy
| | - Roberto Rossi
- University of Study of Turin, Via Po 8, Turin 10100, Italy; Department of Orthopedics and Traumatology, AO Ordine Mauriziano, Largo Turati 62, Turin 10128, Italy
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Meniscal allograft transplantation combined with anterior cruciate ligament reconstruction provides good mid-term clinical outcome. Knee Surg Sports Traumatol Arthrosc 2019; 27:1914-1923. [PMID: 30083970 DOI: 10.1007/s00167-018-5078-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE Aim of this study is to document if combined meniscal allograft transplantation (MAT) and ACL reconstruction can improve knee function, reduce pain and allow patients with meniscal defect and ACL lesion to resume sport activities. METHODS Fifty MAT, arthroscopically performed without bone plugs and combined with one-stage primary or revision ACL reconstruction, with or without high tibial osteotomy (HTO), were included. Patients (aged 38.2 ± 10.6 years, 87% males) were evaluated at a mean follow-up of 5 years with Lysholm, Tegner and VAS scores. Patient satisfaction was also recorded, together with complications and failures. RESULTS VAS and Lysholm scores improved significantly (from 63.7 to 24.5 and from 60.6 to 82.7, respectively, p < 0.001), while the Tegner score did not reach pre-injury values (p < 0.001), but it improved significantly compared to pre-surgery values (from 2.8 to 4.6, p < 0.001). Medial MAT reported significantly better results compared to lateral MAT. Patients undergoing concomitant HTO reported a significantly higher decrease of VAS. Younger patients with higher pre-operative pain and lower activity level presented higher satisfaction. Eight patients needed a reoperation. Three patients were considered surgical failures while four were considered clinical failures, for a total of 15% failures. CONCLUSIONS Meniscal allograft transplantation combined with ACL reconstruction represents a safe and suitable treatment, which should be considered as a suitable option in the clinical practice. All evaluated patient profiles, ACL injury in a patient with post-meniscectomy syndrome, failed ACL reconstruction in patients with a meniscus defect, and ACL reconstruction in patients with malalignment due to meniscal defect, benefited from the combined MAT procedure at medium-term follow-up. LEVEL OF EVIDENCE IV.
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30
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Stride D, Wang J, Horner NS, Alolabi B, Khanna V, Khan M. Indications and outcomes of simultaneous high tibial osteotomy and ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:1320-1331. [PMID: 30737516 DOI: 10.1007/s00167-019-05379-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/25/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to systematically review the existing literature reporting surgical outcomes of simultaneous high tibial osteotomy (HTO) and anterior cruciate ligament reconstruction (ACLR) in anterior cruciate ligament deficient (ACLD) knees. METHODS This study was conducted per the methods of the Cochrane Handbook for Systematic Reviews of Intervention, with findings reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies and pertinent data was extracted. Studies reporting post-operative outcomes following simultaneous HTO and ACLR in ACLD knees were included. RESULTS The search identified 515 studies, of which 18 (n = 516) were included. The mean MINORS scores for non-comparative and comparative studies were 11.6 ± 1.34 and 17.3 ± 1.9, respectively. Simultaneous HTO and ACLR resulted in improved functional subjective patient outcomes across a variety of scales. Simultaneous HTO and ACLR was effective in correcting varus angulation, with the post-operative mechanical angle ranging from 0.3° valgus to 7.7° valgus. The reported complication rate ranged from 0 to 23.5%. Across six studies, a total of 13 (6.5%) patients required revision HTO; while across four studies, 20 (17.5%) patients had failure of the ACL graft, with one receiving revision ACLR. CONCLUSIONS Combined HTO and ACLR may be indicated in patients with ACLD knees with varus angulation. This systematic review found that the combined surgery resulted in significant improvement in post-operative functional subjective outcomes. However, it remains unclear if HTO with ACLR is superior to ALCR or HTO alone due to the lack of comparative studies. Overall, HTO with ACLR was found to have low rates of complications, re-ruptures, and need for revision surgery. This review found that patients continued to have progression of OA despite combined HTO with ACLR. Future research is required to better understand the effects of combined HTO and ACLR compared to ACLR or HTO alone and to evaluate the long-term post-operative progression of medial compartment OA following combined HTO and ACLR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Devon Stride
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Julian Wang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Over-the-top ACL reconstruction yields comparable outcomes to traditional ACL reconstruction in primary and revision settings: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27:427-444. [PMID: 30078121 DOI: 10.1007/s00167-018-5084-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/27/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess clinical outcomes of over-the-top (OTT) ACL reconstruction (ACLR) in skeletally mature patients, where physeal sparing is not a consideration. The hypothesis is that OTT will produce successful yet inferior outcomes compared to anatomic ACL approaches in both primary and revision settings. METHODS Two reviewers searched two online databases (EMBASE and MEDLINE) from inception to October 2017 for literature on OTT ACLR in skeletally mature patients. The systematic screening process was completed in duplicate, independently, and based on predetermined criteria. An expert in the field was consulted to resolve disagreements for full-text screening. Quality assessment of included papers was performed independently and in duplicate. RESULTS From 3148 initial studies, 16 eligible studies (three RCTs and 13 case series) satisfied inclusion criteria. Three focused on the revision setting. The mean age of patients undergoing primary reconstruction was 26.9 ± 3.6, with 21.3% female patients and 31.4 ± 1.2 (26.1% female) in revision settings. Of primary studies reporting return to sport (n = 151), 69% of patients returned to pre-injury sports participation, with a total 94% returning to any sports activity. In revision settings (n = 48), 52.1% of patients returned to pre-injury sports participation, 25.2% returned to a lower level and 12.5% ceased sporting activity. Primary reconstruction studies reported a mean post-operative Tegner score of 6.5 ± 0.5 (n = 181) and mean KOOS of 82.8 ± 8.1 (n = 96). Primary studies reported a total 13 graft failures (3.7%), seven of which were re-ruptures (2.0%). The revision failure rate was 8.4% (four patients). CONCLUSION Clinically important outcomes for OTT ACLR are comparable to literature figures for traditional all-inside, transtibial and/or anteromedial portal drilling techniques. This holds true in revision settings. LEVEL OF EVIDENCE IV.
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Marriott K, Birmingham TB, Pinto R, Primeau C, Bryant D, Degen R, Giffin JR. Gait biomechanics after combined HTO-ACL reconstruction versus HTO alone: A matched cohort study. J Orthop Res 2019; 37:124-130. [PMID: 30303555 DOI: 10.1002/jor.24157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening-wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO-ACLR). Fifty-two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [-1.34 %BW × Ht (-1.71, -0.96) and -1.72 %BW × Ht (-1.99, -1.44) for HTO and HTO-ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [-0.88 %BW × Ht (-1.45, -0.31)] but not in the HTO-ACLR group [0.03 %BW × Ht (-0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening-wedge HTO and ACL reconstruction may not experience the same long-term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Kendal Marriott
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Ryan Pinto
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Codie Primeau
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Ryan Degen
- The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Abstract
Management of anterior cruciate ligament (ACL) injuries in adults aged >40 years has received increased attention in the literature because of an increase in the functional demands of aging athletes. Multiple structural and biomechanical age-dependent changes exist in the ACL, for example, fewer mesenchymal stem cells, decreased healing potential, decreased structural organization, decreased stiffness, and a decreased load to failure with age. As in younger patients, ACL insufficiency can predispose an older patient to the same risks of recurrent instability, meniscal and chondral injury, and osteoarthritis. The role of nonsurgical versus surgical management in these patients remains controversial. Lower-demand patients may be able to cope with ACL deficiency. Higher-demand patients may have functional instability, and the limited studies available suggest good functional outcomes with surgical reconstruction of the ACL in this population.
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Feucht MJ, Tischer T. [Osteotomies around the knee for ligament insufficiency]. DER ORTHOPADE 2018; 46:601-609. [PMID: 28600607 DOI: 10.1007/s00132-017-3439-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The osseous geometry of the lower limb has a significant impact on knee instability after ligament injuries, and osseous malalignment has been shown to be a significant risk factor for the failure of ligament reconstruction procedures. Therefore, osteotomies around the knee have gained importance as a combined or isolated treatment option in the ligament deficient and malaligned knee. In addition to unloading of an arthritic knee compartment, osteotomies are also performed to protect a reconstructed ligament and to stabilize the joint without ligament surgery. PROCEDURE In addition to the correction of varus or valgus malalignment, correction of sagittal imbalance by modifying the tibial slope is an emerging concept. Even small modifications of the tibial slope (≤5°) have been shown to change the anterior-posterior translation in a clinically significant manner. Especially in the case of chronic posterior or posterolateral instability, a valgus-producing and slope-increasing high tibial osteotomy is usually the first treatment option, and ligament surgery is only performed optionally. Isolated modification of the tibial slope is performed infrequently, however, a slope-decreasing osteotomy should be considered in patients with multiple failed ACL reconstructions and a tibial slope of >12°.
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Affiliation(s)
- M J Feucht
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
| | - T Tischer
- Sektion Sportorthopädie, Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland
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[The basics of knee osteotomy : Clinical examination, analysis of the deformity and correction planning]. DER ORTHOPADE 2018; 46:558-562. [PMID: 28597242 DOI: 10.1007/s00132-017-3437-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinical results of knee osteotomies are good. A precise preoperative analysis of the deformity in three dimensions and accurate planning of the correction osteotomy is essential. All pathologies of the knee and the surrounding joints must be considered. The opening wedge technique and locking plate systems have improved accuracy and reliability. An analysis of deformities and the planning of their correction is presented in this article. Access to the extent of the correction according to the level of degeneration has proven useful in clinical praxis. Digital storage of the planning is recommended for legal reasons.
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Schuster P, Geßlein M, Schlumberger M, Mayer P, Richter J. The influence of tibial slope on the graft in combined high tibial osteotomy and anterior cruciate ligament reconstruction. Knee 2018; 25:682-691. [PMID: 29731319 DOI: 10.1016/j.knee.2018.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/13/2018] [Accepted: 04/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Young patients with severe medial osteoarthritis, varus malalignment and insufficiency of the anterior cruciate ligament (ACL) are difficult to treat. The tibial slope has gained attention with regard to osteotomies and ligamentous instability. The purpose was to evaluate the outcome of combined high tibial osteotomy (HTO), ACL reconstruction and chondral resurfacing (CR, abrasion plus microfracture), and to analyse graft failure rates with regard to the tibial slope. METHODS Fifty cases (48.9 ± 5.4 years) of combined HTO, ACLR and CR were retrospectively analysed with regard to survival, functional outcome (subjective International Knee Documentation Committee (IKDC) examination form) and subjective satisfaction. The tibial slope was determined on lateral radiographs and analysed with regard to its influence on graft functionality at the time of hardware removal. RESULTS Follow-up rate was 100% after 5.6 ± 1.6 years. No arthroplasties were performed. Subjective IKDC score was 70 ± 18, and 94% were satisfied with the result. The graft was intact in 39 cases (78%), and non-functional in 11 cases (22%). No significant changes were present in pre- and postoperative tibial slope (P = 0.811). Graft insufficiency was strongly dependent on tibial slope, with a failure rate of seven percent in cases of postoperative tibial slope <7.5°, 24% in cases of 7.5-12.5°, and 36% in cases of >12.5°. CONCLUSION Combined HTO, ACLR and CR is an effective treatment in these cases. The graft failure rate increases with an increase in tibial slope, in particular when exceeding 12.5°. LEVEL OF EVIDENCE Case series, Level 4.
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Affiliation(s)
- Philipp Schuster
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Kurt-Lindemann-Weg, Markgröningen, Germany.
| | - Markus Geßlein
- Paracelsus Medical Private University, Clinic Nuremberg, Department of Orthopedics and Traumatology, Breslauer Str., Nürnberg, Germany
| | - Michael Schlumberger
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Kurt-Lindemann-Weg, Markgröningen, Germany
| | - Philipp Mayer
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Kurt-Lindemann-Weg, Markgröningen, Germany
| | - Jörg Richter
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Kurt-Lindemann-Weg, Markgröningen, Germany
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Jin C, Song EK, Jin QH, Lee NH, Seon JK. Outcomes of simultaneous high tibial osteotomy and anterior cruciate ligament reconstruction in anterior cruciate ligament deficient knee with osteoarthritis. BMC Musculoskelet Disord 2018; 19:228. [PMID: 30021642 PMCID: PMC6052617 DOI: 10.1186/s12891-018-2161-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/27/2018] [Indexed: 02/07/2023] Open
Abstract
Background We aimed to evaluate clinical and radiological results after simultaneous open-wedge high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction in patients with ACL deficiency combined with medial uni-compartmental osteoarthritis (OA) and varus deformity. Methods This retrospective study was performed using data collected from 2005 to 2011 on a total of 24 patients who were diagnosed with ACL injury and medial unicompartmental OA with varus deformity, and who subsequently underwent simultaneous open-wedge HTO and arthroscopic ACL reconstruction. The mean follow-up duration was 5.2 years. For clinical outcomes, we evaluated Lysholm score, Tegner activity score, range of motion, Lachmann test, and pivot-shift test, and for radiological outcomes, we evaluated the degree of varus deformity, progression of medial OA, tibial posterior slope, anterior instability, and postoperative complication. Results There were no limitations in range of motion found in any cases. Three patients showed progressive osteoarthritis on the medial compartment. The mechanical femorotibial angle was significantly corrected from varus 7.0 degrees to valgus 1.2 degrees, and the tibial posterior slope was not significantly changed. The Lysholm and Tegner activity scores were significantly improved after surgery (from 58 to 94 points on the Lysholm scale and from 4.0 to 5.3 points on the Tegner activity scale). Although the Lachman test and the pivot-shift test showed significant improvements after surgery, instability greater than Gr II was observed in three patients on the Lachman test and in four patients on the pivot-shift test. The side-to-side difference improved from 9.6 mm to 4.2 mm postoperatively as assessed using a Telos® arthrometer. There were no cases of nonunion or fixation loss. Conclusions Simultaneous open-wedge HTO and ACL reconstruction in patients with ACL injury with medial compartmental OA showed satisfactory functional outcomes and postoperative activity level scores. However, some patients showed residual instability and progression of OA. Electronic supplementary material The online version of this article (10.1186/s12891-018-2161-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cheng Jin
- Department of Orthopedic Surgery, Chinese People's Armed Police Force, Zhejiang Corps Hospital, Jiaxing, 314000, China
| | - Eun-Kyoo Song
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Quan-He Jin
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Nam-Hun Lee
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Jong-Keun Seon
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, South Korea.
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Southam BR, Colosimo AJ, Grawe B. Underappreciated Factors to Consider in Revision Anterior Cruciate Ligament Reconstruction: A Current Concepts Review. Orthop J Sports Med 2018; 6:2325967117751689. [PMID: 29399591 PMCID: PMC5788104 DOI: 10.1177/2325967117751689] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Primary anterior cruciate ligament (ACL) reconstructions (ACLRs) are being performed with increasing frequency. While many of these will have successful outcomes, failures will occur in a subset of patients who will require revision ACLRs. As such, the number of revision procedures will continue to rise as well. While many reviews have focused on factors that commonly contribute to failure of primary ACLR, including graft choice, patient factors, early return to sport, and technical errors, this review focused on several factors that have received less attention in the literature. These include posterior tibial slope, varus malalignment, injury to the anterolateral ligament, and meniscal injury or deficiency. This review also appraised several emerging techniques that may be useful in the context of revision ACL surgery. While outcomes of revision ACLR are generally inferior to those of primary procedures, identifying these potentially underappreciated contributing factors preoperatively will allow the surgeon to address them at the time of revision, ideally improving patient outcomes and preventing recurrent ACL failure.
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Affiliation(s)
- Brendan R Southam
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Angelo J Colosimo
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brian Grawe
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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Hoorntje A, Witjes S, Kuijer PPFM, Koenraadt KLM, van Geenen RCI, Daams JG, Getgood A, Kerkhoffs GMMJ. High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis. Sports Med 2017; 47:2219-2244. [PMID: 28401426 PMCID: PMC5633634 DOI: 10.1007/s40279-017-0726-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Knee osteotomies are proven treatment options, especially in younger patients with unicompartmental knee osteoarthritis, for certain cases of chronic knee instability, or as concomitant treatment for meniscal repair or transplantation surgery. Presumably, these patients wish to stay active. Data on whether these patients return to sport (RTS) activities and return to work (RTW) are scarce. OBJECTIVES Our aim was to systematically review (1) the extent to which patients can RTS and RTW after knee osteotomy and (2) the time to RTS and RTW. METHODS We systematically searched the MEDLINE and Embase databases. Two authors screened and extracted data, including patient demographics, surgical technique, pre- and postoperative sports and work activities, and confounding factors. Two authors assessed methodological quality. Data on pre- and postoperative participation in sports and work were pooled. RESULTS We included 26 studies, involving 1321 patients (69% male). Mean age varied between 27 and 62 years, and mean follow-up was 4.8 years. The overall risk of bias was low in seven studies, moderate in ten studies, and high in nine studies. RTS was reported in 18 studies and mean RTS was 85%. Reported RTS in studies with a low risk of bias was 82%. No studies reported time to RTS. RTW was reported in 14 studies; mean RTW was 85%. Reported RTW in studies with a low risk of bias was 80%. Time to RTW varied from 10 to 22 weeks. Lastly, only 15 studies adjusted for confounders. CONCLUSION Eight out of ten patients returned to sport and work after knee osteotomy. No data were available on time to RTS. A trend toward performing lower-impact sports was observed. Time to RTW varied from 10 to 22 weeks, and almost all patients returned to the same or a higher workload.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne Witjes
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Joost G Daams
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Alan Getgood
- Department of Orthopaedic Surgery, Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Tischer T, Paul J, Pape D, Hirschmann MT, Imhoff AB, Hinterwimmer S, Feucht MJ. The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence. Orthop J Sports Med 2017; 5:2325967117697287. [PMID: 28451605 PMCID: PMC5400157 DOI: 10.1177/2325967117697287] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability. Hypothesis/Purpose: The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases. Study Design: Systematic review; Level of evidence, 4. Methods: According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS). Results: Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased anterior tibial translation after slope-decreasing high tibial osteotomy in ACL-deficient knees. Correcting varus malalignment in PCL/PLC/LCL instability also showed increased stability and better outcomes. Conclusion: In cases of complex knee instability, the 3-dimensional osseous alignment of the knee should be considered (eg, mechanical weightbearing line and tibial slope). In cases of failed ACL reconstruction, the tibial slope should be considered, and slope-reducing osteotomies are often helpful in the patient revised multiple times. In cases of chronic PCL and/or PLC instability, osseous correction of the varus alignment may reduce the failure rate and is often the first step in treatment. Changes in the mechanical axis should be considered in all cases of instability accompanied by early unicompartmental osteoarthritis.
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Affiliation(s)
- Thomas Tischer
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany.,AGA - Society for Arthroscopy and Joint Surgery, Committee for OA and Joint Preserving Surgery, Wiesbaden, Germany
| | - Jochen Paul
- AGA - Society for Arthroscopy and Joint Surgery, Committee for OA and Joint Preserving Surgery, Wiesbaden, Germany.,Rennbahnklinik, Muttenz, Basel, Switzerland
| | - Dietrich Pape
- AGA - Society for Arthroscopy and Joint Surgery, Committee for OA and Joint Preserving Surgery, Wiesbaden, Germany.,Service de Chirurgie Orthopédique, Centre Hospitalier de Luxembourg-Clinique d'Eich, Akademisches Lehrkrankenhaus der Universität des Saarlandes, Luxembourg
| | - Michael T Hirschmann
- AGA - Society for Arthroscopy and Joint Surgery, Committee for OA and Joint Preserving Surgery, Wiesbaden, Germany.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Andreas B Imhoff
- AGA - Society for Arthroscopy and Joint Surgery, Committee for OA and Joint Preserving Surgery, Wiesbaden, Germany.,Department of Orthopaedic Sports Surgery, Technical University of Munich, Munich, Germany
| | - Stefan Hinterwimmer
- AGA - Society for Arthroscopy and Joint Surgery, Committee for OA and Joint Preserving Surgery, Wiesbaden, Germany.,OrthoPlus München, Munich, Germany
| | - Matthias J Feucht
- AGA - Society for Arthroscopy and Joint Surgery, Committee for OA and Joint Preserving Surgery, Wiesbaden, Germany.,Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany
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Abstract
Patients with unstable, malaligned knees often present a challenging management scenario, and careful attention must be paid to the clinical history and examination to determine the priorities of treatment. Isolated knee instability treated with ligament reconstruction and isolated knee malalignment treated with periarticular osteotomy have both been well studied in the past. More recently, the effects of high tibial osteotomy on knee instability have been studied. Lateral closing-wedge high tibial osteotomy tends to reduce the posterior tibial slope, which has a stabilising effect on anterior tibial instability that occurs with ACL deficiency. Medial opening-wedge high tibial osteotomy tends to increase the posterior tibia slope, which has a stabilising effect in posterior tibial instability that occurs with PCL deficiency. Overall results from recent studies indicate that there is a role for combined ligament reconstruction and periarticular knee osteotomy. The use of high tibial osteotomy has been able to extend the indication for ligament reconstruction which, when combined, may ultimately halt the evolution of arthritis and preserve their natural knee joint for a longer period of time.
Cite this article: Robin JG, Neyret P. High tibial osteotomy in knee laxities: Concepts review and results. EFORT Open Rev 2016;1:3-11. doi: 10.1302/2058-5241.1.000001.
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Mehl J, Paul J, Feucht MJ, Bode G, Imhoff AB, Südkamp NP, Hinterwimmer S. ACL deficiency and varus osteoarthritis: high tibial osteotomy alone or combined with ACL reconstruction? Arch Orthop Trauma Surg 2017; 137:233-240. [PMID: 27915458 DOI: 10.1007/s00402-016-2604-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study investigates the mid- to long-term clinical and radiological outcome in patients with symptomatic varus osteoarthritis (OA) and deficiency of the anterior cruciate ligament (ACL) and analyzes whether there are differences between isolated high tibial osteotomy (HTO) or combined single-stage HTO and ACL reconstruction (ACLR). METHODS 26 patients who underwent HTO alone (group 1) and 26 patients who underwent single-stage HTO and ACLR (group 2) because of varus OA and ACL deficiency were examined at a mean of 5.8 years (SD 3.6 years) post-operatively. Assessment at follow-up (FU) was performed using a questionnaire including clinical scores (Lysholm, IKDC) and the KT-2000 arthrometer to examine anterior knee stability. Radiographic knee alignment and signs of OA according to the classification of Kellgren and Lawrence (KL) were assessed pre-operatively and at FU. RESULTS Eighty-one percent of all patients reported an improvement of pain and 79% an improvement of instability without significant group difference. Significant worse results were observed in group 1 for the Lysholm score (group 1: 69.4, SD 15.7; group 2: 78.3, SD 16.4; p = 0.020) and the IKDC score (group 1: 64.8, SD 13.0; group 2: 74.0, SD 15.6; p = 0.006). No group difference was found for the KT-2000 examination. A significant post-operative increase of radiographic OA could be seen in both groups without significant group difference (KL pre-operative: 2.3, SD 0.63; KL FU: 2.8, SD 0.74; p < 0.001). The radiographic leg alignment at FU showed a significant lower valgus alignment in group 1 (group 1: 0.4 degree, SD 3.3 degree; group 2: 2.1 degree, SD 2.1 degree; p = 0.039). The rate of post-operative complications was low with 4%, and no significant group differences were found. CONCLUSIONS This study shows that HTO alone can improve pain and even subjective knee stability. Additional ACLR was in the mid term not associated with a higher increase of OA or a higher rate of post-operative complications in our study collective.
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Affiliation(s)
- Julian Mehl
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany.
| | - Jochen Paul
- Praxisklinik Rennbahn AG, Basel, Switzerland
| | - Matthias J Feucht
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany
| | - Gerrit Bode
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, Technische Universität Muenchen, Munich, Germany
| | - Norbert P Südkamp
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany
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Crawford MD, Diehl LH, Amendola A. Surgical Management and Treatment of the Anterior Cruciate Ligament–Deficient Knee with Malalignment. Clin Sports Med 2017; 36:119-133. [DOI: 10.1016/j.csm.2016.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Chahla J, Dean CS, Mitchell JJ, Moatshe G, Serra Cruz R, LaPrade RF. Medial Opening Wedge Proximal Tibial Osteotomy. Arthrosc Tech 2016; 5:e919-e928. [PMID: 27709059 PMCID: PMC5040605 DOI: 10.1016/j.eats.2016.04.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/21/2016] [Indexed: 02/03/2023] Open
Abstract
Genu varus malalignment can lead to medial compartment overload and progression of ipsilateral compartment osteoarthritis. To slow this process, a medial opening wedge proximal tibial osteotomy (PTO) can be performed. This type of PTO is indicated in patients with genu varus malalignment and isolated medial compartment osteoarthritis of the knee, prior to or concurrent with medial compartment cartilage procedures or meniscal transplants, chronic posterolateral corner deficiency, or chronic anterior cruciate ligament deficiency. When treating ligamentous instability, a PTO can be performed in isolation, with simultaneous ligament reconstruction, or as a staged procedure with the osteotomy first, followed by ligament reconstruction if instability persists. Failure to address malalignment in cases of concurrent ligament reconstruction leads to increased stress on the graft and potential graft failure. One distinct advantage of this procedure is the ability to correct deformities in the sagittal and coronal planes. The purpose of this article was to describe our technique used to perform a medial opening wedge PTO.
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Affiliation(s)
- Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Chase S. Dean
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Orthopedic Department, Oslo University Hospital, Oslo, Norway,Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | - Raphael Serra Cruz
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Instituto Brasil de Tecnoligias da Saúde, Rio de Janeiro, RJ, Brazil
| | - Robert F. LaPrade
- Steadman Clinic, Vail, Colorado, U.S.A.,Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Address correspondence to Robert F. LaPrade, M.D., Ph.D., Chief Medical Officer, Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, U.S.A.Chief Medical OfficerSteadman Philippon Research InstituteThe Steadman Clinic181 West Meadow DriveSuite 400VailCO81657U.S.A.
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Dean CS, Chahla J, Moulton SG, Nitri M, Serra Cruz R, LaPrade RF. Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy. Arthrosc Tech 2016; 5:e531-40. [PMID: 27656374 PMCID: PMC5021538 DOI: 10.1016/j.eats.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/02/2016] [Indexed: 02/03/2023] Open
Abstract
Proximal tibial anterolateral opening-wedge osteotomies have been reported to achieve successful biplanar lower-extremity realignment. Indications for a proximal tibial anterolateral osteotomy include symptomatic genu recurvatum with genu valgus alignment, usually in patients with a flat sagittal-plane tibial slope. The biplanar approach is able to simultaneously address both components of a patient's malalignment with a single procedure. The correction amount is verified with spacers and intraoperative imaging, while correction of the patient's heel height is simultaneously measured. A plate is secured into the osteotomy site, and the site is filled with bone allograft. The anterolateral tibial osteotomy has been reported to be an effective surgical procedure for correcting concomitant genu recurvatum and genu valgus malalignment.
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Affiliation(s)
- Chase S. Dean
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Marco Nitri
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Robert F. LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
- Address correspondence to Robert F. LaPrade, M.D., Ph.D., Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr., Ste 400, Vail, CO 81657, U.S.A.Steadman Philippon Research InstituteThe Steadman Clinic181 W Meadow Dr.Ste 400VailCO81657U.S.A.
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Dean CS, Liechti DJ, Chahla J, Moatshe G, LaPrade RF. Clinical Outcomes of High Tibial Osteotomy for Knee Instability: A Systematic Review. Orthop J Sports Med 2016; 4:2325967116633419. [PMID: 27047982 PMCID: PMC4790424 DOI: 10.1177/2325967116633419] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: In recent years there has been an increasing interest in high tibial osteotomy (HTO) to treat patients with chronic knee instability due to posterolateral corner (PLC), posterior cruciate ligament (PCL), and anterior cruciate ligament (ACL) insufficiencies with concurrent malalignment in the coronal and/or sagittal plane. Purpose: To perform a systematic review of the use of HTO for the treatment of knee ligament instability with concurrent malalignment. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was conducted for the treatment of combined knee ligament instability and malalignment with HTO using the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE (1980 to present); the queries were performed in July 2015. Terms searched included the following: high or proximal tibial osteotomy, unstable, instability, laxity, subluxation, tibial slope, and malalignment, in the knee joint. Inclusion criteria were as follows: HTO to treat instability of the knee joint in the sagittal and/or coronal plane, minimum 2-year follow-up with reported outcomes measures, English language, and human studies. Animal, basic science, and cadaveric studies were excluded as well as editorials, reviews, expert opinions, surveys, special topics, letters to the editor, and correspondence. Results: The search resulted in 460 studies. After applying exclusion criteria and removing duplicates, 13 studies were considered. Of the studies reviewed, knee ligament pathologies, previous surgeries, and measurement of knee stability were heterogeneous. However, all studies reported an improvement in knee stability after HTO. Most studies reported improvement in outcome scores. However, other studies did not provide preoperative scores for comparison. Reported complication rates ranged from 0% to 47%. Conclusion: Although HTO has been highly advocated and used in treating patients with ligamentous knee instability, there remains a paucity of high-quality studies. Included studies report improvement of instability as well as relatively high patient satisfaction and rate of return to sports. The heterogeneity of the pathology treated, follow-up time, and outcome measures limit comparison between studies.
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Affiliation(s)
- Chase S Dean
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, USA.; Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.; OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.; The Steadman Clinic, Vail, Colorado, USA
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Combined Biplanar High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Abrasion/Microfracture in Severe Medial Osteoarthritis of Unstable Varus Knees. Arthroscopy 2016; 32:283-92. [PMID: 26382636 DOI: 10.1016/j.arthro.2015.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/02/2015] [Accepted: 07/10/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine survivorship and functional results of medial open-wedge high tibial osteotomy (HTO) combined with anterior cruciate ligament reconstruction (ACLR) and a chondral resurfacing (CR) procedure (abrasion/microfracture) in patients with Kellgren-Lawrence grade 3 and 4 osteoarthritis with full-thickness cartilage defects, anterior cruciate ligament (ACL) insufficiency, and varus malalignment. METHODS From October 2005 to March 2009, all combined HTO (fixation with angular stable internal fixator), ACLR, and CR procedures in knees with symptomatic medial osteoarthritis (Kellgren-Lawrence grade 3 and 4), ACL insufficiency, varus malalignment (>4°), and full-thickness large-area cartilage defects were prospectively surveyed with a minimum follow-up period of 5 years regarding survival (not requiring arthroplasty), functional outcome (subjective International Knee Documentation Committee [IKDC] score), and subjective satisfaction. Clinical evaluation (objective IKDC parameters and KT-1000 [MEDmetric, San Diego, CA] measurement), radiologic evaluation, and revision arthroscopy were performed between 1 and 2 years postoperatively. RESULTS Twenty-three knees (mean age, 47.0 ± 5.8 years) were included. The rate of follow-up was 100% at 6.0 ± 0.8 years (range, 5.2 to 7.5 years), with no arthroplasty until then. The mean subjective IKDC score improved from 47.7 ± 11.1 to 72.8 ± 15.0 at 1 year, 70.9 ± 16.0 at 3 years, and 73.1 ± 16.4 at 5 years (P < .001). Clinical examination and revision arthroscopy were performed in 22 cases (95.5%) at 1.3 ± 0.5 years (range, 1.0 to 2.0 years). Four ACL grafts (18.1%) were insufficient, and 2 grafts (9.1%) were stable but showed signs of degeneration. Good cartilage regeneration was seen in most cases, but no correlation with subjective IKDC score was apparent (P = .528). CONCLUSIONS HTO in combination with ACLR and a CR procedure is effective in the treatment of severe medial osteoarthritis with concomitant ACL insufficiency and varus malalignment. The effect of the CR, as well as the reason for the considerable rate of graft insufficiency, remains unclear.
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Beyzadeoglu T, Demirel M, Circi E. Simultaneous ACL-PCL reconstructions with high tibial osteotomy: salvage for an unstable arthritic knee. BMJ Case Rep 2016; 2016:bcr-2015-210053. [PMID: 26762346 DOI: 10.1136/bcr-2015-210053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 28-year-old man with a severe osteoarthritic varus knee after a neglected multiligamentous injury sustained 10 years prior. Simultaneous anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions with high tibial osteotomy (HTO) were performed at a single stage. Five years after surgery, there were no signs of effusion and no instability, and the patient could easily kneel down without any discomfort. We think that salvage procedures and biological reconstructions would be the primary choice of surgical treatment in young patients to delay arthroplasty, and it is possible to perform simultaneous reconstructions of ACL and PCL with HTO in a single stage.
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Affiliation(s)
- Tahsin Beyzadeoglu
- Beyzadeoglu Sports Medicine Clinic, Istanbul, Turkey Department of Physical Therapy and Rehabilitation, School of Health Sciences, Halic University, Istanbul, Turkey
| | - Murat Demirel
- Department of Orthopaedics and Traumatology, Bayindir Hospital, Ankara, Turkey
| | - Esra Circi
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
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Mancuso F, Hamilton TW, Kumar V, Murray DW, Pandit H. Clinical outcome after UKA and HTO in ACL deficiency: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:112-22. [PMID: 25266231 DOI: 10.1007/s00167-014-3346-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 09/22/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE In the treatment of medial osteoarthritis secondary to anterior cruciate ligament (ACL) injury there is no consensus about optimum treatment, with both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) being viable options. The aim of this review was to compare the outcomes of these treatments, both with or without ACL reconstruction. METHODS EMBASE, MEDLINE and the Clinical Trials Registers were searched to identify relevant studies. Studies meeting pre-defined inclusion criteria were assessed independently by two researchers for methodological quality and data extracted. RESULTS Twenty-six studies involving 771 patients were identified for inclusion. No randomized controlled trials were identified. Seventeen studies reported outcomes following HTO and nine studies reported outcomes following UKA. HTO patients were significantly younger than those receiving UKA, and ACL reconstruction patients were younger than non-reconstructed patients. Treatment with HTO ACL reconstruction had the lowest revision rate (0.62/100 observed component years) but the highest rate of complications (4.61/100 observed component years). Too little data were available to test for differences in outcome between different surgical techniques or prosthesis designs. CONCLUSIONS Limited conclusions about the optimum treatment can be made due to the absence of controlled trials. In patients treated with HTO ACL reconstruction, the high complication rate likely outweighs its minimally superior survival. Outcomes following UKA ACL reconstruction are similar to outcomes for UKA in the ACL intact knee without any increase in complications. As such in patients meeting indications for UKA, UKA ACL reconstruction should be performed with further work required to identify the optimum treatment in other patient groups. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Mancuso
- Clinic of Orthopaedics and Traumatology, University of Udine, Udine, Italy
| | - Thomas W Hamilton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Vijay Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Hemant Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
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Grassi A, Zaffagnini S, Marcheggiani Muccioli GM, Roberti Di Sarsina T, Urrizola Barrientos F, Marcacci M. Revision anterior cruciate ligament reconstruction does not prevent progression in one out of five patients of osteoarthritis: a meta-analysis of prevalence and progression of osteoarthritis. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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