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Aykanat F, Kose O, Guneri B, Celik HK, Cakar A, Tasatan E, Ulmeanu ME. Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis. J Orthop Traumatol 2023; 24:30. [PMID: 37358664 DOI: 10.1186/s10195-023-00714-6] [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: 09/23/2022] [Accepted: 06/04/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Conventionally, two 4.5 mm cortical screws inserted toward the posterior tibial cortex are usually advocated for the fixation of Fulkerson osteotomy. This finite element analysis aimed to compare the biomechanical behavior of four different screw configurations to fix the Fulkerson osteotomy. MATERIALS AND METHODS Fulkerson osteotomy was modeled using computerized tomography (CT) data of a patient with patellofemoral instability and fixed with four different screw configurations using two 4.5 mm cortical screws in the axial plane. The configurations were as follows: (1) two screws perpendicular to the osteotomy plane, (2) two screws perpendicular to the posterior cortex of the tibia, (3) the upper screw perpendicular to the osteotomy plane, but the lower screw is perpendicular to the posterior cortex of the tibia, and (4) the reverse position of the screw configuration in the third scenario. Gap formation, sliding, displacement, frictional stress, and deformation of the components were calculated and reported. RESULTS The osteotomy fragment moved superiorly after loading the models with 1654 N patellar tendon traction force. Since the proximal cut is sloped (bevel-cut osteotomy), the osteotomy fragment slid and rested on the upper tibial surface. Afterward, the upper surface of the osteotomy fragment acted as a fulcrum, and the distal part of the fragment began to separate from the tibia while the screws resisted the displacement. The resultant total displacement was 0.319 mm, 0.307 mm, 0.333 mm, and 0.245 mm from the first scenario to the fourth scenario, respectively. The minimum displacement was detected in the fourth scenario (upper screw perpendicular to the osteotomy plane and lower screw perpendicular to the posterior tibial cortex). Maximum frictional stress and maximum pressure between components on both surfaces were highest in the first scenario (both screws perpendicular to the osteotomy plane). CONCLUSIONS A divergent screw configuration in which the upper screw is inserted perpendicular to the osteotomy plane and the lower screw is inserted perpendicular to the posterior tibial cortex might be a better option for the fixation of Fulkerson osteotomy. Level of evidence Level V, mechanism-based reasoning.
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Affiliation(s)
- Faruk Aykanat
- Vocational School of Health Services, SANKO University, Gaziantep, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd., Muratpasa, 07100, Antalya, Turkey.
| | - Bulent Guneri
- Department of Orthopedics and Traumatology, Adana City Education and Research Hospital, Adana, Turkey
| | - H Kursat Celik
- Agricultural Faculty, Department of Agricultural Machinery and Technology Engineering, Akdeniz University, Antalya, Turkey
| | - Albert Cakar
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ersin Tasatan
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Mihaela-Elena Ulmeanu
- Department of Manufacturing, Polytechnic University of Bucharest, Bucharest, Romania
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Minimizing the Risk of Vascular Injury: Anatomy of the Popliteal Artery in the Pediatric Knee. J Pediatr Orthop 2022; 42:e847-e851. [PMID: 35819314 DOI: 10.1097/bpo.0000000000002208] [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
BACKGROUND Displaced pediatric tibial tubercle fractures are commonly stabilized with screws directed posteriorly toward neurovascular structures. Here, we (1) characterize the variation of the popliteal artery among pediatric patients; and (2) recommend a safe screw trajectory for fixation of tibial tubercle fractures. METHODS We retrospectively identified 42 patients (42 knees; 29 female) aged 12-17 years with lower-extremity magnetic resonance imaging (MRI) at a tertiary academic center. The mean patient age was 14.5 (range: 12-17) years, and the mean body mass index value was 19.1 (range: 14.9-25.1). We included patients with open physes or visible physeal scars and excluded those with prior instrumentation or lower-extremity injury. Using sagittal MRI, we measured the distances from 5 levels each on the anterior and posterior tibial cortex to the popliteal artery (level 1, midpoint of proximal tibial epiphysis; level 2, the proximal extent of the tubercle; level 3, tubercle prominence; level 4, 2 cm distal to the proximal extent of the tubercle; level 5, 4 cm distal to the proximal extent of the tubercle). Using coronal MRI, we measured the width of the tibia at each level and the distance from the lateral-most and medial-most cortex to the artery. RESULTS The popliteal artery was laterally positioned in all knees. The mean distance between the artery and lateral-most aspect of the tibia at each level ranged from 1.9 to 2.4 cm, and from 2.3 to 3.9 cm from the medial-most aspect of the tibia. The mean distance that a screw can advance before vascular injury was 5.1 cm at level 1. The shortest mean distance to the popliteal artery was 1.7 cm, at level 5. There is minimal distance between the posterior tibial cortex and the artery at all levels. CONCLUSIONS Understanding the position of the popliteal artery in pediatric patients can help when stabilizing tibial tubercle fractures. Because the artery is close to the posterior cortex, a drill exiting in line with the popliteal artery risks vascular injury. Therefore, we recommend that screws exit within the medial 60% of the tibia. LEVEL OF EVIDENCE IV.
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Guneri B, Kose O, Celik HK, Cakar A, Tasatan E, Rennie AEW. How to fix a tibial tubercle osteotomy with distalisation: A finite element analysis. Knee 2022; 37:132-142. [PMID: 35779431 DOI: 10.1016/j.knee.2022.06.002] [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: 01/04/2022] [Revised: 05/22/2022] [Accepted: 06/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Antero-medialisation osteotomy combined with a distalisation procedure may require a more stable fixation as the osteotomy fragment loses both proximal and distal support. This finite element analysis aimed to compare the mechanical behaviour of different fixation techniques in tibial tubercle antero-medialisation osteotomy combined with distalisation procedure. METHODS Tibial tubercle osteotomy combined with distalisation was modelled based on computerised tomography data, which were acquired from a patient with patellar instability requiring this procedure. Six different fixation configurations with two 3.5-mm cortical screws (1), two 4.5-mm cortical screws (2), three 3.5-mm cortical screws (3), three 4.5-mm cortical screws (4), three 3.5-mm screws with 1/3 tubular plate (5), and four 3.5-mm screws with 1/3 tubular plate (6) were created. A total of 1654 N of force was applied to the patellar tendon footprint on the tibial tubercle. Sliding, gap formation, and total deformation between the osteotomy components were analyzed. RESULTS Maximum sliding (0.660 mm), gap formation (0.661 mm), and displacement (1.267 mm) were seen with two 3.5-mm screw fixation, followed by two 4.5-mm screws, three 3.5-mm screws, and three 4.5-mm screws, respectively, in the screw-only group. Overall, the minimum displacement was observed with the four 3.5-mm screws with 1/3 tubular plate fixation model. CONCLUSIONS Plate fixation might be recommended for tibial tubercle antero-medialisation osteotomy combined with distalisation procedure because it might allow early active range of motion exercises and weight-bearing.
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Affiliation(s)
- Bulent Guneri
- Department of Orthopaedics and Traumatology, Adana City Education and Research Hospital, Adana, Turkey.
| | - Ozkan Kose
- Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - H Kursat Celik
- Department of Agricultural Machinery and Technology Engineering, Agricultural Faculty, Akdeniz University, Antalya, Turkey
| | - Albert Cakar
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ersin Tasatan
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Park SB, Kim JS, Jeong HW, Shim SJ, Park SY, Kim JG, Lee YS. Medially and distally inserted tuberosity screw fixation of the osteotomized tubercle is safe and effective in retro-tubercular bi-planar opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 31:1571-1582. [PMID: 35680679 DOI: 10.1007/s00167-022-07009-z] [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: 03/02/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to develop a safe and effective method of inserting one tuberosity screw and to determine whether retro-tubercular (RT)-Open-wedge high tibial osteotomy (OWHTO) with tuberosity screw fixation can be conducted to overcome the problem of osteotomized tubercle and produce favorable outcomes compared to RT-OWHTO without tuberosity screw fixation. METHODS From 2018 to 2020, patients who underwent bi-planar RT-OWHTO were allocated as two groups (RT-OWHTO without tuberosity screw fixation as group I and with screw fixation as group II). Computed tomography (CT) was used to analyze osteotomy configurations such as RT gap and tip distance, and union of the main and second plane osteotomy sites. The RT gap distance was measured as the length of the osteotomy gap. The RT tip distance was measured as the length of the gap at the tip of the tibial tubercle. Post-operative complications were analyzed also. To evaluate the neurovascular (NV) approximity of screw fixation group, the pre-operative magnetic resonance imaging (MRI) images were referenced on the post-operative CT for the assessment of the safe zone. RESULTS In total, 44 knees in group I and 46 knees in group II were enrolled. The RT gap distance (2.58 ± 0.69 mm vs. 0.57 ± 0.57 mm; p < .001) and RT tip distance (4.31 ± 1.60 mm vs. 1.48 ± 1.42 mm; p < .001) were significantly larger in group I than in group II. The sum of union grade in the second plane osteotomy site (17.93 ± 2.18 points vs. 22.24 ± 2.57 points; p < .001) was statistically different between two groups at three months post operatively. Post-operative tuberosity prominence occurred in five knees only in group I (p = 0.025), although tibial tuberosity fracture developed in seven cases in group II compared with two cases in group I with no statistical significance. NV was safe when the screw was inserted medially. CONCLUSION RT-OWTHO with one-screw fixation for the tuberosity was effective in terms of tuberosity prominence and the union of the second plane osteotomy site. However, it also produced another problem, such as tuberosity fracture. In addition, a tuberosity screw was safe when it was inserted in the medial-distal direction. LEVEL OF EVIDENCE Cohort study; level III.
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Affiliation(s)
- Sung Bae Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Joo Sung Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Ho Won Jeong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Seung Jae Shim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Jung Guel Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Abstract
Orthopedic sports surgery of the knee and shoulder is generally considered to be safe and effective. Vascular complications can occur during or after arthroscopy of either joint. A thorough understanding of anatomy, particularly when placing portals in non-routine locations, is extremely important. Prompt recognition of any vascular complication is of significant importance. This review will discuss the potential vascular complications for both knee and shoulder sports surgery, review the relevant anatomy, and discuss the treatment and expected outcome of each.
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Adequate protection rather than knee flexion prevents popliteal vascular injury during high tibial osteotomy: analysis of three-dimensional knee models in relation to knee flexion and osteotomy techniques. Knee Surg Sports Traumatol Arthrosc 2020; 28:1425-1435. [PMID: 31119339 DOI: 10.1007/s00167-019-05515-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/23/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE (1) To analyse popliteal artery (PA) movement in a three-dimensional (3D) coordinate system in relation to knee flexion and high tibial osteotomy (HTO) techniques (lateral closed wedge HTO [LCHTO], uniplane medial open wedge HTO [UP-MOHTO], biplane medial open wedge HTO [BP-MOHTO]) and (2) to identify safe zones of the PA in each osteotomy plane. METHODS Sixteen knees of patients who underwent magnetic resonance imaging with extension and 90° flexion were used to develop subject-specific 3D knee flexion models. Displacement of the PA during knee flexion was measured along the X- and Y-axis, as was the distance between the posterior tibial cortex and PA parallel to the Y-axis (d-PCA). Frontal plane safety index (FPSI) and maximal axial safe angles (MASA) of osteotomy, which represented safe zones for the osteotomy from the PA injury, were analysed. All measurements were performed along virtual osteotomy planes. Differences among the three osteotomy methods were analysed for each flexion angle using a linear mixed model. RESULTS The average increments in d-PCA during knee flexion were 1.3 ± 2.3 mm in LCHTO (n.s.), 1.4 ± 1.2 mm in UP-MOHTO (P < 0.0001), and 1.7 ± 2.0 mm in BP-MOHTO (P = 0.015). The mean FPSIs in knee extension were 37.6 ± 5.9%, 46.4 ± 5.8%, and 45.1 ± 8.1% for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. The mean MASA values in knee extension were 45.8° ± 4.4°, 37.3° ± 6.1°, and 38.9° ± 6.5° for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. CONCLUSION Although the PA moved posteriorly during knee flexion, the small (1.7 mm) increment thereof and inconsistent movements in subjects would not be of clinical relevance to PA safety during HTO. LEVEL OF EVIDENCE Diagnostic study, Level II.
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A Modified Osteotomy for Anteromedialization of the Tibial Tubercle. Arthrosc Tech 2017; 6:e1107-e1112. [PMID: 28970998 PMCID: PMC5621784 DOI: 10.1016/j.eats.2017.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/22/2017] [Indexed: 02/03/2023] Open
Abstract
Tibial tubercle osteotomy is a common treatment option for a number of patellofemoral joint disorders including chondromalacia, "anterior knee pain" syndromes, patellofemoral arthritis, and patellar instability. Tibial tubercle osteotomy can modify tracking and/or patellofemoral contact forces to effect the unloading of chondral defects of the patella or trochlea, correct multiplanar suboptimal alignment, and be used in conjunction with soft-tissue stabilization procedures for instability. The purpose of this Technical Note is to describe, in detail, a modified osteotomy for anteromedialization of the tibial tubercle. The technique combines the concepts of Elmslie-Trillat and Fulkerson and modifies their techniques to produce an osteotomy that decreases lateral patellar pressure and centers the patella correctly in the trochlear groove.
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Magnetic resonance study on the anatomical relationship between the posterior proximal region of the tibia and the popliteal artery. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2015; 50:422-9. [PMID: 26417569 PMCID: PMC4563072 DOI: 10.1016/j.rboe.2015.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 07/29/2014] [Indexed: 11/24/2022]
Abstract
Objective To analyze and describe the distance from the popliteal artery to three specific areas of the proximal region of the tibia, with the knee extended, by means of magnetic resonance. Methods Images of 100 knees of patients who underwent magnetic resonance examinations were analyzed. The location of the popliteal artery was measured in three different areas of the posterior proximal region of the tibia. The first measurement was made at the level of the knee joint (tibial plateau). The second was 9 mm distally to the tibial plateau. The third was at the level of the anterior tuberosity of the tibia (ATT). Results The distances between the popliteal artery and the tibial plateau and ATT region were significantly greater in males than in females. The distances between the popliteal artery and the regions 9 mm distally to the tibial plateau and the ATT were significantly greater in the age group over 36 years than in the group ≤36 years. Conclusion Knowledge of the anatomical position of the popliteal artery, as demonstrated through magnetic resonance studies, is of great relevance in planning surgical procedures that involve the knee joint. In this manner, devastating iatrogenic injuries can be avoided, particularly in regions that are proximal to the tibial plateau and in young patients.
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Estudo por ressonância magnética da relação anatômica entre a região proximal posterior da tíbia e a artéria poplítea. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sagittal and coronal plane location of the popliteal artery in the open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2014; 22:2629-34. [PMID: 23592027 DOI: 10.1007/s00167-013-2503-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 04/04/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE The objectives of this study were (1) to evaluate the sagittal and coronal plane location of the popliteal artery during the advancement of open-wedge high tibial osteotomy and (2) to confirm the effect of osteoarthritis if it changes the relationship between the popliteal artery and posterior cortex. METHODS Two hundred consecutive patients were enrolled, and we divided patients into two subgroups according to age and cartilage status in the radiologic report of magnetic resonance imaging (group I: 100 non-arthritic knees; group II: 100 arthritic knees). For prediction of the location of the popliteal artery during the operation, sagittal and coronal plane location along the osteotomy plane was evaluated. RESULTS The distance between the posterior cortex of the osteotomy and popliteal artery was 13-14 mm on the sagittal plane, and the popliteal artery was located at an approximately 35 ± 5.5 mm portion from the starting point of the osteotomy on the coronal plane. The distance at the starting point of osteotomy was larger than at the end portion and prominent area. In comparison between groups I and II, group II showed a larger distance on the sagittal planes [osteotomy-vascular: 13.6 vs 14.4 (p = 0.01), fibula-vascular: 4.88 vs 6.5 (p < 0.01), and prominence-vascular: 4.3 vs 5.3 (p < 0.01)] compared to the group I. CONCLUSIONS Special caution and some protection should be given until the approximately 35 mm portion from the starting point of the posteromedial cortex with consideration for the approximity on the sagittal plane. In comparison between the non-arthritic and arthritic knee, differences were observed on the sagittal plane. However, the value was minimal, and the clinical relevance was questionable. LEVEL OF EVIDENCE Case series, Level IV.
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Yang D, Zhou Y, Tang Q, Xu H, Yang X. Anatomical relationship between the proximal tibia and posterior neurovascular structures: a safe zone for surgeries involving the proximal tibia. J Arthroplasty 2011; 26:1123-7. [PMID: 21435819 DOI: 10.1016/j.arth.2011.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 02/10/2011] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to provide a quantitative description of the anatomical relationship between the proximal tibia and posterior neurovascular structures to delineate a safe zone for tibial surgery. We measured the distance between the tibial cortex and neurovascular structures, and the width of the medial/lateral part of the tibia without neurovascular structures, using magnetic resonance imaging data of 50 knees. The average distance was <10 mm. Neurovascular structures passed just lateral to the posterior middle line of the tibia, with major branches passing laterally at 5.5 to 6 cm below the joint line. There was a safe zone posterior to the medial half of the tibia for penetration of the posterior cortex.
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Affiliation(s)
- Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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Wu CC. Combined lateral retinacular release with drilling chondroplasty for treatment of patellofemoral osteoarthritis associated with patellar malalignment in elderly patients. Knee 2011; 18:24-9. [PMID: 20171107 DOI: 10.1016/j.knee.2010.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 12/27/2009] [Accepted: 01/06/2010] [Indexed: 02/02/2023]
Abstract
This paper described a less invasive surgical technique that was performed for treatment of elderly patients with isolated patellofemoral (PF) osteoarthritis (OA) associated with patellar malalignment, although their tibiofemoral joints are minimally osteoarthritic. Two hundred and thirty-four knees in 126 consecutive elderly patients (average, 72 yrs) diagnosed with combined disorders were treated by lateral retinacular release with drilling chondroplasty. The inclusion criteria were patient age ≥ 65 yrs, isolated stage 2 or 3 PF-OA (modified Iwano staging by radiology), and a laterally subluxed patella shown on a Merchant's axial radiograph. Outcome was judged by three parameters: clinical PF function (modified Kujala scoring), congruence angle, and PF-OA staging. Two hundred and one knees in 107 patients were followed-up for an average of 4.2 yrs (range, 2.1-7.5 yrs) and 19 patients were lost to follow-up. No surgical complications occurred through the course of treatment. Clinical PF function improved in knees that showed unsatisfactory performance (modified Kujala scoring < 32) preoperatively, with 78.1% of the knees showing satisfactory performance (modified Kujala scoring ≥ 32) at the latest follow-up. Congruence angle improved in 85.6% of the knees and PF-OA staging improved in 77.1% of the knees. Combined lateral retinacular release with drilling chondroplasty is a feasible alternative for treatment of PF-OA associated with patellar malalignment in elderly patients where knee arthroplasty cannot be performed by various reasons. Advantages of this combined surgical technique include a less invasive procedure, minimal complication rate, and an acceptable success rate (78%, modified Kujala scoring≥32).
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Affiliation(s)
- Chi-Chuan Wu
- Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Yoo JH, Chang CB. The location of the popliteal artery in extension and 90 degree knee flexion measured on MRI. Knee 2009; 16:143-8. [PMID: 19046634 DOI: 10.1016/j.knee.2008.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 10/15/2008] [Accepted: 10/26/2008] [Indexed: 02/02/2023]
Abstract
We measured the location of the popliteal artery (PA) in extension and 90 degree of knee flexion by magnetic resonance images (MRI) to provide practical information to avoid PA injury. The MRIs of 30 knees of Korean male subject whose mean age was 20.7 were acquired in knee extension and 90 degree flexion. The distance from the posterior aspect of knee joint to the PA was measured at three levels on the axial images and one sagittal image. At the joint line level, the PA was located lateral to the PCL 2.4 mm in extension and 3.2 mm in flexion (p=0.247), and 3.9 mm in extension and 7.6 mm in flexion from the posterior capsule (p<0.001). At 1 cm distal to the joint line, it is 2.7 mm in extension and 7.2 mm in flexion (p<0.001), and at 2 cm distal to the joint line, 4.9 mm in extension and 9.7 mm in flexion from the posterior tibial cortex (p<0.001). In sagittal plane, the nearest distance between PA and posterior tibial cortex was 1.8 mm in extension, and 6.2 mm in flexion (p<0.001). The PA was located around 3 mm lateral to the PCL, and within 5 mm in extension and 10 mm in 90 degree flexion of the knee behind knee joint. It moves farther posteriorly in 90 degree flexion than in extension of the knee. The conventional wisdom of flexing the knee to prevent the PA injury was supported by this study.
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Affiliation(s)
- Jae Ho Yoo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Bucheon, 1174 Jung-Dong, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do, 420-767, South Korea.
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Affiliation(s)
- Ronald P Grelsamer
- Mount Sinai Medical School, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
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