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Kawde K, Pisulkar G, Salwan A, Jayasoorya A, Jadawala VH, Taywade S. A Comprehensive Review of Current Management Trends in Medial Compartment Arthritis of the Knee Joint. Cureus 2024; 16:e56666. [PMID: 38646379 PMCID: PMC11032692 DOI: 10.7759/cureus.56666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Medial compartment arthritis of the knee joint presents a significant clinical challenge, with diverse management options ranging from nonsurgical interventions to various surgical procedures. This comprehensive review synthesizes current evidence on the management trends in medial compartment arthritis, highlighting both nonsurgical approaches such as physical therapy, pharmacological interventions, and intra-articular injections as well as surgical interventions, including arthroscopic debridement, high tibial osteotomy, and knee arthroplasty. Through a comparative analysis of efficacy, complication rates, and patient outcomes, this review underscores the importance of tailoring treatment strategies to individual patient characteristics and preferences. Furthermore, emerging techniques and technologies promise to advance the field, necessitating ongoing research efforts to refine treatment algorithms and establish standardized guidelines. By adopting a multidisciplinary approach and integrating evidence-based practices, clinicians can optimize the management of medial compartment arthritis and enhance patient care outcomes.
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Affiliation(s)
- Kevin Kawde
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ankur Salwan
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Adarsh Jayasoorya
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vivek H Jadawala
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shounak Taywade
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Ollivier M, An JS, Kley K, Khakha R, Fernandes LR, Micicoi G. A significant rate of tibial overcorrection with an increased JLO occurred after isolated high tibial osteotomy without considering international consensus. Knee Surg Sports Traumatol Arthrosc 2023; 31:4927-4934. [PMID: 37597039 DOI: 10.1007/s00167-023-07518-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The recent ESSKA consensus recommendations defined indications and outlined parameters for osteotomies around a degenerative varus knee. The consensus collated these guidelines based on the published literature available to answer commonly asked questions including the importance of identifying the site and degree of the lower limb deformity. In the consensus, the authors suggest that a knee joint line obliquity (JLO) greater than 5° or a planned medial proximal tibial angle (MPTA) > 94° preferentially indicates a double level osteotomy (DLO) compared to an isolated opening wedge high tibial osteotomy (OWHTO). This study aimed to analyze the corrections performed on a cohort of isolated opening wedge high tibial osteotomies (OWHTOs) prior to the recent ESSKA recommendations, with a focus on the impact of knee joint line obliquity (JLO) and medial proximal tibial angle (MPTA) on the choice of osteotomy procedure. METHODS This monocentric, retrospective study included 129 patients undergoing medial OWHTO for symptomatic isolated medial knee osteoarthritis (Ahlbäck grade I or II) and a global varus malalignment (hip-knee-ankle angle ≤ 177°). An automated software trained to automatically detect lower limb deformity was implemented using patients preoperative long leg alignment X-rays to identify suitability for an isolated HTO in knee varus deformity. Based on the ESSKA recommendations, the site of the osteotomy was identified as well as the degree of correction required. The ESSKA consensus considers avoiding an isolated high tibial osteotomy if the planned resultant knee joint line orientation exceeds 5 ̊ or MPTA exceeds 94°. A preoperative abnormal MPTA was defined by a value lower than 85° and a preoperative abnormal LDFA by a value greater than 90°. The cases of DLO or DFO suggested by the software and the number of extra-tibial anomalies were collected. Multiple linear regression models were developed to establish a relationship between preoperative values and the risk of being outside of ESSKA recommendations postoperatively. RESULTS Based on ESSKA recommendations and on threshold values considered abnormal, the software suggested a DLO in 17.8% (n = 23/129) of cases, a distal femoral osteotomy in 27.9% (n = 36/129) of cases and advised against an osteotomy procedure in 24% (n = 31/129) of cases. The software detected a femoral anomaly in 34.9% (n = 45/129) of cases and an JLCA > 6° in 9.3% (n = 12/129). Postoperatively, the MPTA exceeds 94° in 41.1% (n = 53/129) and the JLO exceeds 5° in 29.4% (n = 38/129). On multivariate analysis, a high preoperative MPTA was associated with higher risk of postoperative MPTA > 94° (R2 = 0.36; p < 0.001). Similarly, the probability of the software advising a DLO or DFO was associated with the presence of an "normal" preoperative MPTA (R2 = 0.42; p < 0.001) or an abnormal preoperative LDFA (R2 = 0.48; p < 0.001) or a planned JLO > 5° (R2 = 0.27; p < 0.001). CONCLUSIONS Analysis of patients who underwent an isolated OWHTO prior to the ESSKA guidelines, demonstrated a significant rate of post-operative tibial overcorrection and a resultant increased JLO. Pre-operative planning that considers the ESSKA guidelines, allows for better identification of those patients requiring a DFO or DLO and avoidance of resultant post-operative deformities. LEVEL OF EVIDENCE IV, case-series.
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Affiliation(s)
- Matthieu Ollivier
- APHM, CNRS, ISM, Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Sainte-Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
| | - Jae-Sung An
- APHM, CNRS, ISM, Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Sainte-Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Kristian Kley
- Orthoprofis Hannover Luisenstraße, 10/11, 30539, Hannover, Germany
| | - Raghbir Khakha
- Guys and St. Thomas' Hospitals, Great Maze Pond, London, SE1 9RT, England
| | - Levi Reina Fernandes
- Department of Orthopedics and Traumatology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Grégoire Micicoi
- Institute for Locomotion and Sports, iULS-University, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, Nice, France
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An JS, Mabrouk A, Khakha R, Kley K, Koga H, Jacquet C, Ollivier M. Assessment of return to sport and functional outcomes following distal femoral, double level and high tibial osteotomies for active patients with symptomatic varus malalignment. Knee Surg Sports Traumatol Arthrosc 2023; 31:4285-4291. [PMID: 37329369 DOI: 10.1007/s00167-023-07457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/13/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE This study indicated the outcomes of three surgical techniques for the treatment of symptomatic unicompartmental knee osteoarthritis (UKOA) with varus malalignment in younger, active patients: distal femoral osteotomy (DFO), double-level osteotomy (DLO) and high tibial osteotomy (HTO). The outcomes measured included the return to sport, sport activity and functional scores. METHODS A total of 103 patients (19 DFO, 43 DLO, 41 HTO) were enrolled in the study and were divided into three groups based on their oriented deformity, each undergoing one of the three surgical techniques. All patients underwent pre- and post-operative evaluations including X-rays, physical exams and functional assessments. RESULTS All three surgical techniques were effective in treating UKOA with constitutional malalignment. The average time to return to sport was similar among the three groups (DFO: 6.4 ± 0.3 [5.8-7] months, DLO: 4.9 ± 0.2 [4.5-5.3] months, HTO: 5.6 ± 0.2 [5.2-6] months). The sport activity and functional scores improved significantly for all three groups, with no significant differences observed among the groups. CONCLUSION Various knee osteotomy procedures, DFO, DLO, and HTO, result in high RTS rates and quick RTS times with satisfactory functional scores. Despite pre- to post-operative improvements in sport activities following DFO and DLO, pre-symptom levels were not reached following all evaluated procedures. LEVEL OF EVIDENCE Retrospective case-control study, Level III.
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Affiliation(s)
- Jae-Sung An
- Tokyo Medical and Dental University, Tokyo, Japan
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Ahmed Mabrouk
- Leeds Teaching Hospitals, Leeds, UK
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Raghbir Khakha
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
- Guys and St. Thomas' Hospitals, Great Maze Pond, London, UK
| | - Kristian Kley
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
- Harley Street Specialist Hospital, 18-22, Queen Anne Street, London, W1G8HU, UK
- Orthopädie Maximilium, Donauwörth, Germany
| | | | - Christophe Jacquet
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France.
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Abs A, Micicoi G, Khakha R, Escudier JC, Jacquet C, Ollivier M. Clinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus Deformity. Orthop J Sports Med 2023; 11:23259671221148458. [PMID: 36814769 PMCID: PMC9940185 DOI: 10.1177/23259671221148458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background In bifocal varus deformity, double-level osteotomy (DLO) is advocated to treat lower limb alignment to prevent an adverse increase in joint line obliquity. Purpose/Hypothesis The purpose of this study was to compare the clinical and radiological results after DLO and open-wedge high tibial osteotomy (OWHTO) in patients with combined varus deformity. It was hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO. Study Design Cohort study; Level of evidence, 3. Methods Inclusion criteria were medial tibiofemoral compartment pain, varus knee deformity with an abnormal medial proximal tibial angle <84° and a lateral distal femoral angle >90°, a functional anterior cruciate ligament, failure of nonoperative treatment, and a minimum 2-year follow-up with all clinical and radiological data. The rate of return to work or sports; the Knee injury and Osteoarthritis Outcome Score (KOOS); the University of California, Los Angeles (UCLA) activity score; and patient satisfaction were assessed at a minimum of 2 years of follow-up. Statistical comparison of the 2 groups was made using the chi-square or Student t test. Results A total of 69 consecutive patients were analyzed, of whom 38 underwent OWHTO and 31 underwent DLO surgery. A significant between-group difference was found for all radiological parameters; in particular, there was less joint line obliquity after DLO compared with OWHTO (1.7° vs 5.6°; P < .001). DLO provided better outcomes compared with OWHTO regarding the UCLA score (4.3 vs 6.7; P < .001) and patient satisfaction (2.6 vs 3.9; P < .001), but no significant difference in KOOS or return to work or sports was observed. The OWHTO group had more hinge fractures than the DLO group (34.2% vs 12.9%; P < .001). Conclusion For combined tibial and femoral varus deformity, DLO produced more physiologic joint line obliquity with slightly improved UCLA and patient satisfaction scores. A greater incidence of hinge fracture was observed after isolated OWHTO compared with DLO due to a larger tibial correction; however, this had little effect on clinical results at the 2-year follow-up.
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Affiliation(s)
- Alice Abs
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France.,APHM, CNRS, ISM, Aix-Marseille University, Marseille, France
| | - Grégoire Micicoi
- IULS–University Institute for Locomotion and Sports, Pasteur 2 Hospital, Unité de Recherche Clinique Côte d’Azur (UR2CA), Hôpital Pasteur II, Nice, France
| | - Raghbir Khakha
- Guys and St. Thomas’ Hospitals, Great Maze Pond, London, UK
| | - Jean-Charles Escudier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France.,APHM, CNRS, ISM, Aix-Marseille University, Marseille, France
| | - Christophe Jacquet
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France.,APHM, CNRS, ISM, Aix-Marseille University, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France.,APHM, CNRS, ISM, Aix-Marseille University, Marseille, France.,Matthieu Ollivier, MD, PhD, Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France () (Instagram: @pr.matt.ollivier)
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Nakamura R, Kuroda K, Takahashi M, Katsuki Y. Open Wedge High Tibial Osteotomy with Pes Anserinus Preservation and Insertion of Bone Substitutes. Arthrosc Tech 2022; 11:e69-e78. [PMID: 35127431 PMCID: PMC8807857 DOI: 10.1016/j.eats.2021.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023] Open
Abstract
Biplanar open wedge high tibial osteotomy (OWHTO) has become common since the introduction of OWHTO-specific plates. However, the management of soft tissues, including skin, the pes anserinus, and the superficial medial collateral ligament (sMCL) release vary among surgeons. We introduce an OWHTO methodology that avoids pes incision and repair, uses bone substitute insertion into the opening gap and includes management of soft tissues to minimize complications. We adopted a reversed curved oblique incision to reduce the risk of saphenous nerve injury. We avoided pes incision, taking advantage of its posterior component force to allow it to function as a compressor of the ascending osteotomy site. The proximal component force of the pes provides compression between the bone substitute insertions and the proximal/distal cortices. This allows postoperative weight bearing to be distributed to the substitute, which may reduce the risk of implant failure. The sMCL is detached from the distal tibial attachment without cutting, enabling its return to its original position underneath the pes and to be repaired. This sMCL release with complete pes preservation may reduce the risk of deep infection or medial laxity during total knee arthroplasty conversion, and further reduce the risks of OWHTO.
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Affiliation(s)
- Ryuichi Nakamura
- Harue Hospital, Joint Preservation and Sports Orthopaedic Center, Sakai, Japan
| | - Kazunari Kuroda
- Yawata Medical Center, Department of Orthopaedic Surgery, Komatsu, Japan
| | - Masaki Takahashi
- Yawata Medical Center, Department of Orthopaedic Surgery, Komatsu, Japan
| | - Yasuo Katsuki
- Yawata Medical Center, Department of Orthopaedic Surgery, Komatsu, Japan
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