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van Zantvoort APM, de Bruijn JA, Hundscheid HPH, Teijink JAW, Scheltinga MR. Lower Leg Lateral Chronic Exertional Compartment Syndrome: Prospective Surgical Treatment Outcomes for Isolated or Combined Lateral Fasciotomy. Foot Ankle Int 2023; 44:1097-1104. [PMID: 37724857 DOI: 10.1177/10711007231192076] [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] [Indexed: 09/21/2023]
Abstract
BACKGROUND Chronic exertional compartment syndrome involving the lower leg lateral compartment (lat-CECS) seldom occurs isolated but is usually combined with CECS of the anterior (ant-CECS) or deep posterior compartment (dp-CECS). Patient characteristics in lat-CECS and outcome after surgery are largely unknown. The aim of this prospective case series was to describe patient characteristics and symptoms and to report on outcome following a fasciotomy. METHODS All patients diagnosed with lat-CECS based on exertional lateral lower leg symptoms and elevated intracompartmental pressure (ICP) measurements according to the Pedowitz criteria (ICP ≥ 15 mm Hg at rest, and/or ≥30 mm Hg after 1 minute, and/or ≥20 mm Hg 5 minutes after exercise) were eligible for this study. A standard intake questionnaire scoring symptom patterns was completed by all patients. Patients who were operated for lat-CECS were asked to complete a 3-month and 12-month postoperative questionnaire scoring symptoms and surgical outcome. Patients with a history of CECS surgery, recent lower leg trauma, or peripheral neurovascular disease were excluded. RESULTS A total of 881 patients with possible lower leg CECS completed an intake questionnaire and 88 (10%) were diagnosed with lat-CECS according to the Pedowitz criteria (isolated lat-CECS n = 10; lat/ant CECS n = 54, lat/ant/dp CECS n = 19, lat/dp CECS n = 5). Severe pain during exercise and moderate tightness during rest were frequently reported. A group of 28 patients (49 legs; isolated lat-CECS n = 2; lat/ant CECS n = 22, lat/ant/dp CECS n = 3, lat/dp CECS n = 1) was analyzed after fasciotomy. Complications were minor (wound infection requiring antibiotics, n = 3; temporary complex regional pain syndrome with spontaneous recovery, n = 1). Superficial peroneal nerve damage was not observed. One year after surgery, 64% rated outcome as excellent or good, whereas 71% had resumed sports activities. CONCLUSION One in 10 patients with anterolateral exertional lower leg pain evaluated in a tertiary referral center met diagnostic criteria for lat-CECS. Pain and tightness were present during exertion and were often reported occurring during rest and at night. In this series, we found fasciotomy-either an isolated (lateral) or a multiple (combined with anterior and/or deep posterior) compartment fasciotomy-is safe and beneficial in most patients. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Aniek P M van Zantvoort
- Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands
- Caphri Research School, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johan A de Bruijn
- Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands
- Caphri Research School, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Joep A W Teijink
- Caphri Research School, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Marc R Scheltinga
- Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands
- Caphri Research School, Maastricht University Medical Center, Maastricht, the Netherlands
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2
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Richards JA, Williams MD, Gupta NA, Smith LS, Malkani AL. Neutral Mechanical Alignment Alters the Native Distal Femoral Joint Line: A Virtual Three-Dimensional Planning Total Knee Arthroplasty Study. J Arthroplasty 2023; 38:484-90. [PMID: 36122689 DOI: 10.1016/j.arth.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Alternative alignment concepts have garnered great interest in an effort to improve patient satisfaction following primary total knee arthroplasty (TKA). The purpose of this study is to determine variation or deviation from an individual's native joint line in primary TKA using neutral mechanical versus a restricted kinematic technique. METHODS An institutional review board-approved prospective cohort study was performed evaluating the effect of neutral mechanical alignment (nMA) versus a restricted kinematic alignment (rKA) on the native joint line in 100 consecutive patients undergoing primary TKA. Using preoperative computed tomography and intraoperative 3-dimensional software, 2 virtual preoperative plans were created: nMA and rKA. Templated bone resections were recorded. Change in joint line was calculated using known implant planar thickness and planned bone resection. RESULTS nMA yielded significantly greater deviation from the patient's native joint line along the lateral compartment of the knee (lateral distal femoral condyle, lateral posterior femoral condyle, lateral tibial resection). With nMA, the lateral distal femoral joint line was distalized by a mean 4.3 versus 2.6 mm using rKA technique (P < .001). In rKA, >60% of knees had <3 mm of deviation from the native lateral posterior femoral offset, whereas in nMA, >95% of knees had ≥3 mm change in the lateral posterior femoral condylar offset. CONCLUSION nMA-TKA resulted in statistically larger joint line deviations compared to rKA-TKA, most notably along the lateral distal femoral condyle joint line. Further analysis is needed to determine the clinical consequences of joint line deviation from the native anatomy using nMA as the target for primary TKA.
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3
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Zheng N, Dai H, Zou D, Dimitriou D, Wang Q, Tsai TY. Altered In Vivo Knee Kinematics and Lateral Compartment Contact Position During the Single-Leg Lunge After Medial Unicompartmental Knee Arthroplasty. Orthop J Sports Med 2023; 11:23259671221150958. [PMID: 36846813 PMCID: PMC9947695 DOI: 10.1177/23259671221150958] [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: 02/25/2023] Open
Abstract
Background Osteoarthritis (OA) progression in the lateral compartment is the most common reason for revision after medial unicompartmental knee arthroplasty (UKA). Altered contact kinematics in the lateral compartment may be related to the pathogenesis of OA. Purpose To quantify the in vivo 6 degrees of freedom (6-DOF) knee kinematics and contact points in the lateral compartment during a single-leg lunge in knees after medial UKA and compare them with the contralateral native knee. Study Design Descriptive laboratory study. Methods Included were 13 patients (3 male, 10 female; mean age, 64.7 ± 6.2 years) who had undergone unilateral medial UKA. All patients underwent computed tomography preoperatively and 6 months postoperatively, and bilateral knee posture was tracked using dual fluoroscopic imaging system during a single-leg deep lunge to evaluate the in vivo 6-DOF kinematics. The closest points between the surface models of the femoral condyle and the tibial plateau were determined to locate the lateral compartment contact positions. The Wilcoxon signed-rank test was used to compare knee kinematics and lateral contact position between the UKA and native knees. Spearman correlation was used to test the associations of bilateral 6-DOF range difference and lateral compartment contact excursion difference with bilateral limb alignment difference and functional scores. Results Compared with native knees, UKA knees had an increased anterior femoral translation of 2.0 ± 0.3 mm during the entire lunge (P < .05). The lateral contact position in UKA knees was located 2.0 ± 0.9 mm posteriorly and with 3.3 ± 4.0 mm less range of contact excursion than native knees (P < .05). Decreased range of lateral compartment contact excursion in the anterior-posterior direction was significantly associated with increased hip-knee-ankle angle in the UKA side (P < .05). Conclusion The current study revealed altered knee 6-DOF kinematics and the reduced contact excursion range during single-leg lunge after unilateral medial UKA. Clinical Relevance The altered contact kinematics and reduced range of contact excursion in UKA knees could lead to excessive cumulative articular surface contact stress, which is implicated in the pathogenesis of OA.
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Affiliation(s)
- Nan Zheng
- School of Biomedical Engineering and Med-X Research Institute,
Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical
Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical
Translation R&D Center of 3D Printing Technology, Department of Orthopaedic
Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
| | - Huiyong Dai
- Department of Orthopedics, Shanghai Sixth People’s Hospital
Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai,
China
| | - Diyang Zou
- School of Biomedical Engineering and Med-X Research Institute,
Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical
Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical
Translation R&D Center of 3D Printing Technology, Department of Orthopaedic
Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, Zürich,
Switzerland
| | - Qi Wang
- Department of Orthopedics, Shanghai Sixth People’s Hospital
Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai,
China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute,
Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical
Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical
Translation R&D Center of 3D Printing Technology, Department of Orthopaedic
Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China.,Tsung-Yuan Tsai, PhD, School of Biomedical Engineering and Med-X
Research Institute, Shanghai Jiao Tong University; Engineering Research Center
of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai
200030, China ()
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4
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Kim HJ, Shin JY, Lee HJ, Jung CH, Park KH, Oh CW, Kyung HS. Open-wedge high tibial osteotomy in patients with discoid lateral meniscus. J Orthop Surg (Hong Kong) 2021; 29:23094990211017355. [PMID: 34114526 DOI: 10.1177/23094990211017355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There are concerns about the progression of the lateral osteoarthritis (OA) should be taken into account when high tibial osteotomy (HTO) is performed in patients with discoid lateral meniscus (LM). This study evaluated the clinical results of HTO in patients with discoid LM and elucidated factors affecting the results. METHODS This study evaluated 32 female patients with varus deformity and medial OA. Patients with discoid LM (8 patients) or without discoid LM (24 patients) underwent open-wedge HTO. The mean age was 53.5 years and the mean follow-up period was 35 months. Clinical results, including the Hospital for Special Surgery (HSS) score, Knee Society knee score (KS) and function score (FS), were evaluated. The progression of OA in the lateral compartment was also evaluated. Finally, we evaluated the factors affecting the clinical results and OA progression in the lateral compartment. RESULTS Between two groups, all clinical scores were not different (p = 0.964, 0.963, and 0.559, respectively). Three of eight patients (37.5%) in the discoid group developed OA in the lateral compartment, whereas 2 of 24 patients (8.3%) in the control group developed such; however, this was not significantly different (p = 0.085). In discoid group, patients with undercorrection has higher KS relative to patients with acceptable correction (p = 0.044). Other clinical results and OA change in the lateral compartment were not affected by evaluated factors. CONCLUSIONS Patients who underwent open-wedge HTO showed the satisfactory clinical results and lateral OA progression regardless of the presence or absence discoid LM. However, when discoid LM was present, patients with undercorrection showed higher KS in comparison with patients with acceptable correction.
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Affiliation(s)
- Hee-June Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chul-Hee Jung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Hee-Soo Kyung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Vestergaard V, Colon Iban YE, Kappel A, Melnic CM, Bedair H, Huddleston JI 3rd, Bragdon CR, Malchau H, Troelsen A. Do Knee Osteoarthritis Patterns Affect Patient-Reported Outcomes in Total Knee Arthroplasty? Results From an International Multicenter Prospective Study With 3-Year Follow-Up. J Arthroplasty 2021; 36:507-13. [PMID: 32919849 DOI: 10.1016/j.arth.2020.08.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/08/2020] [Accepted: 08/17/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this multicenter study is to answer (1) Does patellofemoral osteoarthritis (OA) affect preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) scores in total knee arthroplasty (TKA)? and (2) Do different OA patterns affect preoperative and postoperative KOOS scores in TKA? METHODS This international, multicenter prospective study examined 384 TKA patients. Compartmental OA was divided into (1) medial, (2) medial + patellofemoral, (3) lateral, (4) lateral + patellofemoral, (5) medial + lateral (bicompartmental), and (6) medial + lateral + patellofemoral (tricompartmental), based on preoperative anterior-posterior and lateral ± skyline radiographs with Kellgren-Lawrence grade III-IV and joint space width <2.5 mm. KOOS was collected preoperatively, 1 year postoperatively, and 3 years postoperatively. Higher KOOS score represented better clinical state, for example, higher KOOS Pain score indicated less pain. RESULTS Patellofemoral OA had no effect on preoperative KOOS scores (P > .15). Compared to medial ± patellofemoral OA patients, bicompartmental/tricompartmental OA patients had less preoperative pain (KOOS Pain 7.4, P = .03) and higher daily function (KOOS-ADL [Activities of Daily Living] 7.1, P = .05), and higher 1-year postoperative daily function (KOOS-ADL 9.2, P = .03) and sports activity (KOOS Sports & Recreation Function 15.0, P = .04), while lateral ± patellofemoral OA patients had more symptoms (KOOS-Symptoms 7.0, P < .01), more pain (KOOS-Pain 7.5, P = .01), lower daily function (KOOS-ADL 9.3, P < .01), and lower quality of life (KOOS-QOL 9.0, P = .04), at 3 years postoperatively. CONCLUSION Patellofemoral OA does not affect medial ± lateral OA patients' preoperative KOOS scores, challenging the importance of patellofemoral OA in TKA. Lateral ± patellofemoral OA patients have lower postoperative KOOS scores than medial/more progressed compartmental OA patients, indicating that patients with less common OA patterns present with unique surgical challenges. Further development of indications for and correct timing of TKA surgery in different patient subgroups is needed.
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6
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Tu Y, Ma T, Wen T, Yang T, Xue L, Xue H. Does Unicompartmental Knee Replacement Offer Improved Clinical Advantages Over Total Knee Replacement in the Treatment of Isolated Lateral Osteoarthritis? A Matched Cohort Analysis From an Independent Center. J Arthroplasty 2020; 35:2016-2021. [PMID: 32265142 DOI: 10.1016/j.arth.2020.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 02/04/2020] [Revised: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to compare the functional and radiographic results, perioperative complications, satisfaction rate, and mid-term survivorship after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) for the treatment of lateral compartmental knee osteoarthritis (LCKO). METHODS Between March 2007 and September 2017, we identified 35 patients with primary TKAs and 121 patients with lateral UKAs (LUKAs) for LCKO with a minimum follow-up of 2 years (mean 5.3 years, range 2-12.4). The matched variables were age, gender, operation side, body mass index, American Society of Anesthesiologist grade, initial diagnosis, osteoarthritis grade in lateral compartment, and follow-up time. All patients were assessed using the Oxford Knee Score, Hospital for Special Surgery score, range of motion, length of hospital stay, satisfaction, and complications. Survivorship of UKA and TKA implants was also compared. RESULTS At last follow-up, LUKA had a significantly better postoperative Oxford Knee Score, Hospital for Special Surgery score, range of motion, shorter length of hospital time, and higher satisfaction rate than matched TKA group. There were significant differences regarding patellar tendon injury (P = .043), superficial wound infection (P = .028), patellar snapping or impingement (P = .047), and stiffness (P < .001). Five-year survivorships free from revision were similar in both groups (99.2% vs 97.1%, P = .347). CONCLUSION LUKA for LCKO demonstrated more favorable 5-year results in comparison with TKA. Furthermore, LUKA achieved comparable mid-term survivorship and was less likely to suffer from wound infection and knee stiffness, although not overall surgical complications.
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Affiliation(s)
- Yihui Tu
- Department of Orthopaedics, Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Tong Ma
- Department of Orthopaedics, Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Tao Wen
- Department of Orthopaedics, Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Tao Yang
- Department of Orthopaedics, Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Long Xue
- Department of Orthopaedics, Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Huaming Xue
- Department of Orthopaedics, Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China
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7
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Kim DH, Kim SC, Yoon JS, Lee YS. Are There Harmful Effects of Preoperative Mild Lateral or Patellofemoral Degeneration on the Outcomes of Open Wedge High Tibial Osteotomy for Medial Compartmental Osteoarthritis? Orthop J Sports Med 2020; 8:2325967120927481. [PMID: 32637430 PMCID: PMC7313345 DOI: 10.1177/2325967120927481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background Early osteoarthritis of the knee joint mostly affects the medial compartment, making osteotomy a rational approach to slow the progression of the disease. However, some patients show asymptomatic mild degeneration in the lateral or patellofemoral compartment. Purpose To evaluate the effect of asymptomatic mild lateral or patellofemoral degeneration on the outcomes of medial open wedge high tibial osteotomy (OWHTO) by assessing the outcomes according to the preoperative status of the lateral or patellofemoral degenerative changes. Study Design Cohort study; Level of evidence, 3. Methods A total of 114 patients (121 knees) who underwent biplanar OWHTO with second-look arthroscopic surgery and postoperative magnetic resonance imaging (MRI) were retrospectively enrolled. Patients were categorized into 4 groups according to the Osteoarthritis Research Society International (OARSI) and MRI Osteoarthritis Knee Score (MOAKS) classification systems. The International Cartilage Repair Society (ICRS) grade was used to evaluate the preoperative and postoperative cartilage status. Clinical outcomes were assessed by the American Knee Society (AKS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-item Short Form Health Survey (SF-36). Results No degenerative changes in the lateral and patellofemoral compartments of knees (group I) were identified in 51.2% of cases (62 knees). Asymptomatic degenerative changes only in the lateral compartment (group II: OARSI grades 1-3 and MOAKS grades 1-3) were identified in 15.7% of cases (19 knees), changes only in the patellofemoral compartment (group III: OARSI grades 1-3 and MOAKS grades 1-3) were identified in 10.7% of cases (13 knees), and changes in both the lateral and the patellofemoral compartments (group IV) were identified in 22.3% of cases (27 knees). In the medial compartment, there was no significant difference in the improvement of MOAKS and ICRS grades among all groups (P = .813 and .985, respectively). In the lateral and patellofemoral compartments, there was no significant difference in the decline of MOAKS (P = .649 and .421, respectively) and ICRS grades (P = .927 and .676, respectively) among all groups. Conclusion The presence of mild lateral or patellofemoral degenerative changes did not affect the MRI, arthroscopic, and clinical outcomes of OWHTO. However, long-term observations are necessary to draw definitive conclusions as to whether OWHTO can be indicated in such patients without harmful effects.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seong Chan Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ji Soo Yoon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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8
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van Zantvoort APM, Hundscheid HPH, de Bruijn JA, Hoogeveen AR, Teijink JAW, Scheltinga MRM. Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity? Orthop J Sports Med 2020; 7:2325967119890105. [PMID: 31903402 PMCID: PMC6931149 DOI: 10.1177/2325967119890105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/16/2022] Open
Abstract
Background: Chronic exertional compartment syndrome (CECS) mostly occurs in the anterior
or deep posterior compartments (ant-CECS and dp-CECS, respectively) of the
leg. It is generally accepted that CECS of the third or lateral compartment
(lat-CECS) always occurs together with ant-CECS. However, whether exertional
leg pain (ELP) can be caused by an isolated form of lat-CECS is unknown. Purpose: To determine the existence of isolated lat-CECS and study whether history
taking and a physical examination aid in discriminating between different
subtypes of CECS. Study Design: Case series; Level of evidence, 4. Methods: Patients were eligible for this single-center study, conducted between
January 2013 and February 2018, if they reported anterolateral ELP and
completed a questionnaire scoring the frequency and intensity of pain,
tightness, cramps, muscle weakness, and paresthesia during rest and
exercise. They were asked to mark areas of altered foot skin sensation, if
present, on a drawing. All patients underwent a dynamic intracompartmental
pressure (ICP) measurement of the anterior and lateral compartments
simultaneously. The diagnosis of CECS was confirmed by elevated ICP
(Pedowitz criteria). There were 3 patient groups: (1) isolated ant-CECS with
elevated ICP in the anterior compartment and normal ICP in the lateral
compartment, (2) isolated lat-CECS with elevated ICP in the lateral
compartment but normal ICP in the anterior compartment, and (3)
ant-/lat-CECS with elevated ICP in both the anterior and lateral
compartments. Results: A total of 73 patients with anterolateral ELP fulfilled study criteria
(isolated ant-CECS: n = 26; isolated lat-CECS: n = 5; ant-/lat-CECS: n =
42). Group differences were not observed regarding age (isolated ant-CECS:
median, 26 years [range, 13-68 years]; isolated lat-CECS: median, 20 years
[range, 17-63 years]; ant-/lat-CECS: median, 28 years [range, 17-57 years];
χ2 (2) = 0.466; P = .79), sex (isolated
ant-CECS: 50% male; isolated lat-CECS: 40% male; ant-/lat-CECS: 62% male;
P = .49), or bilateral symptoms (isolated ant-CECS:
54%; isolated lat-CECS: 80%; ant-/lat-CECS: 69%; P = .40).
However, cramps at rest were present in a portion of the patients with
isolated ant-CECS (38%) and ant-/lat-CECS (57%) but not in those with
isolated lat-CECS (P = .032). Patient drawings of altered
foot skin sensation did not contribute to the diagnosis (P
= .92). ICP values after provocation were all lower in patients with
isolated ant-CECS and isolated lat-CECS compared with those with
ant-/lat-CECS (P < .05). Conclusion: Seven percent of patients with CECS and anterolateral ELP who had symptoms
due to isolated lat-CECS in the presence of normal muscle pressure in the
anterior compartment.
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Affiliation(s)
- Antonia P M van Zantvoort
- Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Johan A de Bruijn
- Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Adwin R Hoogeveen
- Department of Sports Medicine, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands
| | - Joep A W Teijink
- Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Marc R M Scheltinga
- Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands
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9
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Baron JE, Day MA, DeMik DE, Westermann RW, Wolf BR. Return to Collegiate Athletics After Distal Femoral Osteotomy: A Report of Three Cases and Review of the Literature. Iowa Orthop J 2020; 40:143-146. [PMID: 32742222 PMCID: PMC7368529] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The authors present three cases of high-level athletes with successful return to competitive collegiate athletics following distal femoral osteotomy for knee lateral compartment overload. CONCLUSION Distal femoral varus osteotomy (DFO) is used to treat valgus knee malalignment and to offload the lateral knee compartment in the setting of symptomatic cartilage or meniscus pathology. DFO can be considered a viable treatment for collegiate athletes, with satisfactory outcomes and ability to return to sport participation at pre-injury functional levels.Level of Evidence: IV.
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Affiliation(s)
- Jacqueline E Baron
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
| | - Molly A Day
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
| | - David E DeMik
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
| | - Robert W Westermann
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
| | - Brian R Wolf
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
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10
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Kinsey TL, Anderson DN, Phillips VM, Mahoney OM. Disease Progression After Lateral and Medial Unicondylar Knee Arthroplasty. J Arthroplasty 2018; 33:3441-3447. [PMID: 30122434 DOI: 10.1016/j.arth.2018.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/17/2018] [Revised: 07/02/2018] [Accepted: 07/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Medial unicompartmental knee arthroplasty (UKA) has been a successful option for treatment of arthritis in patients with a healthy lateral compartment. However, lateral UKA is less common and results are less consistent. The purpose of this study is to compare progression of radiographically evident osteoarthritis in unoperated compartments during 5 years after lateral and medial UKA. METHODS We undertook serial radiographic evaluation of 20 lateral and 114 medial UKA performed by the senior author during calendar years 2007-2008. Anteroposterior, lateral, and skyline radiographs obtained preoperatively and 1 and 5+ (mean, 5.3; range, 5.1-6.4) years postoperatively were independently graded for osteoarthritis in the unoperated tibiofemoral (TF) and patellofemoral (PF) compartments using established scales of Kellgren (0-4 point global scale for osteoarthritis), Ahlbäck (0-5 point scale based on joint space narrowing), and Altman (0-12 point composite criteria score). Rates of disease progression were compared between lateral and medial UKA groups using bivariate methods and multilevel growth models that adjusted for baseline characteristics. RESULTS All mean disease grades for the TF and PF compartments increased (worsened) over time. The adjusted rate of Kellgren grade change was statistically (P < .05) faster for lateral UKA in the TF and PF compartments, as was Ahlbäck change in the TF compartment. Kellgren grade for the TF compartment of lateral and medial UKA groups increased 1.1 vs 0.6 points on average over 5 years adjusted for age, sex, and body mass index (P < .001). CONCLUSION Surgeons should consider the propensity for faster disease progression after UKA in evaluating patients with isolated lateral compartment disease. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | | | - Val M Phillips
- North Metropolitan Radiology Associates, Lawrenceville, GA
| | - Ormonde M Mahoney
- Athens Orthopedic Clinic, Athens, GA; Department of Kinesiology, University of Georgia, Athens, GA
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11
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van Zantvoort APM, Setz MJM, Hoogeveen AR, Scheltinga MRM. Common Peroneal Nerve Entrapment in the Differential Diagnosis of Chronic Exertional Compartment Syndrome of the Lateral Lower Leg: A Report of 5 Cases. Orthop J Sports Med 2018; 6:2325967118787761. [PMID: 30148178 PMCID: PMC6100130 DOI: 10.1177/2325967118787761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Aniek P M van Zantvoort
- Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands.,Caphri Research School, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maikel J M Setz
- Department of Neurology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Adwin R Hoogeveen
- Department of Sports Medicine, Máxima Medical Center, Veldhoven, the Netherlands
| | - Marc R M Scheltinga
- Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands.,Caphri Research School, Maastricht University Medical Center, Maastricht, the Netherlands
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12
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Song GY, Zhang H, Zhang J, Liu X, Xue Z, Qian Y, Feng H. Greater Static Anterior Tibial Subluxation of the Lateral Compartment After an Acute Anterior Cruciate Ligament Injury Is Associated With an Increased Posterior Tibial Slope. Am J Sports Med 2018; 46:1617-1623. [PMID: 29578774 DOI: 10.1177/0363546518760580] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Static anterior tibial subluxation of the lateral compartment after an anterior cruciate ligament (ACL) injury highlights an increased anterior position of the tibia relative to the femur. However, the precise cause of this phenomenon is not entirely clear. Recently, an increased posterior tibial slope (PTS) has been identified as an independent risk factor for noncontact ACL injuries. HYPOTHESIS An increased PTS is associated with an increased anterior position of the lateral compartment of the tibia relative to the femur after acute ACL injuries. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS From March 2016 to March 2017, a total of 154 patients with clinically diagnosed noncontact ACL injuries who underwent primary ACL reconstruction were retrospectively analyzed. Static anterior subluxation of the lateral compartment relative to the lateral femoral condyle was measured on preoperative magnetic resonance imaging. Among them, 23 patients (study group) who demonstrated ≥6-mm anterior subluxation of the lateral compartment were matched in a 1:1 fashion to 23 control participants (control group), who showed <6-mm anterior subluxation of the lateral compartment. The PTS was measured on routinely available preoperative weightbearing lateral knee radiographs. Predictors of increased (≥6 mm) static anterior subluxation of the lateral compartment, including body mass index (BMI), PTS, injuries to the anterolateral ligament (ALL), and concomitant lateral meniscal lesions, were assessed by multivariable conditional logistic regression analysis. RESULTS The mean PTS in the study group was 15.4°, which was significantly larger than that in the control group (8.8°) ( P < .001). In addition, an abnormal degree of PTS (≥10.0°) was determined to be an independent risk factor (odds ratio, 8.0 [95% CI, 2.7-29.2]; P < .001) associated with ≥6-mm anterior subluxation of the lateral compartment after acute ACL injuries. However, BMI, presence of concomitant lateral meniscal lesions, and presence of ALL ruptures were not. CONCLUSION An increased PTS was identified to be an independent anatomic risk factor of increased (≥6 mm) anterior subluxation of the lateral compartment in acute noncontact ACL injuries. For patients with obviously increased anterior tibial subluxation of the lateral compartment after ACL injuries, the PTS should be measured.
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Affiliation(s)
- Guan-Yang Song
- Sports Medicine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Hui Zhang
- Sports Medicine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Jin Zhang
- Sports Medicine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Xin Liu
- Sports Medicine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Zhe Xue
- Sports Medicine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Yi Qian
- Sports Medicine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Hua Feng
- Sports Medicine Department, Beijing Jishuitan Hospital, Beijing, China
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13
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Teitge RA. CORR Insights(®): Lateral-compartment Osteophytes are not Associated With Lateral-compartment Cartilage Degeneration in Arthritic Varus Knees. Clin Orthop Relat Res 2017; 475:1393-4. [PMID: 28236082 DOI: 10.1007/s11999-016-5192-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 01/31/2023]
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van Zantvoort APM, de Bruijn JA, Winkes MB, Dielemans JP, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Scheltinga MR. Isolated Chronic Exertional Compartment Syndrome of the Lateral Lower Leg: A Case Series. Orthop J Sports Med 2016; 3:2325967115617728. [PMID: 26740955 PMCID: PMC4687834 DOI: 10.1177/2325967115617728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/26/2022] Open
Abstract
Background: Exercise-induced lower leg pain may be caused by chronic exertional compartment syndrome (CECS). The anterior (ant-CECS) or deep posterior compartment (dp-CECS) is usually affected. Knowledge regarding CECS of the lateral compartment (lat-CECS) is limited. Purpose: To describe demographic characteristics and symptoms in a consecutive series of patients with isolated CECS of the lateral compartment of the leg. Study Design: Case series; Level of evidence, 4. Methods: Since 2001, patients undergoing dynamic intracompartmental pressure (ICP) measurements for suspected CECS in a single institution were prospectively monitored. Individuals with a history possibly associated with lat-CECS and elevated ICP measurements (Pedowitz criteria) were identified. Exclusion criteria were concomitant ipsilateral ant-CECS/dp-CECS, acute compartment syndrome, recent significant trauma, peroneal nerve entrapment, or vascular claudication. Results: During an 11-year time period, a total of 26 patients with isolated lat-CECS fulfilled study criteria (15 females; median age, 21 years; range, 14-48 years). Frequently identified provocative sports were running (n = 4), walking (n = 4), field hockey (n = 3), soccer (n = 3), and volleyball (n = 2). Exercise-induced lateral lower leg pain (92%) and tightness (42%) were often reported. The syndrome was bilateral in almost two-thirds (62%, n = 16). Delay in diagnosis averaged 24 months (range, 2 months to 10 years). Conclusion: Young patients with exercise-induced pain in the lateral portions of the lower leg may suffer from isolated CECS of the lateral compartment. ICP measurements in the lateral compartment in these patients are recommended.
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Affiliation(s)
| | - Johan A de Bruijn
- Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands
| | - Michiel B Winkes
- Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands
| | - Jeanne P Dielemans
- Máxima Medical Center Academy, Máxima Medical Center, Veldhoven, the Netherlands
| | | | - Adwin R Hoogeveen
- Department of Sports Medicine, Máxima Medical Center, Veldhoven, the Netherlands
| | - Marc R Scheltinga
- Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands
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Harris JD, Hussey K, Saltzman BM, McCormick FM, Wilson H, Abrams GD, Cole BJ. Cartilage Repair With or Without Meniscal Transplantation and Osteotomy for Lateral Compartment Chondral Defects of the Knee: Case Series With Minimum 2-Year Follow-up. Orthop J Sports Med 2014; 2:2325967114551528. [PMID: 26535271 PMCID: PMC4555547 DOI: 10.1177/2325967114551528] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 11/20/2022] Open
Abstract
Background: Treatment decision making for chondral defects in the knee is multifactorial. Articular cartilage pathology, malalignment, and meniscal deficiency must all be addressed to optimize surgical outcomes. Purpose: To determine whether significant clinical improvements in validated clinical outcome scores are observed at minimum 2-year follow-up after articular cartilage repair of focal articular cartilage defects of the lateral compartment of the knee with or without concurrent distal femoral osteotomy and lateral meniscus transplant. Study Design: Case series; Level of evidence, 4. Methods: Symptomatic adults who underwent surgical treatment (microfracture, autologous chondrocyte implantation [ACI], osteochondral autograft or allograft) of full-thickness lateral compartment chondral defects of the knee with or without a postmeniscectomy compartment or valgus malalignment by a single surgeon with minimum 2-year follow-up were analyzed. Validated patient-reported and surgeon-measured outcomes were collected pre- and postsurgery. Pre- and postoperative outcomes were compared via Student t tests. Results: Thirty-five subjects (mean age, 29.6 ± 10.5 years) were analyzed. Patients had been symptomatic for 2.51 ± 3.52 years prior to surgery and had undergone 2.11 ± 1.18 surgeries prior to study enrollment, with a mean duration of follow-up of 3.65 ± 1.71 years. The mean defect size was 4.42 ± 2.06 cm2. Surgeries included ACI (n = 18), osteochondral allograft (n = 14), osteochondral autograft (n = 2), and microfracture (n = 1). There were 18 subjects who underwent concomitant surgery (14 lateral meniscus transplant, 3 distal femoral osteotomy, and 1 combined). Statistically significant (P < .05) and clinically meaningful improvements were observed at final follow-up in Lysholm, subjective International Knee Documentation Committee (IKDS), Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, Short Form–12 (SF-12) scores, and patient satisfaction. At follow-up, patients undergoing isolated articular cartilage surgery had a significantly higher KOOS quality of life subscore than did those undergoing articular cartilage surgery and lateral meniscus transplant (P = .039). Otherwise, there were no significant postoperative differences between the isolated and combined surgery groups in any outcome score. Five patients underwent 6 reoperations (1 revision osteochondral allograft, 5 chondroplasties). No patient was converted to knee arthroplasty. Conclusion: In patients with lateral compartment focal chondral defects with or without lateral meniscal deficiency and valgus malalignment, surgical cartilage repair and correction of concomitant pathology can significantly improve clinical outcomes at 2-year follow-up with no significant differences between isolated and combined surgery and a low rate of complications and reoperations.
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Affiliation(s)
- Joshua D Harris
- Center for Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA. ; Center for Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Kristen Hussey
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bryan M Saltzman
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Frank M McCormick
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Hillary Wilson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Geoffrey D Abrams
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. ; Department of Orthopaedic Surgery, Veterans Administration Palo Alto, Stanford University, Palo Alto, California, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Heijink A, Morrey BF, Eygendaal D. Radiocapitellar prosthetic arthroplasty: a report of 6 cases and review of the literature. J Shoulder Elbow Surg 2014; 23:843-9. [PMID: 24739796 DOI: 10.1016/j.jse.2014.01.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 06/16/2013] [Revised: 01/16/2014] [Accepted: 01/27/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radiocapitellar prosthetic arthroplasty has recently been introduced to treat isolated degenerative arthritis of the radiocapitellar joint. Although this procedure is conceptually attractive and sound in situations in which radial head resection is inadequate, clinical experience is still limited. Its role in the treatment of isolated radiocapitellar degenerative arthritis in the ligamentous-intact elbow and forearm is not yet defined. Our purpose was to report the short-term results of 6 patients who were treated by radiocapitellar prosthetic arthroplasty for isolated radiocapitellar degenerative arthritis in the ligamentous-intact elbow, as well as to provide a review of the literature. METHODS Six patients were treated by radiocapitellar prosthetic arthroplasty for isolated degenerative arthritis of the radiocapitellar joint in the ligamentous-intact elbow. Their medical records were reviewed, and each patient was seen in the office. The mean follow-up period was 50 months (range, 30-64 months). RESULTS The implant survival rate was 100%. Pain improved in all patients and all patients were satisfied. The mean flexion-extension arc increased from 98° (range, 75°-115°) to 110° (range, 105°-120°) (P = .17), and the mean pronation-supination arc increased from 133° (range, 75°-115°) to 143° (range, 120°-170°) (P = .34). The mean Disabilities of the Arm, Shoulder and Hand score was 24.3 (range, 6.7-52.5). According to the Mayo Elbow Performance Score, there were 3 excellent and 3 good results. CONCLUSION The short-term follow-up results of radiocapitellar prosthetic arthroplasty for isolated radiocapitellar degenerative arthritis in the ligamentous-intact elbow and forearm seem favorable. LEVEL OF EVIDENCE Level IV, case series, treatment study.
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Affiliation(s)
- Andras Heijink
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
| | - Bernard F Morrey
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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