Distal tibial oblique osteotomy for reconstruction of ankle joint congruity and stability

Teramoto distal tibial oblique osteotomy (DTOO) is a joint-preserving surgery for ankle osteoarthritis (AOA). However, there are few articles on the radiological assessment of DTOO. The purpose of this study was to report the clinical outcomes and radiological evaluations of weight-bearing radiographs before and after DTOO.We retrospectively reviewed 52 patients who underwent DTOO between 2007 and 2018. We recorded the Tanaka–Takakura classification, fixation methods, Japanese Society for Surgery of the Foot Ankle/Hindfoot Scale (JSSF scale), and complications. The tibial articular surface angle (TAS), medial malleolar angle (MMA), tibial lateral surface angle (TLS), talar tilt angle (TTA), and tibiotalar surface angle (TTS) were evaluated using weight-bearing ankle radiographs.The median patient age was 66 years, and the mean follow-up duration was 46 ± 23 months. Two stage 2, 9 stage 3a, 30 stage 3b, and 11 stage 4 according to the Tanaka–Takakura classification were performed using DTOO. The JSSF scale improved significantly from 39.9 ± 13.8 before surgery to 87.2 ± 7.5 after surgery. Seven cases were fixed using a locking plate, and 45 cases were fixed using a circular external fixator. The TAS, MMA, TLS, TTA, and TTS significantly changed before and after DTOO.Radiological evaluation indicated that DTOO influences talar behavior during weight-bearing, and improves the clinical outcomes of AOA.     

The Teramoto distal tibial oblique osteotomy (DTOO): surgical technique and applicability for ankle osteoarthritis with varus deformity

We have devised a medial peri-articular osteotomy, the distal tibial oblique osteotomy (DTOO), and have used this technique since 1994 for ankle osteoarthritis of advanced and late stages associated with varus inclination. This report describes the surgical technique and its applicability. DTOO can be used for cases of varus ankle osteoarthritis with a range of the ankle joint movement of at least 10° or more. The osteotomy is obliquely directed cut across the distal tibia from proximal-medial to distal lateral and is of an opening-wedge type with the centre of rotation coincident with the centre of the tibiofibular joint. A laminar spreader instrument is inserted in the osteotomy to open the wedge until the lateral surface of the talar body is seen on X-ray to be in contact and congruent with medial articular surface of the lateral malleolus. Common obstacles which may prevent this contact and congruency are bony spurs present on the anterior side of fibula or on the lateral side of the tibia; these require removal. The opening-wedge osteotomy is held in position by an Ilizarov external fixator or internally fixed with a plate. Bone graft is taken from the iliac crest and inserted into the open wedge. If, after completion of the osteotomy, the dorsiflexion angle of the ankle joint does not exceed 0°, a Z-lengthening is performed of the Achilles tendon. In the DTOO for ankle osteoarthritis, the contact area of the ankle joint increases and decreases the load pressure per unit area. Furthermore, as the width of the ankle mortice is restored through the realignment of the body of the talus, instability at the ankle joint decreases. There is additional improvement with restoration of the inclination of the distal tibial articular surface as this directs the hindfoot valgus and corrects the alignment of the foot, with consequent improvement of ankle pain.     

Joint preserving procedures for painful plantar callosities in patients with flexible cavovarus foot

BackgroundThe outcome of a constant joint preserving procedure for painful plantar callosities with cavovarus foot remains unclear.MethodsEleven patients (11 feet) who underwent lateral displacement calcaneal osteotomy (LDCO), dorsiflexion first metatarsal osteotomy (DFMO), and plantar fasciotomy (PF), simultaneously were included. The presence of painful callosities, heel alignment of standing (HA), and the Japanese Society for Surgery of the Foot ankle/hindfoot (JSSF) score were evaluated. Radiographically, the talonavicular coverage angle (TNCA), lateral talo-first metatarsal angle (LTMA), calcaneal pitch angle (CPA), and heel alignment angle (HAA) were measured.ResultsPostoperatively, painful plantar callosities disappeared in 10 patients and remained in one patient. The postoperative HA and JSSF score significantly improved. The postoperative TNCA, LTMA, CPA, and HAA significantly improved.ConclusionsIn patients with flexible cavovarus foot, LDCO, DFMO, and PF yielded good outcomes at mid-term follow-up with preservation of the foot and ankle joints.     

胫骨内侧高位楔形截骨治疗膝关节骨性关节炎

目的　探讨胫骨内侧高位楔形截骨治疗伴有膝内翻畸形的膝关节骨性关节炎的疗效。方法　对 1996年 7月～ 1999年 9月 ,采用胫骨内侧高位楔形截骨结合髂骨植骨钢板内固定术治疗 19例 (2 6膝 )膝关节骨性关节炎伴膝内翻畸形 ,病程 1～ 2 4年 ,平均 6 .3年 ,按 Ahlback分类 度 10膝 , 度 9膝 , 度 6膝 , 度 1膝。患者术前、术后 8周和术后 2年进行患肢全长 X线片检查 ,测量胫股角、胫骨角、股骨角、胫股关节面切线夹角及胫股内侧关节间距大小。按膝关节功能评定标准 ,评定术后膝关节功能恢复情况。　结果　 19例 (2 6膝 )术后获随访 2 4～ 4 5个月 ;术后 2年随访膝关节功能自 (4 8.6± 16 .6 )分增至 (81.7± 14 .8)分 ,胫股内侧关节间距自 (2 .2± 1.6 ) mm增至 (4 .9± 1.5 ) mm,胫股关节面切线夹角自 7.4°± 3.1°减少至 1.7°± 3.1°。植骨愈合满意 ,无膝内翻复发。术中出现关节内骨折 1例 ;皮肤感染 2例。结论　胫骨内侧高位楔形截骨结合植骨钢板内固定 ,可作为治疗伴有膝内翻畸形的膝关节骨性关节炎的有效方法之一。     

One-stage tibial deformity correction and ankle arthrodesis for ankle osteoarthritis and tibial malalignment after low tibial osteotomy

IntroductionThere are no reports on one-stage corrective tibial opening wedge osteotomy and arthrodesis for osteoarthritis of the ankle and tibial malalignment after distal tibial osteotomy.Presentation of caseThe patient was a 70-year-old woman who presented with complaints of ankle pain and lower limb deformity after tibial osteotomy performed for ankle arthritis 17–18 years earlier. Clinical examination revealed marked swelling around the ankle joint and pain and tenderness at the joint line. Imaging showed tibial malalignment and severe osteoarthritic changes in the ankle. The patient had valgus deformity of 21° and recurvatum deformity of 4°. In two months, she admitted to Department of Orthopedics at Tokushima University Hospital in Japan and we performed one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis with an anterolateral plate through a lateral longitudinal incision. After removal of the previous implants, the remaining articular cartilage and osteophytes were removed from the tibial and talar surfaces. After debridement of the talar trochlea and tibial plateau, the center of rotation and angular deformity of the tibia was cut transversely and a 1-cm bone graft obtained from the removed fibula was inserted into the osteotomy site, which decreased the tibial malalignment. An anterolateral locking plate was inserted over the anterior and lateral sides of the tibia, and the ankle was fused using 2 cannulated screws.DiscussionThe patient wore an above-knee splint for 6 weeks to avoid weight-bearing followed by gradual weightbearing with a brace thereafter. Osseous fusion was achieved after about 3.5 months. Radiographs obtained at the 2-year follow-up visit showed complete union of the tibia and talus. Full correction of valgus and recurvatum deformity was achieved, and the patient was able to perform daily activities with almost no pain.ConclusionWe reported a rare case of ankle osteoarthritis and tibial malalignment that was successfully treated with one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis using an anterolateral plate via a transfibular approach.     

Radiographic effects observed in the coronal view after medial malleolar osteotomy at total ankle arthroplasty in rheumatoid arthritis cases

BackgroundWhen soft tissue balance is not acceptable at total ankle arthroplasty (TAA) for rheumatoid varus deformity, medial malleolar osteotomy has been performed. At the same time, the shape of the ankle joint changes after soft tissue balancing with such an osteotomy, however there is few information for the radiographic findings after the osteotomy. Thus, radiographic changes in the coronal view of such cases were investigated.MethodsJSSF-RA foot and ankle scale and SAFE-Q scores were determined along with pre/postoperative radiographic parameters of the ankle joint in 70 ankles (65 patients) with rheumatoid arthritis followed for a mean of 7.9 years (range, 2–16 years) after TAA. Seven ankles were excluded because those underwent lateral or lateral/medial malleolar osteotomy. Twenty-seven ankles underwent medial malleolar osteotomy, and compared with 36 ankles without osteotomy.ResultsAll ankles achieved bone union after medial malleolar osteotomy, and the tibial medial malleolus (TMM) angle was significantly decreased [30.3°–19.1°] following significant valgus correction [TC angle: −2.7° to 0.5°]. The gap due to medial soft tissue tightness was significantly improved by medial malleolar osteotomy [4.95° to 0.7°]. Lateral malleolar fractures sometimes occurred (19%: 5/27 ankles) at valgus correction, but they healed completely without any internal fixation.ConclusionMedial malleolar osteotomy was useful in rheumatoid varus ankle for not only controlling the soft tissue balance, but also providing a stabilized shape of the ankle joint. Lateral malleolar fractures were caused by valgus correction following medial malleolar osteotomy in some cases, but all fractures were completely healed without any internal fixation.     

计算机导航胫骨高位截骨联合关节镜的短期疗效

目的观察计算机导航辅助下胫骨高位截骨(HTO)联合关节镜治疗胫骨内翻畸形的临床疗效。 方法本回顾性研究收集了2018年11月至2019年1月在上海长海医院接受治疗的20例膝内翻畸形合并内侧间室骨关节炎的患者,男性7例,女性13例。纳入标准：膝关节内侧间室骨关节炎,症状局限于膝内侧;膝关节内翻畸形,且胫骨近端内翻畸形。排除标准：膝关节外侧间室骨关节炎;外侧半月板损伤或有手术史;膝关节屈曲挛缩>10°;严重肥胖。手术方式为计算机导航辅助下开放楔形胫骨高位截骨联合关节镜手术。测量术前、目标及术后的机械胫股角(mTFA)、胫骨近端内侧角(MPTA)、关节线会聚角(JLCA),测量术前及术后的Lysholm评分及美国特种外科医院(HSS)膝关节评分,进行配对t检验及Mann-Whitney U检验。 结果本组20例患者,平均年龄(55±7)岁,平均随访(11±3)个月。术后mTFA、MPTA、JLCA及力线位置均较术前显著改善。术后Lysholm评分与HSS评分均高于术前[67(60,75) vs. 51(46,61)(Z＝-4.22,P<0.001),67(59,71)vs. 55(49,59)(Z＝-3.64,P<0.001)];术后mTFA、力线位置、矫正角度及撑开高度与术前规划目标无差异统计学意义(P>0.05)。关节镜探查发现6例患者伴有内侧半月板撕裂(其中2例患者为内侧半月板后脚根部撕裂),5例存在内侧肥厚或纤维化的滑膜皱襞,4例股骨内侧髁明显骨赘增生,均予以相应处理。 结论计算机导航辅助下胫骨高位截骨能获得与术前力线矫正计划一致的精确性;关节镜探查时处理关节内半月板、滑膜及骨赘增生等病理性改变,改善内侧间室的局部环境,是提高胫骨高位截骨术疗效必要的操作。     

Clinical Outcomes of Supramalleolar Osteotomy in Intermediate Stage of Varus Ankle Osteoarthritis in Joint Preservation

Supramalleolar osteotomy (SMO) is an effective treatment for intermediate-stage varus ankle osteoarthritis (OA). This study aimed to investigate how clinical outcomes were associated with radiological changes and cartilage regeneration shown on arthroscopy before and after SMO in patients with intermediate-stage varus ankle OA. Twenty-six cases with intermediate-stage varus ankle OA underwent SMO with at least 1 year of postoperative follow-up. Clinical assessment was performed preoperatively and postoperatively using the visual analog scale (VAS), American Orthopedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores, and their associations with postoperative changes in tibial ankle surface angle (TAS), talar tilt, tibial lateral surface angle, and heel alignment ratio. The degrees of cartilage regeneration in the tibia plafond and talar dome were observed via second-look arthroscopy. Afterward, their associations with the corresponding clinical outcomes were analyzed. There were significant changes in the TAS, talar tilt, and heel alignment ratio (p < .001, for all). However, there were no significant changes in the tibial lateral surface angle (p = .864) at the final follow-up compared to its preoperative value. Postoperative changes in TAS (p = .013) and the degree of cartilage regeneration (p = .028) in the talar dome significantly influenced the final follow-up AOFAS score. Changes in the TAS angle and the degree of cartilage regeneration after SMO were predictors of clinical outcomes after SMO. In particular, greater changes in the TAS angle corresponded to better clinical outcomes.     

踝间线足背动脉在全膝关节置换术髓外定位中的临床应用

目的探讨踝关节力学中心体表标志点,为全膝关节置换术(TKA)下肢力线的准确定位提供依据。方法对64例膝骨关节炎(OA)终末期患者实施初次TKA治疗,股骨侧采用髓内定位,胫骨侧采用髓外定位,实验组(34例)踝关节力学中心位于踝间线足背动脉处,对照组(30例)定位则按传统方法进行。术后测量患者胫骨假体胫骨角及后倾角。结果患者均获得随访,时间4~6年。胫骨假体胫骨角平均度数:实验组为(2.1±0.2)°,对照组为(2.6±0.1)°,差异有统计学意义(P0.05);胫骨假体后倾角:实验组为(3.1±0.2)°,对照组为(3.3±0.1)°,差异无统计学意义(P0.05)。实验组胫骨假体力线优于对照组。结论踝间线足背动脉定位可靠,其标示简单易行,能提高胫骨假体力线的精确度,不失为TKA术中踝关节力学中心定位的理想参考。     

Changes in the subtalar joint alignment after supramalleolar osteotomy for varus ankle arthritis

BackgroundThe subtalar joint may compensate for tibio-talar deformity, but what would happen to the joint after the deformity was corrected is not well known. Supramalleolar osteotomy (SMOT) is an effective procedure for the treatment of varus deformity of ankle arthritis. The objective of this study was to investigate the subtalar joint alignment pre and postoperatively following SMOT, and the factors which influenced the alignment of the subtalar joint.MethodsThirty-one patients with varus ankle arthritis (Takakura stage 2, 3a and 3b) who were treated using SMOT were retrospectively reviewed. The subtalar and ankle joint alignment was measured on weightbearing radiograph and weightbearing computerized tomography (WBCT).ResultsThe foot and ankle offset (FAO), tibial articular surface angle (TAS), tibio-talar surface angle (TTS), and subtalar vertical angle (SVA) were significantly corrected (P＜0.05). The subtalar inclination angle (SIA) decreased in 19 patients and increased in the other 12 cases after the SMOT (P＜0.001). The shift of subtalar joint (ΔSIA) showed an inverse correlation with the preoperative FAO (P＜0.001, r = −0.621).ConclusionsThe shift of subtalar joint after SMOT could maintain the neutral position of the hindfoot and showed a negative correlation with the preoperative FAO. The ΔSIA was greater in the severer preoperative hindfoot deformity.Level of evidenceLevel IV, case series.     

Linear mixed modeling on the effects of varus knee surgery on the ankle joint weight-bearing axis

BackgroundVarus knee correction may affect the ankle and subtalar joints and impact the prognosis of ankle arthritis because the weight-bearing load on the lower extremity extends from the hip to the foot. We aimed to evaluate the changes in the mechanical axis and the weight-bearing axis of the ankle after varus knee surgery.MethodsPatients with a varus knee were followed up after undergoing high tibial osteotomy or total knee replacement arthroplasty. The inclusion criteria were age (>18 years) and a history of preoperative and postoperative scanograms. The postoperative change to the ankle joint axis point on the mechanical axis and weight-bearing axis according to the hip–knee–ankle angle correction was adjusted by multiple factors using a linear mixed model.ResultsOverall, 257 limbs from 198 patients were evaluated. The linear mixed model showed that the change in the ankle joint axis point on the mechanical axis was not statistically significant after high tibial osteotomy and total knee replacement arthroplasty (p = 0.223). The ankle joint axis point on the weight-bearing axis moved laterally by 0.9% per degree of postoperative hip–knee–ankle angle decrease (p < 0.001).ConclusionsVarus knee correction could affect the subtalar joint and the ankle joint. Our findings require consideration when utilized during pre- and postoperative evaluations using the weight-bearing axis of patients undergoing varus knee correction.     

Do microfractures improve high tibial osteotomy outcome?

The aim of this study was to determine if microfractures improve the outcome of high tibial osteotomy in patients with medial compartmental osteoarthritis in genu varum. Forty patients presenting with Outerbridge grade III and IV chondropathies on the femoral and/or the tibial joint surface underwent high tibial osteotomy with Puddu plates (Arthrex, Inc, Naples, Florida) for primary medial compartment osteoarthritis in genu varum at our institution. Patients were randomly assigned to either the high tibial osteotomy plus microfractures group (A; n=20) or the high tibial osteotomy alone group (B; n=20). Final assessment was conducted 5 years postoperatively, including clinical response measured by the International Knee Documentation Committee (IKDC), Lysholm score, and patient satisfaction score. All patients were blinded to the treatment received and followed the same rehabilitation protocol. A statistically significant improvement between pre- and postoperative values was observed for Lysholm and IKDC scores in both groups, without any statistically significant difference between them. Regarding the satisfaction score, there were no differences between the 2 groups in terms of preoperative self-assessment (P>.05), whereas postoperative subjective satisfaction at 5-year follow-up was significantly higher in group A than in group B (P=.0036).Our study results provide further evidence that medial tibial osteotomy is an effective surgical option for treating a varus knee associated with medial degenerative arthritis in patients wishing to continue accustomed levels of physical activity. In particular, patient satisfaction was higher among those who underwent the combined treatment involving high tibial osteotomy to correct femorotibial angle and microfractures.     

胫骨高位嵌插截骨与传统高位截骨治疗高龄屈曲型膝内侧间隙骨关节炎的对比研究

目的:报告胫骨高位嵌插截骨治疗高龄屈曲型膝内侧间隙骨关节炎的方法疗效,并与传统高位胫骨截骨的疗效进行比较。方法:2003年7月至2007年7月对年龄60～82岁,病史3～20年,屈曲度7°～19°的膝内侧间隙骨关节炎的30例患者随机分成2组,分别进行胫骨高位嵌插截骨和传统高位截骨手术治疗。术后观察骨折愈合时间、膝关节内翻畸形和屈曲畸形恢复、膝关节功能恢复等情况。要求患者术后第4、6、8、9、10、12、14、16周及5、7、9、12个月复查,记录骨折愈合时间及内翻、屈曲角度纠正情况。术后12个月时根据Lysholm膝关节评分标准进行评分,并对2组的疗效进行比较。结果:胫骨高位嵌插截骨组平均骨折愈合时间(9.26±2.23)周,传统高位截骨组平均(11.53±3.15)周,2组相比差异有统计学意义(P0.05)。膝关节功能恢复方面,术后1年,根据Lysholm评分标准进行评分,胫骨高位嵌插截骨平均(88.5±4.4)分,优14例,良1例;传统高位截骨组平均(78.1±5.7)分,优8例,良5例,可2例。胫骨高位嵌插截骨组术后膝关节伸直位角度0°～-1.1°,术后平均矫正(13±3.3)°;传统高位截骨组术后膝关节伸直位角度与术前相同,为(14°±3.3)°。两组术后站立位X线测量,FTA平均170.2°(l69.1°～172.3°),平均矫正12.3°～12.5°。结论:胫骨高位嵌插截骨手术治疗膝关节内侧间隙骨关节炎缩短了骨折愈合时间,同时矫正了膝关节内翻畸形和屈曲畸形,更好地恢复了膝关节的功能,此手术方式明显优于传统的高位截骨术。     

Aggravation of Ankle Varus Incongruency Following Total Knee Replacement Correcting ≥10° of Genu Varum Deformity: A Radiographic Assessment

BackgroundThis study aimed to investigate the change in ankle varus incongruencies following total knee replacement (TKR) in patients with preoperative genu varum deformity of ≥10°.MethodsThe study cohort was composed of patients who underwent TKR in a single institution for knee osteoarthritis with preoperative genu varum deformity of ≥10° and concomitant varus ankle incongruencies. Eight radiographic measurements were evaluated preoperatively and postoperatively: mechanical tibiofemoral angle, mechanical lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle, tibial plafond inclination, talar inclination, tibiotalar tilt angle (TTTA), and tibia-mechanical axis angle. Of these, TTTA represented the quantitative degree of ankle joint incongruency.ResultsA total of 110 patients (male = 2; female = 108) were included in the analysis. The mean patient age was 68.9 (standard deviation [SD] 7.2) years at the time of TKR. All radiographic measurements showed significant changes postoperatively, representing the appropriate correction of genu varum deformity and restoration of the mechanical axis. Nineteen patients (17.3%) showed postoperative decrease in TTTA, 2 (1.8%) remained the same, and 89 (80.9%) showed increase. Overall, mean preoperative and postoperative TTTA were 3.3° (SD 2.2°) and 4.7° (SD 2.9°), respectively (P < .001), representing the aggravation of varus ankle incongruencies.ConclusionVarus ankle incongruencies showed aggravation following TKR despite correction of genu varum deformity and restoration of the mechanical axis. This could be an important cause of postoperative increase or development of ankle pain following TKR. Therefore, patients with preoperative varus ankle incongruencies need to be warned of possible aggravation of ankle symptoms and be evaluated before TKR.Level of EvidencePrognostic level III.     

胫骨高位截骨联合内侧半月板中央化治疗膝骨关节炎

目的:探讨胫骨高位截骨(high tibial osteotomy,HTO)联合内侧半月板中央化治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效。方法:回顾分析2018年10月至2020年10月接受手术治疗的KOA患者26例,其中行胫骨高位截骨联合关节镜下半月板中央化手术14例为中央化组,男8例,女6例,年龄(50.2±1.4)岁,随访时间(16.8±4.0)个月;仅行胫骨高位截骨术12例患者为对照组,男6例,女6例,年龄(50.9±1.8)岁,随访时间(19.0±4.8)个月。记录并比较两组手术时间、术前后膝关节Lysholm评分和膝关节2000IKDC评分、MRI、股骨胫骨角(femur tibia angle,FTA)、髋膝踝角(hip knee ankle angle,HKA)等放射学影像及并发症情况。结果:术后患者切口均获Ⅰ期愈合,无并发症。中央化组手术时间长于对照组[(65.0±2.1) min vs 52.0±2.1) min,P<0.05]。中央化组内侧半月板外突减少值明显高于对照组[(2.8±1.4) mm vs (1.1±2.2) m...     

To wedge or not to wedge; A cadaveric comparison study of two medial malleolar osteotomy modalities

ObjectiveTo quantify the surface area of the talus accessible with a uniplanar and a biplanar medial malleolus osteotomy. Our secondary purpose study is to quantify the amount of weightbearing area that each osteotomy effects on the tibial articular surface.Patients and methodsEight ankle joint specimens were dissected for this study. The uniplanar osteotomy was performed first. A K-wire marked the limits of access at two different angles: 90° and 30°. The boundaries were marked with a skin marker. Wedges were then created on the tibia plafond, and the osteotomy was converted into a biplanar one. Measurements were repeated again for this osteotomy. The talus, the tibial plafond, and the medial malleolus were then excised. Images were taken and then electronically calibrated for two-dimensional digital measurement of accessible areas. Areas of perpendicular and 30-degree access were recorded for both osteotomies. The articular surface of the tibia was also measured, and an area analysis was performed to calculate the amount of weightbearing cartilage removed by each osteotomy.ResultsAlmost the entire sagittal plane was accessible with both osteotomies. At a 30° angle, bone purchase was achieved for 67.7 % of the talar articular surface with the uniplanar osteotomy and for 74.8 % with the biplanar osteotomy. At a 90° angle, uniplanar osteotomy provided access to 32.7 % of the talar articular area, whereas the biplanar osteotomy achieved an average coverage of 52.8 %. The difference was statistically significant. On average, 25.3 % of the weightbearing area of the tibial plafond is affected when a biplanar osteotomy is performed.ConclusionMedial malleolar osteotomy provides varying degrees of access to the talar dome depending on how it is performed. A wedge-shaped biplanar osteotomy provides greater access and is therefore more suitable for defects located deeper on the talar dome. Despite providing wider access, it results in greater disruption of the weightbearing cartilage of the tibial plafond.Level of evidenceLevel V.     

开放楔胫骨高位截骨术对髌骨位置与关节功能的影响

目的：探讨开放楔胫骨高位截骨术对髌骨位置、膝前痛及关节功能的影响。方法：2016年6月至2021年6月,根据纳入和排除标准,共纳入采用开放楔胫骨高位截骨术治疗的膝关节内侧骨关节病患者109例（111膝）,其中男41例,女68例;年龄38～78(57.98±7.07)岁;病程1～36(8.58±6.91)个月。观察比较手术前后股胫角（femoral tibial angle,FTA）,胫骨近端内侧角（medial proximal tibial angle,MPTA）,负重位力线（weight bearing line,WBL）百分比,CD指数（Caton-Deschamps index）,髌骨外倾角（lateral patella tilt angle,LPTA）和髌骨外移（lateral patella shift,LPS）。采用Lysholm评分评价膝关节功能,视觉模拟评分（visual analogue scale,VAS）评价膝前痛程度,Kellgren-Lawrence (K-L)分级系统评价髌股关节骨关节炎进展情况。结果：109例患者获得随访,时间6～38(12.41±2....     

膝关节内侧单间室骨性关节炎的临床对照研究

目的:比较Oxford膝关节单髁置换(unicompartmental knee arthroplasty,UKA)与胫骨高位截骨(high tibial osteotomy,HTO)治疗膝关节内侧单间室骨性关节炎的疗效。方法:回顾性分析Oxford膝关节UKA与HTO治疗膝关节内侧单间室骨性关节炎的资料,其中UKA组65例,HTO组45例,对2组手术时间、术中出血量、术后3 d血红蛋白下降量、住院时间进行比较;采用膝关节侧位片测量股骨胫骨角(FTA)、胫骨平台后倾角(PS)、Insall-Salvati(IS)指数、Blackbume peezh(BP)指数、美国膝关节协会评分(American knee society knee score,KSS)及视觉模拟评分(visual analogue scale,VAS)比较2组术前、术后3月、术后1年情况。结果:110例均获得随访,UKA组在手术时间、术中出血量、术后3 d血红蛋白下降量及住院时间方面均低于HTO组(P0.05);UKA组和HTO组术后3月、术后1年FTA、PS、IS、BP、VAS、KSS评分与术前比较,差异均有统计学意义(P0.05)。结论:Oxford膝关节UKA与HTO治疗膝关节内侧单间室骨性关节炎,前者更具有优势,且安全性高,值得临床推广。     

Tibial condylar valgus osteotomy (TCVO): Surgical technique and clinical results for knee osteoarthritis with varus deformity

Tibial condylar valgus osteotomy (TCVO) is an intra-articular proximal tibial osteotomy developed in 1989 and has since been used for the treatment of knee osteoarthritis (OA) associated with genu varum. This article describes the surgical technique and clinical results of TCVO. TCVO can be used for all grades of varus knee OA in patients of any age. he preoperative range of movement should be at least 90°. Preoperative screening showed varus-valgus instability due to an intra-articular deformity of the proximal tibia. Using intraoperative image intensification, a sagittally oriented “L”-shaped osteotomy is made from the medial to the tibial tuberosity to the center of the tibial plateau between the medial and lateral tibial spines. The separation of the osteotomy using the lamina spreader is gradually increased using an image intensifier guidance until the articular surface of the lateral tibial plateau comes in contact with the articular surface of the lateral femoral condyle. Adequate correction is indicated by parallelism of the lateral tibial plateau and a line tangential to the distal convexity of the lateral femoral condyle on an anteroposterior (AP) image and the elimination of the valgus instability with the knee in extended position. A “T”-plate (locking or non-locking plate or circular external fixator) is used to fix the osteotomy in the corrected position. Synthetic or autologous bone grafts can be used. We used the Japanese Orthopaedic Association score to evaluate the patient's function and also measured the %MAD, medial plateau opening angle, medial plateau angle, and lateral plateau opening angle on an AP view of the long length roentgenogram of the lower limb (standing position). The JOA score, radiologically measured values, and instability of the knee joint remarkably improved.     

Perioperative axial loading computed tomography findings in varus ankle osteoarthritis: Effect of supramalleolar osteotomy on abnormal internal rotation of the talus

BackgroundWe used axial loading computed tomography (AL CT) to evaluate preoperative and postoperative talocrural joints of patients who underwent supramalleolar osteotomy (SMO) to treat varus ankle osteoarthritis.MethodsWe performed retrospective analyses of 16 patients (18 feet) who underwent SMO including fibular osteotomy. Radiographic assessment was performed with weightbearing radiographs and AL CT. Clinical outcomes were assessed based on American Orthopedic Foot & Ankle Society (AOFAS) scale, visual analog scale (VAS) for pain, and Foot and Ankle Ability Measure (FAAM).ResultsThe mean 2-year follow-up tibial-ankle surface angle, talar tilt angle, Takakura stage, and tibial-lateral surface angle were all significantly different relative to preoperative parameters (P < .05). The mean 6-month follow-up talus rotation ratio was significantly corrected compared to the preoperative value (P = .001). The mean 2-year follow-up AOFAS, VAS at gait, and FAAM scores were all significantly improved relative to preoperative measurements (P = .001).ConclusionsAbnormal internal rotation of the talus in mild to moderate varus ankle osteoarthritis found on AL CT was significantly corrected after SMO.Level of evidenceTherapeutic Level IV