Can patients really participate in sport after high tibial osteotomy?

Purpose

The possibility to return to sporting activity can be an important consideration in the decision-making process in femorotibial osteoarthritis. We analyzed functional outcomes and sport participation in a continuous series of HTO and asked whether this procedure could match expectations in active and motivated patients.

Methods

We retrospectively investigated activities, sports participation, and the level of satisfaction in 139 patients with unilateral noncomplicated HTO. The study included 41 women and 98 men with a mean age of 59 years and a mean 50 months of follow-up.

Results

Eighty-seven patients (63%) reported that their knee was “normal,” and eighty-six patients (62%) felt that their activities were limited by their knee. A total of 78 patients (56%) reported that they were as active as they expected to be before the intervention. Of these patients, 98% were satisfied. Of the patients who were not as active as they thought they would be, 51% were satisfied (P < 0.0001). The duration of preoperative pain, the age at evaluation, and the number of previous surgeries did not influence the subjective result. Among patients under 75 years, 28% regularly participated in strenuous sports, but 40% were motivated for these activities. 66% of the motivated patients regularly participated in at least one impact sport.

Conclusion

This study shows that young motivated patients are able to resume strenuous activities following HTO. However, patients must be informed that they will typically not recover their pre-pathology level and that residual pain during strenuous sports is not exceptional.

Level of evidence

Therapeutic study, Level IV.     

Residual Varus Alignment does not Compromise Results of TKAs in Patients with Preoperative Varus

Background   

Postoperative varus alignment has been associated with lower IKS scores and increased failure rates. Appropriate positioning of TKA components therefore is a key concern of surgeons. However, obtaining neutral alignment can be challenging in patients with substantial preoperative varus deformity and it is unclear whether residual deformity influences revision rates.     

The brain tissue response to biodegradable poly(methylidene malonate 2.1.2)-based microspheres in the rat

The aim of this study was to follow the in vivo biodegradation as well as to appreciate the brain tissue response to poly(methylidene malonate 2.1.2) (PMM 2.1.2)-based microspheres implanted into the rat brain. Ninety-three adult Sprague-Dawley female rats were engaged in the study in which 54 underwent stereotactic implantation of blank gamma-sterilized PMM 2.1.2-based microspheres, prepared by an emulsion-extraction method. Twelve rats were implanted with the same 5-fluorouracil (5-FU)-loaded microspheres. Seventeen controls received the suspension medium alone (carboxymethylcellulose aqueous solution). The animals were sacrificed on post-operative days 1, 2, 8 and months 1, 2, 3, 6, 9, 12, 15 and 18. The brains were dissected, frozen, cut in a freezing microtome, and the slides were processed for immunohistological evaluation and scanning electron microscopy. During the first few days, the moderate inflammatory response to blank or loaded PMM 2.1.2 microspheres was largely a consequence of the mechanical trauma that occurs during surgery. The macrophagous-microglial reaction was similar to the one typically found following any damage in the CNS. There were also no differences in GFAP reactivity between the implanted animals and the controls. Blank microspheres began to degrade between 3 and 6 months, while 5-FU microspheres degraded between 8 days and 1 month. The polymer degradation generated in both cases a pronounced inflammatory and immunological reaction, leading to an important cell loss, a cerebral atrophy and to the death of several animals. PMM 2.1.2 was thus shown to be inadequate for intracerebral drug delivery.     

Interstitial 6q deletion: clinical and array CGH characterisation of a new patient

We report on a patient with an interstitial 6q deletion presenting with moderate mental retardation, persisting hypotonia, facial dysmorphism, but no internal malformations. Standard cytogenetic analysis identified a de novo interstitial 6q deletion. Molecular karyotyping using a 1 Mb array estimated the size of the deletion at approximately 14 Mb encompassing band q16 of chromosome 6. This case report illustrates how the molecular delineation enables improved genotype-phenotype correlations of chromosomal abnormalities to be made and may improve medical care and genetic counselling in individuals with chromosomal imbalances.     

Tunnel position following posterior cruciate ligament reconstruction: an in vivo computed tomography analysis

The success of posterior cruciate ligament (PCL) reconstruction is dependent on appropriate tunnel placement. Computed tomography (CT) provides detailed images of intra-articular osseous anatomy. The objective of this study was to analyze by CT the position of femoral and tibial tunnels relative to intra-operative goals following arthroscopic-assisted PCL reconstruction. Nineteen patients who underwent single-bundle PCL reconstruction were evaluated 16 months post-operatively. Each underwent a CT scan and tunnel locations were identified in the coronal, sagittal, and axial planes. The coronal plane tibial tunnel location was within 5mm of the intra-operative goal (48% of the total tibial plateau width from the medial border of the plateau) in 16 patients (84%). The sagittal plane tibial tunnel location was within 5mm of the intra-operative goal (the middle of the posterior half of the retrospinal surface) in 14 patients (74%). In the sagittal plane, the femoral tunnel location was within 5mm of the intra-operative goal (10mm from in the distal articular margin of the medial femoral condyle) in 15 patients (79%). In the notch, the femoral tunnel was between 10:30 and 11:30 for left knees or between 12:30 and 1:30 for right knees (the intra-operative goal was 11 o'clock for left knees and 1 o'clock for right knees) in 18 patients (95%). Arthroscopic PCL reconstruction results in tunnel positions near intra-operative goals. Further work is necessary to define CT-specific criteria for the assessment of PCL tunnel position.