Isolating factors for the prediction of rebound after guided growth with tension band plating for the valgus deformity of the knee
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ABSTRACT:
SUBMITTER: Eberle A
PROVIDER: S-EPMC10549697 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
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Project description:Meniscal stabilization with saucerization has recently been recommended for discoid lateral meniscus (DLM) to preserve the meniscus shape and prevent the progression of osteoarthritis. However, axial alignment of the lower limb causes a significant valgus change after arthroscopic partial meniscectomy and can lead to progressive lateral osteoarthritic changes. Thus, valgus knees in patients with DLM are a suspected predictive factor for poor outcomes after DLM surgery. Valgus malalignment in pediatric patients can be corrected by temporarily tethering one side of the open physis using implant-mediated guided growth to generate differential growth in the coronal plane. This Technical Note describes simultaneous arthroscopic meniscal surgery and temporary hemiepiphysiodesis to treat DLM with valgus deformities to reduce the risk of future chondral damage to the lateral knee compartment.
| S-EPMC11411329 | biostudies-literature
Project description:BackgroundFunctional knee positioning (FKP) represents an innovative personalized approach for total knee arthroplasty (TKA) that reconstructs a three-dimensional alignment based on the optimal balance of soft tissue and bony structures, but it has mostly been described for varus knee deformity.Surgical techniqueValgus deformities present specific challenges due to altered bone remodeling and soft tissue imbalances. Using robotic assistance, FKP enables precise intraoperative assessment and correction of compartmental gaps, accommodating each individual's unique anatomy and laxities. The distal femoral cut is calibrated for 9 mm resection at the intact medial femoral condyle and adjusted on the lateral side to accommodate bone wear, while the tibial plateau resection aims for 8 mm from the medial side and 4-6 mm from the lateral side. Intraoperative evaluations of mediolateral laxities are performed at extension and 90° flexion. Adjustments are made to femoral and tibial cuts to balance gaps, aiming for 0 mm in posterior stabilized implants and minimal discrepancies in cruciate-retaining designs with lateral gap looser in flexion.DiscussionFKP emphasizes soft tissue-driven adjustments with the use of robotic platforms. Hence, intact soft tissue envelope of the knee is essential. This technique holds significant promise for managing valgus deformities in TKA, but further research is needed to evaluate its functional outcomes.
| S-EPMC11809196 | biostudies-literature
Project description:BackgroundIn children with angulating deformities of the lower limbs, hemiepiphysiodesis can be used to guide growth to achieve better alignment at skeletal maturity. Traditionally, this has been performed with staples. The tension-band plating technique is new and it has been advocated because it is believed to reduce the risk of premature closure of the growth plate compared to stapling. The benefit of the tension-band plating technique has not yet been proven in experimental or randomized clinical studies.MethodsWe performed a randomized clinical trial in which 26 children with idiopathic genu valgum were allocated to stapling or tension-band plating hemiepiphysiodesis. Time to correction of the deformity was recorded and changes in angles on long standing radiographs were measured. Pain score using visual analog scale (VAS) was recorded for the first 72 h postoperatively. Analgesics taken were recorded by the parents.ResultsMean treatment times for stapling hemiepiphysiodesis (n = 10) and for tension-band plating hemiepiphysiodesis (n = 10) were similar. Postoperative VAS scores and consumption of analgesics were also similar in both groups. No hardware failure or wound-related infection was observed.InterpretationTreatment time for the 2 treatment modalities was not significantly different in this randomized clinical trial. Tension-band plating and stapling appeared to have a similar effect regarding correction of genu valgum. We cannot rule out type-II error and the possibility that our study was underpowered. ClinicalTrials.gov Identifier: NCT01641354.
| S-EPMC3639343 | biostudies-literature
Project description:BackgroundThe traditionally recommended fixed valgus cutting angle (VCA) of 3° is used as the standard method in total knee arthroplasty (TKA) for valgus deformity. The accuracy of distal femur cutting can be affected by the type of valgus deformity because the intramedullary rod for distal femoral resection can become impinged on the femoral cortex. The purpose of this study is to analyze the accuracy and precision of a VCA of 3° in mechanical alignment in TKA for valgus deformity, based on the type of the deformity.MethodsTKAs with a fixed VCA of 3° performed in 110 intra-articular and 102 juxta-articular valgus knees were retrospectively reviewed. The age (65.8 vs. 66.1 years), sex (female: male =78/32 vs. 70/32), body mass index (26.0 vs. 26.0), and severity of deformities (valgus 12.1 vs. valgus 12.5) were not significantly different (P>0.647). The mechanical-lateral-distal-femoral angle (mLDFA) and anatomical-mechanical-axis angle (AMA-A) were evaluated. The adjusted-VCA (aVCA) was defined as the maximum angle within the range without the intramedullary rod impinging on the femoral cortex. The proportion of well-aligned femoral component (mLDFA <90°±3°) was assessed. The correlation between AMA-A-3° or aVCA-3° and postoperative mLDFA-90° was analyzed.ResultsDespite the larger AMA-A in the juxta-articular group (6.2° vs. 6.8°, P<0.001), the aVCA was lesser in the juxta-articular group (5.4° vs. 4.1°, P<0.001). The mLDFA was more varus in the intra-articular group (91.7° vs. 90.6°, P<0.001) postoperatively. The proportion of well-aligned femoral component was higher in the juxta-articular group (85.3% vs. 70%, P=0.009). Postoperative mLDFA-90° was moderately correlated with aVCA-3° (r=0.301, r=387), but weakly correlated with AMA-A-3° (r=0.274, r=294) in both groups.ConclusionsAlthough a fixed VCA of 3° is a reliable method in achieving mechanical alignment in valgus deformity, it can be more appropriate in juxta-articular deformity than in intra-articular deformity. The aVCA is a more reasonable predictor of femoral component alignment than the AMA-A, considering the femoral cortex impingement of the intramedullary rod.
| S-EPMC10929302 | biostudies-literature
Project description:The increasing incidence and distribution of primary and post-traumatic knee osteoarthritis (OA) in the young, active population has renewed interest in joint-preserving procedures. High tibial osteotomy (HTO) represents the most common treatment for medial knee OA associated with varus tibial deformity. However, deformities may also be related to intra-articular defects that an extra-articular procedure could not correct. The tibial condylar valgus osteotomy (TCVO) represents an intra-articular surgical technique for treating advanced medial knee OA with lateral joint subluxation. Currently, only a few papers with small samples and limited follow-up report the use of TCVO for the treatment of intra-articular deformities. Indications and operative techniques are various and not standardized. After an extensive search of PubMed, Scopus and Cochrane library, the main purpose of this paper is to summarize and discuss the indications, surgical techniques, and outcomes of intra-articular osteotomies while also reporting the preoperative planning and surgical procedure performed at our institution. These characteristics allow earlier weight-bearing and faster complete recovery. TCVO is an effective procedure to correct lower limbs' intra-articular defects from degenerative conditions developmental and post-traumatic deformities. This surgical technique, working at the intra-articular level, leads to some benefits related to restoring joint congruence and stability by realigning the axis of the lower limb and reducing the lateral joint subluxation. Moreover, the improved valgisation and lateralization of the mechanical axis and the limitation of the osteotomy to the medial condyle led to a better load distribution to the not osteotomy-involved compartment.
| S-EPMC10929301 | biostudies-literature
Project description:BackgroundThe lateral opening wedge distal femoral osteotomy (DFO) is an effective treatment for genu valgum to improve mechanical alignment, decrease lateral compartment loads, and decrease the risk of knee osteoarthritis. Multiple studies have utilized outcome scores assessing functional changes related to pain and joint stability, with a focus solely on knee pain and functional outcomes.Questions/purposesThe primary aim of this study was to evaluate patient-reported outcome measures (PROMs) that assessed knee function, pain, patient's perception of body image, and limb deformity-related quality of life, both preoperatively and at least 1-year postoperatively.MethodsIn a retrospective review of nontraumatic genu valgum patients who underwent bilateral DFO, preoperative and postoperative radiographs were evaluated. Routinely collected preoperative and 1-year postoperative PROMs scores were analyzed, using the Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS-JR) and the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) score, in 72 limbs (36 patients): 7 men (19.44%) and 29 women (80.56%) with an average age of 35.34 ± 13.57 years. The mean follow-up time was 36.85 ± 24.43 months.ResultsOverall mechanical axis deviation, lateral distal femoral angle, and mechanical axis alignment angle were significantly improved after DFO in all patients. Both PROMs also improved significantly from preoperative to postoperative scores: LD-SRS (3.10 ± 0.56 vs 4.19 ± 0.44, respectively) and KOOS-JR (63.02 ± 19.25 vs 78.06 ± 16.29, respectively).ConclusionThis retrospective review suggests that bilateral lateral opening-wedge DFOs in patients with symptomatic valgus knee deformity may be associated with improved overall knee health, limb deformity-related quality of life, and patients' body image. Further study is needed.
| S-EPMC11572583 | biostudies-literature
Project description:Background: Skeletally immature patients with coronal plane angular deformity (CPAD) may be at increased risk for intra-articular pathology and patellofemoral instability (PFI). These patients may be candidates for implant-mediated guided growth (IMGG) procedures with tension band plates to address CPAD in addition to procedures for concomitant knee pathology. However, there are limited data on performing these procedures simultaneously. Questions/Purpose: We sought to demonstrate the feasibility of combined procedures to address both knee pathology and concomitant CPAD using IMGG in skeletally immature patients. Methods: We conducted a retrospective review of skeletally immature patients who underwent IMGG and concomitant surgery for anterior cruciate ligament reconstruction, osteochondritis dissecans repair, meniscus pathology, or PFI at a single institution by 2 surgeons between 2008 and 2019. Data on demographics, surgical details, follow-up, and complications were recorded. Deformity correction was assessed in a subset of eligible patients. Results: Of 29 patients meeting inclusion criteria, deformity correction was assessed in a subset of 17 patients (15 valgus, 2 varus). At final follow-up, 16 of 17 patients had mechanical tibiofemoral (mTFA) angles of <5° of varus or valgus. One patient developed "rebound" valgus >5° after plate removal. Conclusions: The IMGG performed in the setting of treating intra-articular knee pathology is feasible and should be considered for skeletally immature patients with CPAD undergoing surgery for concomitant knee pathology.
| S-EPMC9247586 | biostudies-literature
Project description:BackgroundRobotic-assisted total knee arthroplasty (rTKA) has been shown to reduce the number of alignment outliers and to improve component positioning compared to manual TKA (mTKA). The primary purpose of this investigation was to compare the frequency of achieving target postoperative limb alignment and component positioning for rTKA vs mTKA.MethodsA retrospective comparative study was performed on 250 patients undergoing primary TKA by 2 fellowship-trained arthroplasty surgeons. Surgeon A performed predominantly rTKA (103 cases) with the ROSA system (Zimmer Biomet, Warsaw, IN) and less frequently mTKA (44 cases) with conventional instrumentation. Surgeon B performed only mTKA (103 cases). Target limb alignment for surgeon A was 0° for all cases and for surgeon B was 2° varus for varus knees and 0° for valgus knees. Radiographic measurements were determined by 2 reviewers. Target zone was set at ± 2 degrees from the predefined target.ResultsWhen comparing rTKA to mTKA performed by different surgeons, there were no differences in the percentage within the target zone (57.28% vs 53.40%, P = .575), but rTKA did result in a greater percentage for cases with preoperative valgus (71.42% vs 44.12%, P = .031). Patient-reported Outcomes Measurement Information System Global-10 physical scores were statistically higher at both 3 (P = .016) and 6 months (P = .001) postoperatively for rTKA compared to mTKA performed by different surgeons.ConclusionsAlthough experienced surgeons can achieve target limb alignment correction with similar frequency when comparing rTKA to mTKA for all cases, rTKA may achieve target limb alignment with more accuracy for preoperative valgus deformity.Level of evidenceRetrospective Cohort Study, Level III.
| S-EPMC10517281 | biostudies-literature
Project description:Patients with hereditary multiple exostosis develop several benign osseocartilaginous bulge lesions throughout the body. A 62-year-old woman presented for evaluation of worsening left knee valgus deformity, and left knee pain. She had been diagnosed with hereditary multiple exostosis at the age of 12 years. Radiographic evaluation of the left knee revealed exostoses that caused continuous bulges from cortical bone at the metaphyseal regions of the femur and tibia as well as extra-articular deformity. We used patient-specific instrumentation to indicate the direction of the stem into curved metaphyseal bone regions and then corrected the patient’s left knee deformity by performing total knee arthroplasty with titanium-constrained prostheses. Soft tissue release was performed with only complete iliotibial band release at a minimum, and stability was obtained.
| S-EPMC9249969 | biostudies-literature
Project description:IntroductionPrevious studies have reported a lower extremity stress fracture after total knee arthroplasty (TKA). However, a fibular fracture after TKA is quite rare. We report a case of proximal fibula fracture after TKA in a patient with rheumatoid arthritis (RA).Presentation of caseA 45 year old woman with RA had severe knee and foot pain with an antalgic gait disturbance. There was a significant joint deformity in many of lower limb joints. Interval bilateral TKAs were performed two weeks apart. Right TKA was performed using a constraint-type prosthesis, through lateral parapatellar approach. Left TKA was performed using a posterior-stabilized (PS) prosthesis through the more commonly employed, medial parapatellar approach. Seven weeks after the right TKA, the patient was found to have an atraumatic proximal fibular fracture. The fracture went on to heal conservatively.DiscussionThe fracture was considered to have occurred after the TKA. The callus appeared eleven weeks after the TKA. The factors that contributed to the fracture were thought to be overload of the fragile bone secondarily to disuse osteopaenia, RA or potentially the significant valgus malalignment correction. The surgical approach, the implant or implantation or the persisting joint deformity, were thought to be contributing factors to the aetiology of the stress fracture. The resultant change in clinical outcome/course is outlined in this case report.ConclusionA stress fracture of the proximal fibula has the potential in the aetiology of may cause other stress fractures, joint other instability, and/or malalignment of the total lower extremity.
| S-EPMC6000722 | biostudies-literature