The Association of Forefoot Varus Deformity with Patellofemoral Cartilage Damage in Older Adult Cadavers

Aims and Objectives: High tibial osteotomy (HTO) has gained more and more importance in the treatment of cartilage damage of the medial compartment with concurrent varus deformity. Concerning the extent of axis correction, various different views exist. The aim of this study was to evaluate the effect of the degree of axis correction on the functional outcome in patients suffering from cartilage damage of the medial compartment and undergoing a valgus HTO. Materials and Methods: From January 2005 to December 2013 there were 156 patients suffering from cartilage damage of the medial compartment and an underlying varus deformity who were treated by a biplanar valgus HTO. According to the degree of axis correction - mirrored by the position of the intersection point of the weight bearing line and the tibial plateau - patients were allocated to different groups. For this purpose 3 adjacent areas respectively comprising 5% of the tibial plateau were defined. Limits of those areas were set as follows: with the medial border representing the 0%-point and the lateral border representing the 100%-point, the 3 areas were separated according to their intersection point (group 1 50-55%, group 2 55-60%, group 3 > 60%). For comparison of the functional outcomes, standardized measures and scores were used (pre-OP: VAS, Lysholm; post-OP: VAS, Lysholm, KOOS, IKDC). Analysis of the pre- and post-operatively recorded X-Rays was effected by means of a planning software (mediCAD\, Hectec GmbH, Germany), statistical analysis was carried out with the aid of SPSS Statistics 21.0 (IBM Corp., Armonk, USA.). A p-value of 0.05 was considered statistically significant. Results: 39 patients were allocated to group 1, 49 patients to group 2, 68 to group 3. Concerning mean follow up, age, gender, height, weight and pre-operative VAS there were no statistically significant differences (p>0,05). Thus, patients in each group were of a homogenous constitution. Regarding outcome parameters, group 1 showed significantly higher results. They reached statistical significance when comparing results of the Lysholm score (83,50±15,41 vs. 68,64±23,31 vs. 61,36±30,58), KOOSpain (89,93±9,62 vs. 77,15±15,37 vs. 74,24±21,05), KOOS (81,25±9,20 vs. 72,63±17,38 vs. 66,45± 19,29), KOOS4 (77,89±10,69 vs. 69,56±18,21 vs. 63,28±19,35) and VAS post-OP (1,88±1,73 vs. 2,36±0,92 vs. 3,45±2,84). A positive correlation between height and KOOSpain (Pearson correlation 0,181) KOOSadl (PC 0,239), KOOSsport (PC 0,213) and KOOS5 (0,196)was calculated . A negative correlation existed between age and Lysholm Post (PC -0,207), KOOSpain (PC 0,190), KOOSadl (PC -0,231) and KOOSges (PC -0,161) Conclusion: Valgus HTO of varus deformity in patients with concomitant cartilage damage of the medial compartment is highly efficient regarding functional outcome. Precise preoperative planning regarding individual factors in each patient is mandatory as correction to a neutral weight bearing axis or only mild overcorrection seem to be beneficial in comparison to larger correction angles.

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The Rationale of Osteotomy around the Knee

The Journal of Knee Surgery ◽

10.1055/s-0037-1603755 ◽

2017 ◽

Vol 30 (05) ◽

pp. 386-392 ◽

Cited By ~ 3

Author(s):

Philipp Lobenhoffer

Keyword(s):

Sagittal Plane ◽

Weight Bearing ◽

Cartilage Damage ◽

Frontal Plane ◽

Varus Deformity ◽

Valgus Deformity ◽

Wedge Osteotomy ◽

Early Weight Bearing ◽

Plate Fixator ◽

Closed Wedge

AbstractFrontal plane varus or valgus deformity causes overload in the ipsilateral compartment and may induce and accelerate cartilage damage. Osteotomy around the knee should be considered in symptomatic constitutional and posttraumatic metaphyseal deformities of more than 3-degree deviation. Age, grade of osteoarthritis, obesity, and nicotine consumption are no exclusion criteria for osteotomy. For correction of varus deformity, biplanar open wedge osteotomy of the tibia with fixation by a plate fixator has proven to be a safe and stable construct allowing for early weight-bearing. Valgus deformities of the tibia can be treated by biplanar closed wedge osteotomy of the proximal tibia. For femur deformities closed wedge biplanar osteotomy and fixation with a specific plate fixator is an attractive solution reducing implant-related morbidity. Osteotomy around the knee may also be used to protect cartilage reconstruction and meniscus transplantation. Corrections in the sagittal plane may improve the anteroposterior stability of the knee significantly and can be combined with frontal plane corrections.

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Radiographic Outcomes of Cotton Osteotomy in Treatment of Adult-Acquired Flatfoot Deformity

Foot & Ankle International ◽

10.1177/10711007211015175 ◽

2021 ◽

pp. 107110072110151

Author(s):

Mostafa M. Abousayed ◽

Michelle M. Coleman ◽

Lawrence Wei ◽

Cesar de Cesar Netto ◽

Lew C. Schon ◽

...

Keyword(s):

Case Series ◽

Varus Deformity ◽

Significant Loss ◽

Column Height ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Metatarsal Angle ◽

Adult Acquired Flatfoot Deformity ◽

Forefoot Varus

Background: We investigated the long-term radiographic outcomes of the Cotton osteotomy performed at our institution by the 2 senior authors in conjunction with other reconstruction procedures to correct adult-acquired flatfoot deformity (AAFD). Methods: We retrospectively studied patients who underwent Cotton osteotomy between 2005 and 2010 with minimum 4-year follow-up. Radiographic assessment was made on weightbearing radiographs taken at 4 different time intervals: preoperative, early (first postoperative full weightbearing), intermediate (between 1 and 4 years postoperatively), and final (over 4 years postoperatively). Results: Nineteen patients were included. Final follow-up was 8.6 ± 2.6 years. The lateral talus–first metatarsal angle improved significantly from preoperative to early radiographs (n = 15; mean change: 30 degrees, 95% CI, 21.6-38.7; P < .0001). A significant loss of correction was observed between intermediate and final radiographs (n = 11; mean change: 17 degrees, 95% CI, 8.1-26.4; P < .0001). Of 14 patients with early radiographs, 8 lost >50% of the correction initially achieved. Medial column height decreased by 3.0 mm (95% CI, 1.80-7.90; P = .35) between early radiographs and final follow-up. Discussion: This is the longest reported radiographic follow-up of the Cotton osteotomy performed to address forefoot varus deformity as part of AAFD. The Cotton osteotomy achieved radiographic correction of the medial longitudinal arch at early follow-up, but approximately half of the patients had lost over 50% of that correction at final follow-up. The lengthened angular shape of the cuneiform did not collapse, implying that further collapse occurred through the medial column joints. Level of Evidence: Level IV, case series.

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High Tibial Osteotomy: Review of Techniques and Biomechanics

Journal of Healthcare Engineering ◽

10.1155/2019/8363128 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 5

Author(s):

Xiaoyu Liu ◽

Zhenxian Chen ◽

Yongchang Gao ◽

Jing zhang ◽

Zhongmin Jin

Keyword(s):

Contact Mechanics ◽

High Tibial Osteotomy ◽

Cartilage Damage ◽

Varus Deformity ◽

Patient Specific ◽

Tibial Osteotomy ◽

Element Analysis ◽

Term Survival ◽

Joint Contact

High tibial osteotomy becomes increasingly important in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. HTO produces a postoperative valgus limb alignment with shifting the load-bearing axis of the lower limb laterally. However, maximizing procedural success and postoperative knee function still possess many difficulties. The key to improve the postoperative satisfaction and long-term survival is the understanding of the vital biomechanics of HTO in essence. This review article discussed the alignment principles, surgical technique, and fixation plate of HTO as well as the postoperative gait, musculoskeletal dynamics, and contact mechanics of the knee joint. We aimed to highlight the recent findings and progresses on the biomechanics of HTO. The biomechanical studies on HTO are still insufficient in the areas of gait analysis, joint kinematics, and joint contact mechanics. Combining musculoskeletal dynamics modelling and finite element analysis will help comprehensively understand in vivo patient-specific biomechanics after HTO.

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Consensus on Indications for Medial Cuneiform Opening Wedge (Cotton) Osteotomy in the Treatment of Progressive Collapsing Foot Deformity

Foot & Ankle International ◽

10.1177/1071100720950739 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1289-1291

Author(s):

Jeffrey E. Johnson ◽

Bruce J. Sangeorzan ◽

Cesar de Cesar Netto ◽

Jonathan T. Deland ◽

Scott J. Ellis ◽

...

Keyword(s):

Varus Deformity ◽

Radiographic Examination ◽

Foot Deformity ◽

Level Of Evidence ◽

Opening Wedge ◽

Medial Cuneiform ◽

Varus Angulation ◽

Forefoot Varus ◽

Varus Position ◽

Consensus Expert

Recommendation: Forefoot varus is a physical and radiographic examination finding associated with the Progressive Collapsing Foot Deformity (PCFD). Varus position of the forefoot relative to the hindfoot is caused by medial midfoot collapse with apex plantar angulation of the medial column. Some surgeons use the term forefoot supination to describe this same deformity (see Introduction section with nomenclature). Correction of this deformity is important to restore the weightbearing tripod of the foot and help resist a recurrence of foot collapse. When the forefoot varus deformity is isolated to the medial metatarsal and medial cuneiform, correction is indicated with an opening wedge medial cuneiform (Cotton) osteotomy, typically with interposition of an allograft bone wedge from 5 to 11 mm in width at the base. When the forefoot varus is global, involving varus angulation of the entire forefoot and midfoot relative to the hindfoot, other procedures are needed to adequately correct the deformity. Level of Evidence: Level V, consensus, expert opinion.

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Bone Marrow Lesions Associated With Cartilage Damage at Follow-Up

Rheumatology News ◽

10.1016/s1541-9800(08)70047-4 ◽

2008 ◽

Vol 7 (2) ◽

pp. 7

Keyword(s):

Bone Marrow ◽

Cartilage Damage ◽

Bone Marrow Lesions

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Talk or Walk? Gait Speed over Self-Report in Association with Cognitive Speed in Healthy Older Adults

GeroPsych ◽

10.1024/1662-9647/a000202 ◽

2019 ◽

Vol 32 (1) ◽

pp. 41-52

Author(s):

Matthew C. Costello ◽

Shane J. Sizemore ◽

Kimberly E. O’Brien ◽

Lydia K. Manning

Keyword(s):

Older Adults ◽

Older Adult ◽

Gait Speed ◽

Well Being ◽

Self Report ◽

Subjective Report ◽

Healthy Older Adults ◽

Relative Value ◽

Cognitive Speed ◽

Age Range

Abstract. This study explores the relative value of both subjectively reported cognitive speed and gait speed in association with objectively derived cognitive speed. It also explores how these factors are affected by psychological and physical well-being. A group of 90 cognitively healthy older adults ( M = 73.38, SD = 8.06 years, range = 60–89 years) were tested in a three-task cognitive battery to determine objective cognitive speed as well as measures of gait speed, well-being, and subjective cognitive speed. Analyses indicated that gait speed was associated with objective cognitive speed to a greater degree than was subjective report, the latter being more closely related to well-being than to objective cognitive speed. These results were largely invariant across the 30-year age range of our older adult sample.

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Cognitive Aging in a Precision Sport Context

European Psychologist ◽

10.1027/1016-9040.1.3.166 ◽

1996 ◽

Vol 1 (3) ◽

pp. 166-179 ◽

Cited By ~ 6

Author(s):

Bo Molander ◽

Lars Bäckman

Keyword(s):

Older Adult ◽

Cognitive Abilities ◽

Cognitive Aging ◽

Motor Performance ◽

Intervention Programs ◽

Laboratory Studies ◽

High Arousal ◽

Memory And Attention ◽

Age Related ◽

Principal Finding

Highly skilled miniature golf players were examined in a series of field and laboratory studies. The principal finding from these studies is that young and young adult players (range = 15-38 years) score equally well or better in competition than in training whereas older adult players (range = 46-73 years) perform worse in competitive events than under training conditions. It was also found that the impairment in motor performance on the part of the older players is associated with age-related deficits in basic cognitive abilities, such as memory and attention. These results support the hypothesis that older players may be able to compensate for age-related deficits under relaxed conditions, but not under conditions of high arousal. The possibility of improving the performance of the older players in stressful situations by means of various intervention programs is discussed.

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