Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

2019 ◽  
Vol 33 (06) ◽  
pp. 536-546
Author(s):  
Cheng Jingbo ◽  
Feng Mingli ◽  
Cao Guanglei ◽  
Li Zheng ◽  
An Shuai ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Patellofemoral Joint ◽  
Lateral Displacement ◽  
Patellar Height ◽  
Patient Specific ◽  
Trochlear Groove ◽  
Tibial Osteotomy ◽  
Short Term ◽  
Significant Difference ◽  
Axis Correction

AbstractThe objectives of our study were to evaluate (1) patellar height changes when the knee axis correction was < 15 degrees and (2) the clinical effect after open wedge high tibial osteotomy (OWHTO). Sixty-nine patients (69 knees) undergoing OWHTO between January 2016 and June 2017 were enrolled in this prospective study. All patients underwent OWHTO using a three-dimensional (3D)-printed patient-specific instrument. We used X-ray and lower-limb computed tomography scan to measure the osteotomy angle, patellar height, and other patellofemoral joint indices. We used the hospital for special surgery knee (HSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Kujala's scores to evaluate the clinical outcome. All knee axis corrections were less than 15 degrees. The change in posterior tibial slope (PTS) did not show a statistically significant difference. We observed that the patellar height was not altered when we used femur referenced measurement method. The change in modified Miura–Kawamura index (MKI) and Femoral patellar height index (FPHI) did not show a statistically significant difference. The differences in Blackburne–Peel index (BPI) and Caton–Deschamps index (CDI) were statistically significant, decreasing from 0.91 ± 0.12 and 1.06 ± 0.11 preoperatively to 0.79 ± 0.13 and 0.95 ± 0.11 postoperatively, respectively. In the axial plane, we did not observe a change in lateral patellar shift (LPS), but we found that lateral patellar tilt (LPT) showed a significant decrease from 8.67 ± 2.60 degrees preoperatively to 6.13 ± 2.30 postoperatively, respectively. The tuberositas tibae–trochlear groove (TT–TG) distance showed a significant decrease after OWHTO from 14.30 ± 4.10 mm preoperatively to 11.52 ± 3.63 mm postoperatively. The clinical score showed a significant increase after OWHTO, and all patients were satisfied with the outcome. After OWHTO, the patellar height was not altered when the knee axis correction was < 15 degrees. It was also found that there was still lateral displacement of the patella. Internal rotation of the distal tibia is an important cause of LPT reduction. After OWHTO, all patients achieved satisfactory clinical outcomes. At 1-year short-term follow-up, patients did not report discomfort in the patellofemoral joint. The Level of Evidence for this study was IV.

Erratum to: Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

2019 ◽  
Vol 33 (06) ◽  
pp. e2-e2
Author(s):  
Cheng Jingbo ◽  
Cao Guanglei ◽  
Li Zheng ◽  
An Shuai ◽  
Huang Jiang ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Patellar Height ◽  
Short Term ◽  
Axis Correction

Biplanar ascending opening-wedge high tibial osteotomy increases tibial tubercle–trochlear groove distance and decreases patellar height

2020 ◽  
Vol 5 (1) ◽  
pp. 15-20
Author(s):  
Alexandre Barbieri Mestriner ◽  
Jakob Ackermann ◽  
Gergo Merkely ◽  
Takahiro Ogura ◽  
Juan Pablo Zicaro ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
High Tibial Osteotomy ◽  
Pearson Correlation ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
The Impact

ObjectivesTo assess the impact of a biplanar ascending opening-wedge high tibial osteotomy (OWHTO) on the alignment of the knee extensor mechanism and patellar height using preoperative and postoperative MRI.MethodsMedical records of all patients submitted to ascending biplanar OWHTO between July 2008 and March 2017 were retrospectively assessed. Five parameters of the patellofemoral joint—tibial tubercle–trochlear groove distance (TT-TG), patellofemoral (PF) axial engagement index, lateral patellar tilt, Blackburne-Peel index (BPI) and Caton-Deschamps index (CDI)—were measured by two blinded independent observers on both preoperative and postoperative MRIs. Interobserver reliability was assessed with the intraclass correlation coefficient (ICC). Paired t-test was performed to compare preoperative and postoperative measurements. The association of the amount of HTO opening and the assessed PF joint parameters was also investigated with Pearson correlation coefficient.Results26 patients who underwent ascending biplanar OWHTO were enrolled in this imaging analysis (63.4%) with a mean follow-up of 16.3 months (SD, 16.9). ICC for all measurements ranged between 73.3% and 89.3%. Postoperatively, TT-TG distance significantly increased by 2.0 mm±2.3 mm (p<0.001). Patellar height significantly decreased when evaluated by the BPI (p<0.001) and CDI (p=0.001). The amount of osteotomy opening significantly correlates with the postoperative BPI (p=0.023) and CDI (p=0.013).ConclusionThis study comprehensively reports significant increase on TT-TG distance after an ascending biplanar OWHTO using MRI. Small but significant decreases in patellar height were also observed and are correlated to the amount of axis correction.Level of evidenceLevel IV, retrospective case study.

scholarly journals The effect of distal tibial tuberosity high tibial osteotomy on postoperative patellar height and patellofemoral joint degeneration

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Changxiao Han ◽  
Xia Li ◽  
Xiangdong Tian ◽  
Jiping Zhao ◽  
Liqun Zhou ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Weight Bearing ◽  
Patellar Height ◽  
Tibial Tuberosity ◽  
Tibial Osteotomy ◽  
Patellar Tilt ◽  
Femoral Trochlea ◽  
Second Look ◽  
Joint Congruity

Abstract Background Distal tibial tuberosity high tibial osteotomy (DTT-HTO) can prevent distalization of the tibial tuberosity and thus patellar infera. However, no studies on the clinical and radiological effects of DTT-HTO on the patellofemoral joint have been conducted. The purpose of the study was to evaluate the effect of DTT-HTO on patella height and patellofemoral joint congruity based on the severity of patellofemoral joint OA. Methods Twenty-nine patients (33 knees) who underwent DTT-HTO and second-look arthroscopy when implant was removed between January 2018 and May 2020 were eligible for the study. Among them, 6 were males, and 23 were females, with ages from 51 to 78 years old. The Caton-Deschamps index (CDI), congruence angle (CA), and lateral patellar tilt (LPT) were measured to evaluate the effect of surgery on patellar height and patellofemoral joint congruity. The weight-bearing line ratio (WBLR) was measured to assess lower limb alignment. The cartilage lesion in the patellofemoral joint was assessed arthroscopically during surgery and implant removal by the International Cartilage Repair Society (ICRS) grading system at 18–24 months after surgery. The Hospital for Special Surgery (HSS) scale was used to evaluate knee joint function. Results Twenty-nine patients were followed up for 18–28 months. The preoperative CDI, CA, and LPT changed from 0.92 ± 0.16 to 0.89 ± 0.14, from 5.52 ± 2.19 to 5.44 ± 2.27, and from 6.95 ± 2.88 to 6.54 ± 2.42, respectively, and the differences were not statistically significant (p > 0.05). The preoperative WBLR significantly increased from 16.72 ± 6.77 to 58.77 ± 7.69% (p < 0.001). The cartilage lesions in the patella and femoral trochlea did not progress significantly from the first- to the second-look arthroscopy, according to the ICRS grades (p > 0.05). The HSS score significantly improved from 50.64 ± 19.18 preoperatively to 67.33 ± 14.72, 81.63 ± 11.92, and 82.73 ± 8.05 at the 3-month, 12-month, and last follow-up after surgery (p < 0.001). Conclusion DTT-HTO can effectively prevent patellar infera, and its effects on postoperative patellofemoral joint congruity and patellofemoral joint OA progression are inconspicuous. It can be recommended as a treatment of varus knee combined with patellar infera or patellofemoral joint OA.

scholarly journals The Effect of Distal Tibial Tuberosity High Tibial Osteotomy on Postoperative Patellar Height and Patellofemoral Joint Degeneration

2020 ◽  
Author(s):  
Changxiao Han ◽  
Xia Li ◽  
Xiangdong Tian ◽  
Jiping Zhao ◽  
Liqun Zhou ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Patellar Height ◽  
Tibial Tuberosity ◽  
Implant Removal ◽  
Tibial Osteotomy ◽  
Patellar Tilt ◽  
Femoral Trochlea ◽  
Second Look ◽  
Joint Congruity

Abstract Background: Distal tibial tuberosity high tibial osteotomy (DTT-HTO) can prevent distalization of the tibial tuberosity and thus patella infra. However, no studies on the clinical and radiological effects of DTT-HTO on the patellofemoral joint have been conducted. The purpose of the study was to evaluate the effect of DTT-HTO on patella height and patellofemoral joint congruity based on the severity of patellofemoral joint OA.Methods: Twenty-nine patients (33 knees) who underwent DTT-HTO and second-look arthroscopy when implant removal between January 2018 and May 2020 were eligible for the study. Among them, 6 were males, and 23 were females, with ages from 51-78 years old. The Caton-Deschamps index (CDI), congruence angle (CA) and lateral patellar tilt (LPT) were measured to evaluate the effect of surgery on patellar height and patellofemoral joint congruity. The weightbearing line ratio (WBLR) was measured to assess lower limb alignment. The cartilage lesion in the patellofemoral joint was assessed arthroscopically during surgery and implant removal by the International Cartilage Repair Society (ICRS) grading system at 18-24 months after surgery. The Hospital for Special Surgery scale (HSS) was used to evaluate knee joint function.Results: Twenty-nine patients were followed up for 18-28 months. The preoperative CDI, CA and LPT changed from 0.92±0.16 to 0.89±0.14, from 5.52±2.19 to 5.44±2.27 and from 6.95±2.88 to 6.54±2.42, respectively, and the differences were not statistically significant (p＞0.05). The preoperative WBLR significantly increased from 16.72±6.77% to 58.77±7.69% (p < 0.001). The cartilage lesions in the patella and femoral trochlea did not progress significantly from the first- to the second-look arthroscopy, according to the ICRS grades (p＞0.05). The HSS score significantly improved from 50.64±19.18 preoperatively to 67.33±14.72, 81.63±11.92 and 82.73±8.05 at the 3-month, 12-month, and last follow-up after surgery (p < 0.001).Conclusion: DTT-HTO can effectively prevent patellar infra, and its effects on postoperative patellofemoral joint congruity and patellofemoral joint OA progression are inconspicuous. It can be recommended as a treatment of varus knee combined with patella infra or patellofemoral joint OA.

Short-term Outcomes after High Tibial Osteotomy Aimed at Neutral Alignment Combined with Arthroscopic Centralization of Medial Meniscus in Osteoarthritis Patients

2020 ◽  
Author(s):  
Hiroki Katagiri ◽  
Yusuke Nakagawa ◽  
Kazumasa Miyatake ◽  
Koji Otabe ◽  
Toshiyuki Ohara ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Medial Meniscus ◽  
Control Group ◽  
Tibial Osteotomy ◽  
Short Term ◽  
Subjective Satisfaction ◽  
Significant Difference ◽  
Neutral Alignment

Abstract Purpose To improve long-term outcomes of open-wedge high tibial osteotomy (OWHTO), procedures combining OWHTO aimed at neutral alignment and arthroscopic centralization for meniscal extrusion have been introduced. The purpose of the present study was to compare short-term clinical and radiological outcomes of medial joint space width (JSW) after the OWHTO aimed at neutral alignment with and without arthroscopic centralization for an extruded medial meniscus. Methods A retrospective review of 50 primary OWHTO patients was conducted. Thirty-five patients included for analysis after exclusion criteria was applied. Twenty-one knee osteoarthritis patients, who underwent the OWHTO with arthroscopic meniscal centralization, were included in the centralization group. Fourteen patients, who underwent solely OWHTO, were included in the control group. Lysholm knee scale, International Knee Documentation Committee (IKDC) subjective score, Knee Osteoarthritis Outcome Score (KOOS), and patient subjective satisfaction scores were recorded at the final follow-up. Radiographic changes of JSW and joint line congruence angle (JLCA) were measured 2 years postoperatively. Patient demographic data were also reviewed. Results IKDC subjective scores, KOOS subgroup scores, patient subjective satisfaction scores, and Lysholm score did not show significant differences between the two groups at the final follow-up. Change of the JSW in the centralization group was significantly greater than that in the control group 2 years postoperatively (Control group: -0.1 mm, Centralization group: 0.8 mm P =0.03). Conclusion Change of JSW after OWHTO aimed at neutral alignment with arthroscopic centralization for extruded medial meniscus was greater than solely OWHTO, and there was no significant difference in the short-term clinical outcomes between the 2 procedures at the final follow-up.

A comparative study to determine the short-term mortality and clinical improvement in hepatic encephalopathy using either rifaximin and or lactulose

2021 ◽  
Vol 12 (3) ◽  
pp. 46-50
Author(s):  
Uttam Biswas ◽  
Shyamal Kanti Pal ◽  
Pallabi Ray Chaudhuri ◽  
Debanjan Roychowdhury ◽  
Abhranil Dhar ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Clinical Outcome ◽  
Clinical Improvement ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Precipitating Factors ◽  
Chronic Liver Diseases ◽  
Short Term ◽  
Significant Difference ◽  
Short Term Mortality

Background: Hepatic encephalopathy can be reversed by correcting precipitating factors and efficiently managed by lactulose and or rifaximin. Aims and Objective: The aim of this study to compare the effectiveness of three different modes of treatment in our study populations. Materials and Methods: Ninety patients of decompensated chronic liver diseases were selected and randomised to treat with either lactulose or rifaximin or both lactulose and rifaximin (30 patients in each group) for 7 days. Clinical outcome and short term mortality were noted in each group of treatment. This study was to review the comparison of the effectiveness of Rifaximin (1200mg/day , in 3 divided doses ) alone or in combination with Lactulose (60gram/day ,in divided doses) or Lactulose (60gram/day) alone to reduce the short term mortality and clinical improvement in hepatic encephalopathy of any grade of any cause in adult (>18 years) admitted patients of decompensated chronic liver diseases. Result: Clinical improvement was noted in all three modes of treatment but there is no statistically significant difference in clinical improvement of hepatic encephalopathy when compared amongst each of three modes of treatment. There was obvious reduction of short term mortality or clinical down gradation of hepatic encephalopathy grade after 7 days treatment using lactulose or rifaximin or combined lactulose and rifaximin but there was no statistically significant difference in this regard among these three modes of treatment. Conclusion: All three modes of treatment are equally effective though combination therapy is little better.

scholarly journals Myofascial release versus Mulligan sustained natural apophyseal glides’ immediate and short-term effects on pain, function, and mobility in non-specific low back pain

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e10706
Author(s):  
Vignesh Bhat P ◽  
Vivek Dineshbhai Patel ◽  
Charu Eapen ◽  
Manisha Shenoy ◽  
Steve Milanese
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Manual Therapy ◽  
Patient Specific ◽  
Low Back ◽  
Short Term ◽  
Myofascial Release ◽  
Lumbar Flexion ◽  
Significant Difference ◽  
Strengthening Exercises

Background Myofascial release (MFR) and Mulligan Sustained Natural Apophyseal Glides (SNAGs) are manual therapy techniques routinely practiced in the management of non-specific low back pain (NSLBP). As a solo intervention or along with other therapies, both methods have reported positive results for individuals with NSLBP. However, which technique improves NSLBP-related pain, restricted range of motion (ROM) and disability, warrants further research. Objective To study the comparative effects of MFR and SNAGs on pain, disability, functional ability, and lumbar ROM in NSLBP. Method A parallel-group study was conducted at tertiary care hospitals. Sixty-five Sub-acute or chronic NSLBP patients were allocated to receive strengthening exercises along with either MFR (n = 33) or SNAGs (n = 32) for six treatment sessions over one week. An independent assessor evaluated outcome measures such as the Visual Analog Scale (VAS), Patient-Specific Function Scale (PSFS), and ROM at baseline, immediate (after 1st treatment), and short-term (post-sixth day of the intervention). The Modified Oswestry disability index (MODI) was assessed at baseline and short-term. Results Within-group analysis found clinically and statistically significant (p < 0.05) changes for VAS and PSFS at immediate and short-term for both the groups. The lumbar extension also showed improvement immediately and in the short-term. Improvement in Lumbar flexion was seen only in the SNAGs group over the short-term. A statistically significant improvement was seen for MODI in both the groups but was not clinically significant in the MFR group. The analysis observed no statistically significant difference (p < 0.05) between the groups at both the immediate and short-term. Conclusions Pain and restricted function associated with NSLBP can be improved using SNAGs or MFR, along with strengthening exercises. For limited lumbar flexion ROM, Mulligan SNAGs have a better outcome than MFR over the short-term. Hence, both manual therapy techniques can be incorporated along with exercises for immediate and short-term management of sub-acute to chronic NSLBP. Clinical Trial Registration. CTRI/2018/12/016787 (http://ctri.nic.in/Clinicaltrials/).

1053 Comparing MRI Parameters in Quantifying Patellofemoral Instability

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Nagi ◽  
C Hing
Keyword(s):  
Soft Tissue ◽  
Tilt Angle ◽  
Patellofemoral Joint ◽  
Patellofemoral Instability ◽  
Trochlear Groove ◽  
Magnetic Resonance Imaging Measurement ◽  
Patellar Tilt ◽  
Significant Difference ◽  
Soft Tissue Changes ◽  
Patellar Tilt Angle

Abstract Aim Patellofemoral instability is where various stabilising factors of the patellofemoral joint undergo pathomorphological changes. It has an incidence rate of 5.8 per 100,000 in UK and has been associated with osteoarthritis[1]. Variations in the factors that stabilise the patellofemoral joint can be observed on MRI including measurements of the trochlea in relation to the patella, the femur and soft tissue changes. This study aims to compare different measures used to detect and quantify patellofemoral instability on MRIs and to look for any significant difference in their use both in isolation and together. Method 109 MRI reports of 78 patients diagnosed with patellofemoral instability were reviewed and all quantitative and qualitative parameters reported were inputted in a data table. Quantitative elements known as the Dejour protocol included the trochlear sulcus angle, patellar tilt angle, tibial tuberosity-trochlear groove distance and the Insall-Salvati ratio. Qualitative factors involved facet changes, patellar position, and any damage to soft tissue. Results It was found that the Insall-Salvati ratio greater than 1.2 and the patellar tilt angle of greater than 11 degrees irregular ranges had the greatest incidence in the MRI reports found 77.1% and 87.6% respectively in MRIs that reported them. Conclusions There is a discrepancy between quantitative parameters in their correlation with patellofemoral instability for the MRI reports observed. [1]: Ye Q, Yu T, Wu Y, Ding X, Gong X. Patellar instability: the reliability of magnetic resonance imaging measurement parameters. BMC Musculoskeletal Disorders. 2019;20(1).

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