Patellofemoral Chondromalacia Does Not Influence Radiographic and Clinical Outcomes following High Tibial Osteotomy

2019 ◽  
Author(s):  
You Keun Kim ◽  
Jae Doo Yoo ◽  
Minjoon Oh ◽  
Euihwan Cho ◽  
Nam Ki Kim
Keyword(s):  
Clinical Outcomes ◽  
Joint Space Width ◽  
Lateral Compartment ◽  
Joint Space ◽  
Tibial Osteotomy ◽  
Kujala Score ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Space Width

AbstractEffect of patellofemoral (PF) chondromalacia on results of high tibial osteotomy (HTO) has not been identified. Therefore, the objective of the present study was to analyze the effect of PF chondromalacia on relatively short-term radiographic and clinical outcomes of HTO. Patients who underwent open wedge HTO (OWHTO) from February 2010 to January 2015 were enrolled. A total of 101 knees were divided into two groups: 56 knees without PF chondromalacia in group A, while 45 knees with PF chondromalacia extended to subchondral bone in group B. Radiologic outcomes were compared using mechanical tibiofemoral angle, ratio of weight-bearing line (WBL), and minimal joint space width of the lateral compartment. Clinical outcomes were compared using range of motion in affected knee, visual analog scale, modified Lysholm score, and Kujala score. The mean mechanical tibiofemoral angle was 4.6 degree in group A and 4.8 degree in group B. The mean ratio of WBL was 63.8% in group A and 63.6% in group B at final. The mean minimum joint space width of the lateral compartment was 5.8 mm in group A and 5.8 mm in group B on standing AP radiograph. It was 5.3 mm in group A and 5.4 mm in group B on Rosenburg view at final. The mean ROM was 137.2 degree in group A and 137.5 degree in group B. The mean visual analog scale was 2.1 in group A and 2.3 in group B at final. The mean modified Lysholm score was 90.6 in group A and 89.1 in group B at final. The mean Kujala score was 90.2 in group A and 89.1 in group B at final. PF chondromalacia does not influence short-term radiographic and clinical outcomes following OWHTO.

Quantitative Evaluation of Joint Space Width in the Lateral Compartment after Medial Unicompartmental Knee Arthroplasty: Comparison of Three Radiographic Views

2017 ◽  
Vol 31 (08) ◽  
pp. 730-735
Author(s):  
Ju'an Yue ◽  
Wanshou Guo ◽  
Fuyin Wan ◽  
Pengfei Wen ◽  
Zhaohui Liu ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Weight Bearing ◽  
Joint Space Width ◽  
Lateral Compartment ◽  
Joint Space ◽  
Valgus Stress ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Group A ◽  
Group B ◽  
Space Width

AbstractLateral compartment cartilage deterioration is the most common complication affecting medial unicompartmental knee arthroplasty (UKA) survivorship. The purpose of this study was to determine the best method of judging the degeneration of cartilage in the lateral compartment after medial UKA through analysis of different radiographic views. Forty-two participants were divided into two groups. Patients in Group A were followed for at least 10 months after undergoing a medial UKA (mean: 17.67 ± 7.65 months, range: 10–24 months), whereas those in Group B were evaluated 3 days after surgery. Joint space width in the lateral compartment of all patients was evaluated using three types of knee radiographs: weight-bearing anterior posterior (AP), supine AP, and supine valgus stress. No difference in joint space width in the lateral compartment after medial UKA was found for the three kinds of radiographs in Group A (F = 0.97, p = 0.39) and Group B (F = 1.499, p = 0.233). After evaluating the patients 3 days after surgery or following them for approximately 18 months after medial UKA, we determined that weight-bearing AP, supine AP, and supine valgus stress knee radiographs were comparable when used to assess residual cartilage thickness of the lateral compartment.

Pullout Fixation of Posterior Medial Meniscus Root Tears: Correlation Between Meniscus Extrusion and Midterm Clinical Results

2016 ◽  
Vol 45 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Kyu Sung Chung ◽  
Jeong Ku Ha ◽  
Ho Jong Ra ◽  
Gun Woo Nam ◽  
Jin Goo Kim
Keyword(s):  
Clinical Outcomes ◽  
Medial Meniscus ◽  
Joint Space ◽  
Radiographic Findings ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Pullout Fixation ◽  
Meniscus Extrusion

Background: Medial meniscus posterior root tears (MMPRTs) lead to extrusion of the meniscus during weightbearing as well as loss of the ability of the meniscus to generate hoop stress. This loss of load-sharing ability leads to progressive arthritic changes. However, there have been no studies that correlate the correction of meniscus extrusion with clinical outcomes. Hypothesis: Decreased meniscus extrusion is associated with better clinical and radiographic outcomes compared with increased meniscus extrusion after MMPRT pullout fixation. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 39 patients who underwent MMPRT pullout fixation and had been observed for more than 5 years were recruited for this study. The mean follow-up period was 69.8 months. Participants were categorized into 2 groups according to the direction of meniscus extrusion: group A (increased extrusion; 23 patients) and group B (decreased extrusion; 16 patients). Meniscus extrusion was assessed in the coronal plane on magnetic resonance imaging preoperatively and at 1 year postoperatively. The postoperative clinical outcomes (Lysholm and International Knee Documentation Committee [IKDC] scores) and radiographic results (Kellgren-Lawrence [K-L] grade and medial joint space) were compared between groups. Results: Meniscus extrusion in group A increased significantly from a mean (±SD) of 3.5 ± 0.9 mm preoperatively to 5.1 ± 1.4 mm at 1 year postoperatively ( P < .001), whereas in group B, it decreased significantly from 4.1 ± 1.3 mm preoperatively to 3.5 ± 1.4 mm at 1 year postoperatively ( P < .001). The K-L arthritis grade (0/1/2/3/4) significantly progressed in group A (from 2/12/9/0/0 preoperatively to 0/1/14/8/0 postoperatively, respectively; P = .009) but not in group B (from 1/11/4/0/0 preoperatively to 0/6/8/2/0 postoperatively, respectively; P = .274). The mean final Lysholm and IKDC scores in group B (88.1 ± 12.1 and 79.0 ± 11.4, respectively) were significantly better than those in group A (81.0 ± 9.0 and 71.1 ± 7.8, respectively) ( P < .05). There was less medial joint space narrowing at final follow-up in group B (0.6 ± 0.8 mm) than in group A (1.1 ± 0.6 mm) ( P = .015). Progression of the K-L arthritis grade was seen in 50% (8/16) of the patients in group B compared with 87% (20/23) of the patients in group A ( P = .027). Conclusion: The current study demonstrates that in patients with MMPRTs, pullout fixation leads to favorable midterm outcomes, regardless of meniscus extrusion at 1-year follow-up. However, patients with decreased meniscus extrusion at postoperative 1 year have more favorable clinical scores and radiographic findings at midterm follow-up than those with increased extrusion at 1 year. This study indicates that one of the main goals of the repair of MMPRTs is to reduce meniscus extrusion as much as possible.

scholarly journals The change of joint space width after medial open wedge high tibial osteotomy

2020 ◽  
Vol 28 ◽  
pp. S400-S401
Author(s):  
S.-H. Kim ◽  
H.-S. Moon ◽  
C.-H. Choi ◽  
M. Jung ◽  
T.-H. Lee
Keyword(s):  
High Tibial Osteotomy ◽  
Joint Space Width ◽  
Joint Space ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Space Width

scholarly journals Knee Osteoarthritis Revisited; But Only After KL Grading Is Tested: A Retrospective Analysis

2019 ◽  
pp. 9-13
Author(s):  
Victoria David Kuttan ◽  
Deepak Anap ◽  
Sushil Kachevar
Keyword(s):  
Knee Joint ◽  
Disease Progression ◽  
Joint Space Width ◽  
Lateral Compartment ◽  
Exercise Programme ◽  
Joint Space ◽  
Osteoarthritis Of The Knee ◽  
Tibiofemoral Joint ◽  
Keywords Osteoarthritis ◽  
Space Width

Background: Osteoarthritis (OA) of the knee is one of the major causes in musculoskeletal condition leading to functional loss in patients. Determining the progression of the disease is a useful tool which will help in the planning of the exercise programme to slow or halt the disease progression. Measuring the joint space width of the tibiofemoral joint is one of the best options for knowing the disease progression and helps in designing an exercise programme. Aim: Retrospective measurement of joint space width in patients with bilateral tibiofemoral osteoarthritis of the knee joint. Methodology: Data was retrieved from the picture archiving and communication system (PACS) from 1st of February to 22nd of June 2018. Radiographs that were showing OA knee features by using Kellegren Lawrence (KL) grading system were considered and the joint space between the tibial and femoral compartment was measured. Result: The joint space width showed more reduction in the medial compartment of the joint as compared to the lateral compartment. Conclusion: In the rural population of Maharashtra the medial joint space is markedly decreased as compared to the lateral compartment of the tibiofemoral joint and as the KL grade increases the joint space width decreased. Keywords: Osteoarthritis; Knee; Joint space width; Rural Maharashtra.

Associated factors with the severity of hip involvement in spondyloarthritis and efficacy of TNF α inhibitors in these patients

2021 ◽  
Vol 17 ◽  
Author(s):  
Maroua Slouma ◽  
Safa Rahmouni ◽  
Rim Dhahri ◽  
Elhem Cheour ◽  
Imen Gharsallah ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Body Mass ◽  
Associated Factors ◽  
Joint Space Width ◽  
Joint Space ◽  
Radiographic Findings ◽  
Lequesne Index ◽  
Spine Mobility ◽  
The Mean ◽  
Space Width

Introduction: Hip involvement in patients with spondyloarthritis is responsible for disability and functional impairment. Its treatment is not codified. Our study aimed to determine the associated factors with moderate and severe hip involvement in spondyloarthritis patients. It also aimed to assess the efficacy of tumour necrosis factor inhibitors (TNFi) on hip disease. Methods: We conducted a cross-sectional study, including 44 spondyloarthritis patients with hip involvement. Hip involvement was diagnosed based on radiographic findings. We assessed the following parameters: Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), patient global assessment (PGA), and Lequesne index. We compared these parameters and the mean radiographic joint space width between the time of the study to those right before the use of TNFi. Results: Hip involvement was bilateral in 31 patients. The mean age was 44.56±12.21 years. There were 29 men. Severe and moderate involvement (BASRI-hip>3) was reported in 21 hips from 75 affected. These patients were older and had longer diagnosis delay than patients with BASRI-hip<3. They had a higher body mass index and more limited spine mobility (BASMI). Functional hip impairment assessed by the Lequesne index was higher in these patients. TNFi prescribed in 23 patients with hip involvement, led to an improvement in the Lequesne index (12.75vs7.5,p:0.001) and PGA (7vs2,p:0.001). However, the mean joint space width remained unchanged (3.8vs3.7mm,p:0.532). Conclusion : Our study showed that higher body mass and Lequesne indexes are associated with moderate and severe hip involvement. TNFi may improve both the Lequesne index and PGA and stabilize the radiological findings.

Serial Changes in the Joint Space Width and Joint Line Convergence Angle After Closed-Wedge High Tibial Osteotomy

2017 ◽  
Vol 45 (14) ◽  
pp. 3254-3261 ◽  
Author(s):  
Cheol Hee Park ◽  
Dae Kyung Bae ◽  
Kang Il Kim ◽  
Jong Whan Lee ◽  
Sang Jun Song
Keyword(s):  
Joint Space Width ◽  
Womac Score ◽  
Joint Space ◽  
Joint Line ◽  
Tibial Osteotomy ◽  
Convergence Angle ◽  
Joint Line Convergence Angle ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Background: There have been little data concerning serial changes in the joint space width (JSW) and joint line convergence angle over the course of follow-up periods after closed-wedge high tibial osteotomy (CWHTO). Purpose: To evaluate serial changes in the JSW and joint line convergence angle after CWHTO. Study Design: Case series; Level of evidence, 4. Methods: A total of 100 computer-assisted CWHTOs with a minimum follow-up period of 3 years (mean, 4.4 years) were analyzed. Clinically, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was evaluated. Radiographically, the mechanical axis was measured preoperatively and postoperatively. The minimal JSW was measured as the shortest distance between the femur and the tibia. The convergence angle was measured as the angle between the tangent to the subchondral plates of the femoral condyle and the tibial plateau. Serial changes in these measurements were analyzed preoperatively; at 3 months, 6 months, 1 year, and 2 years postoperatively; and at the final follow-up. The intraclass correlation coefficients for all measurements were greater than 0.8. Results: The mean WOMAC score improved from 41.4 preoperatively to 14.9 at the final follow-up. The preoperative and postoperative mean mechanical axis was 8.1° varus and 1.6° valgus, respectively. The mean minimal JSW was 2.5, 2.9, 2.9, 3.1, 3.2, and 3.1 mm preoperatively and at 3 months, 6 months, 1 year, 2 years, and the final follow-up, respectively ( P < .001). The mean convergence angle was 4.4°, 3.9°, 4.0°, 4.1°, 4.2°, and 4.3°, respectively, during the same time periods ( P = .068). Conclusion: Cartilage healing, as indicated by the JSW, and clinical improvement were maintained over the minimum 3-year follow-up after CWHTO. Cartilage pressure, as indicated by the convergence angle, remained unchanged after CWHTO.

Medial joint space width and convergence angle change with time after medial opening-wedge high tibial osteotomy

The Knee ◽  
2020 ◽  
Vol 27 (6) ◽  
pp. 1923-1930
Author(s):  
Yueh-Cheng Tsai ◽  
Tzu-Hao Tseng ◽  
Cheng-Han Ho ◽  
Chun-Chieh Wang ◽  
Yin-Chuan Shih ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Joint Space Width ◽  
Joint Space ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Convergence Angle ◽  
Angle Change ◽  
Wedge High Tibial Osteotomy ◽  
Space Width

Two-Year Outcomes After Meniscoplasty by Capsular Advancement With the Application of Arthroscopic Centralization Technique for Lateral Compartment Knee Osteoarthritis

2020 ◽  
Vol 48 (13) ◽  
pp. 3154-3162
Author(s):  
Hideyuki Koga ◽  
Tomomasa Nakamura ◽  
Hiroki Katagiri ◽  
Yusuke Nakagawa ◽  
Nobutake Ozeki ◽  
...  
Keyword(s):  
Joint Space Width ◽  
Lateral Compartment ◽  
Joint Space ◽  
Lysholm Score ◽  
Sports Performance ◽  
Resonance Imaging ◽  
Meniscal Extrusion ◽  
Radiographic Outcomes ◽  
Subjective Score ◽  
Space Width

Background: A high prevalence of osteoarthritis (OA) progression in patients with lateral meniscal defects has been reported. However, optimal management techniques for active patients remain ill-defined. Hypothesis: Meniscoplasty by capsular advancement with the application of the centralization technique would improve clinical and radiological outcomes in patients with lateral compartment OA attributed to lateral meniscal defects. Study Design: Case series; Level of evidence, 4. Methods: A total of 27 patients were enrolled who had undergone meniscoplasty by capsular advancement for lateral compartment OA attributed to lateral meniscal defects. In these patients, the meniscotibial capsule was released from the tibia and advanced with the remaining meniscus onto the rim of the tibial plateau to reform a meniscus-like configuration. Measures of clinical outcomes included clinical examination, Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Knee injury and Osteoarthritis Outcome Score (KOOS), subjective rating scales regarding recovery of the operated knee, and sports performance level. Measures of radiographic outcomes included meniscal extrusion width or regeneration of the meniscus-like tissue on magnetic resonance imaging and lateral joint space width on standing extension anteroposterior and Rosenberg views. All clinical and radiographic outcomes were reported preoperatively and 2 years postoperatively, except magnetic resonance imaging findings, which were reported preoperatively and 1 year postoperatively. Results: The clinical outcomes were significantly improved 2 years postoperatively as compared with baseline: Lysholm score, IKDC subjective score, and KOOS subscores (all P < .0001). The patients’ subjective recovery ( P < .0001) and sports performance level ( P < .0001) were also improved. One year postoperatively, 10 of 11 patients who had no meniscus remaining at the middle segment showed more than one-third the volume of meniscal tissue–like regeneration, and meniscal extrusion width was significantly reduced as compared with baseline in the remaining 16 patients ( P = .0006). Joint space width increased at 2 years on the standing anteroposterior view ( P < .0001) and the Rosenberg view ( P = .0001). Conclusion: Meniscoplasty of the lateral meniscus by capsular advancement improved clinical and radiographic outcomes at 2-year follow-up in patients with lateral compartment OA attributed to lateral meniscal defects.

scholarly journals OP0185 KNEE JOINT DISTRACTION IS MORE EFFICIENT IN RESTORING CARTILAGE THICKNESS THAN HIGH TIBIAL OSTEOTOMY IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 114.2-115
Author(s):  
M. Jansen ◽  
S. Maschek ◽  
R. Van Heerwaarden ◽  
S. Mastbergen ◽  
W. Wirth ◽  
...  
Keyword(s):  
Stock Options ◽  
Joint Space Width ◽  
Joint Space ◽  
Cartilage Thickness ◽  
Tibial Osteotomy ◽  
Knee Oa ◽  
Leg Axis ◽  
Cartilage Restoration ◽  
Joint Distraction ◽  
Space Width

Background:Both high tibial osteotomy (HTO) and knee joint distraction (KJD) are joint preserving surgical techniques unloading the affected femorotibial compartment in patients with knee osteoarthritis (OA). While HTO permanently unloads the more affected compartment (MAC) by overcorrecting the leg axis, KJD temporarily unloads the whole joint by separating the tibia and femur for 5 mm for 6 weeks. In a previous randomized controlled trial (RCT), comparable clinical benefit and radiographic joint space width (JSW) increase over 2 years follow-up were demonstrated for both treatments1. Yet, comparison of JSW before and after HTO may be unreliable, as pseudo-widening of the unloaded compartment may occur due to the induced leg axis change. Therefore, direct cartilage thickness measurements need to be compared between KJD and HTO, to accurately evaluate the efficacy of both treatment options on cartilage structure.Objectives:To compare two-year cartilage thickness changes after treatment with KJDvsHTO and identify factors predicting cartilage thickness restoration.Methods:Patients indicated for HTO were randomized to KJD (KJDHTO) or HTO treatment. Patients indicated for total knee arthroplasty received KJD (KJDTKA). Standardized semi-flexed weight-bearing radiographs and 3T MRIs with 3D spoiled gradient recalled imaging sequence with fat suppression (SPGR-fs) were acquired before and two years after surgical treatment. Cartilage thickness in the knee was measured using Chondrometrics Works 3.0 software. On the radiographs the mean JSW in the MAC were measured with KIDA software. Readers were blinded to the type of intervention and acquisition order. The primary and secondary outcomes were the mean MAC cartilage thickness (ThCtAB) and percentage of denuded bone area (dABp) change before and two years after treatment (MRI), with radiographic joint space width (JSW) used as a reference.Results:No statistically significant differences in the baseline characteristics were seen between KJDHTO(n=18) and HTO (n=33). The KJDTKAgroup (n=18) had a higher age and Kellgren-Lawrence grade (KLG) than the HTO and KJDHTOgroups.KJDHTOpatients did not show significant changes in MAC cartilage thickness, dABp, or JSW over time (all p>0.10; figure 1). HTO patients displayed a decrease in MAC cartilage thickness and an increase in dABp (both p<0.03), but an increase in JSW (p=0.006). KJDTKAshowed a significant increase in MAC cartilage thickness and JSW and decrease in dABp (all p<0.01). Baseline OA severity was the strongest predictor of cartilage restoration. KJD patients with severe OA (KJDsevere; KLG ≥3) showed significant restoration (all p<0.01; figure 2); mild OA patients (KJDmild; KLG ≤2) showed a slight deterioration. KJDsevereshowed a significantly greater cartilage restoration response in the MAC than HTOseverefor cartilage thickness (p=0.005) and dABp (p=0.003), but not JSW change (p=0.521). The changes in all three parameters did not differ significantly between KJDmildand HTOmild(all p>0.08).Conclusion:In patients with severe knee OA, KJD is more efficient in restoring cartilage thickness than HTO is. In these patients, KJD causes significant cartilage restoration while HTO, despite shifting the leg axis and demonstrating radiographic joint space widening, shows loss of cartilage as measured on MRI. In patients with mild knee OA, neither HTO nor KJD treatment results in significant cartilage restoration and both treatments show a slight deterioration that is likely the result of natural OA progression. As such, this research promotes the choice KJD as joint-preserving surgery in case of knee OA patients with more severe structural damage.References:[1]MP Jansenet al, Cartilage 2019.Disclosure of Interests:Mylène Jansen: None declared, Susanne Maschek Shareholder of: Stock/stock options at Condrometrics GmbH, Employee of: Employment at Condrometrics GmbH, Ronald Van Heerwaarden: None declared, Simon Mastbergen: None declared, Wolfgang Wirth Shareholder of: Stock/stock options at Condrometrics GmbH, Consultant of: Consultancy to Galapagos NV, Employee of: Employment at Condrometrics GmbH, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV, Felix Eckstein Shareholder of: Stock/stock options at Condrometrics GmbH, Consultant of: Consultancy at Merck KGaA, Samumed, Bioclinica, Galapagos, Servier, Novartis, Employee of: Employment at Condrometrics GmbH, Speakers bureau: Development of educational presentations for Medtronic

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