Osteochondritis Dissecans Lesion Location Is Highly Concordant With Mechanical Axis Deviation

2020 ◽  
Vol 48 (4) ◽  
pp. 871-875
Author(s):  
Matthew L. Brown ◽  
Julie C. McCauley ◽  
Guilherme C. Gracitelli ◽  
William D. Bugbee
Keyword(s):  
Lower Extremity ◽  
Osteochondritis Dissecans ◽  
Distal Femur ◽  
Mechanical Axis ◽  
Femoral Condyle ◽  
Lesion Size ◽  
Osteochondral Allograft ◽  
Axis Deviation ◽  
Mechanical Axis Deviation ◽  
Lesion Location

Background: The cause of osteochondritis dissecans (OCD) is unknown. Purpose: To determine if mechanical axis deviation correlates with OCD lesion location in the knee, if degree of mechanical axis deviation correlates with size of OCD lesion, and if the deformity was primarily in the distal femur or proximal tibia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We identified 61 knees that underwent osteochondral allograft (OCA) transplantation for femoral condyle OCD lesions and used preoperative lower extremity alignment radiographs to measure lower extremity mechanical axis, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and hip-knee-ankle angle. Lesion location and area were retrieved from operative records. Results: The location of the OCD lesion was the medial femoral condyle (MFC) for 37 knees and lateral femoral condyle (LFC) for 24 knees. Among knees with MFC lesions, alignment was varus in 25 (68%). Conversely, knees with LFC lesions had valgus alignment in 16 (67%). The mLFDA was significantly more valgus in the LFC group. mMPTA was not different between MFC and LFC groups. There was no significant correlation between degree of mechanical axis deviation and lesion size. Conclusion: In this cohort, two-thirds of patients with symptomatic OCD lesions had associated mechanical axis deviation. Lesion location correlated with mechanical axis deviation (LFC lesions were associated with a deformity in the distal femur). Degree of deformity was not correlated with lesion size. Mechanical axis deviation may play a role in OCD pathogenesis. These data do not allow analysis of the role of mechanical axis deviation in causation or prognosis of OCD lesions, but surgeons treating OCD should be aware of this common association.

Effect of foot deformity on conventional mechanical axis deviation and ground mechanical axis deviation during single leg stance and two leg stance in genu varum

The Knee ◽  
2007 ◽  
Vol 14 (6) ◽  
pp. 452-457 ◽  
Author(s):  
Sameer Shrikrishna Desai ◽  
Gautam M. Shetty ◽  
Hae-Ryong Song ◽  
Seok Hyun Lee ◽  
Tae Young Kim ◽  
...  
Keyword(s):  
Mechanical Axis ◽  
Genu Varum ◽  
Axis Deviation ◽  
Foot Deformity ◽  
Mechanical Axis Deviation ◽  
Single Leg Stance

Interobserver and Intraobserver Reliability in the Evaluation of Mechanical Axis Deviation

2009 ◽  
Vol 29 (3) ◽  
pp. 281-284 ◽  
Author(s):  
J. Eric Gordon ◽  
Ryan C. Chen ◽  
Matthew B. Dobbs ◽  
Scott J. Luhmann ◽  
Margaret M. Rich ◽  
...  
Keyword(s):  
Mechanical Axis ◽  
Intraobserver Reliability ◽  
Axis Deviation ◽  
Mechanical Axis Deviation

Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation

2018 ◽  
Vol 46 (4) ◽  
pp. 900-907 ◽  
Author(s):  
Luis E.P. Tírico ◽  
Julie C. McCauley ◽  
Pamela A. Pulido ◽  
William D. Bugbee
Keyword(s):  
Cartilage Repair ◽  
Femoral Condyle ◽  
Relative Size ◽  
Surgical Techniques ◽  
Lesion Size ◽  
Osteochondral Allograft ◽  
Fresh Osteochondral Allograft ◽  
Graft Area ◽  
The Mean

Background: Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. Purpose: To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm2 (range, 2.3-11.5 cm2). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. Results: The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. Conclusion: The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.

scholarly journals Retroarticular Drilling with Supplemental Bone Marrow Aspirate Concentrate for the Treatment of Osteochondritis Dissecans of the Knee

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0013 ◽  
Author(s):  
Kelsey Davidson ◽  
Nathan L. Grimm ◽  
Melissa A. Christino ◽  
S. Clifton Willimon ◽  
Michael T. Busch
Keyword(s):  
Bone Marrow ◽  
Osteochondritis Dissecans ◽  
Bone Marrow Aspirate ◽  
Femoral Condyle ◽  
Lesion Size ◽  
Autogenous Bone ◽  
Bone Marrow Aspirate Concentrate ◽  
The Mean ◽  
Back Filling

Objectives: Osteochondritis dissecans (OCD) is an idiopathic alteration of the subchondral bone which may lead to early osteoarthritis. This condition is commonly seen in the knee and is more common in young, athletic individuals. Several techniques have been developed to address the variable presentation of OCD in the knee, each with varying results. To our knowledge the use of autogenous bone marrow supplementation to an OCD lesion has not been described. The purpose of this study was to determine the radiographic healing of OCD lesions of the knee in a cohort of young, active patients who underwent retroarticular drilling of an OCD lesion with supplemental back-filling with bone marrow aspirate concentrate as an adjuvant to facilitate healing. Methods: We evaluated adolescent patients who were diagnosed with OCD of the knee who had previously failed non-operative, conservative treatment. All subjects underwent retroarticular drilling of the knee with supplemental back-filling of the lesion with bone marrow aspirate concentrate (BMAC®), harvested from the ilium, by two Orthopaedic Surgeons from a single institution. Based off previously published definitions, lesions were assigned as small if < 320 mm2 or large >320 mm2. All lesions were then followed radiographically for evidence of healing. Healing was graded based off the ROCK (Research in OsteoChondritis of the Knee) group radiographic healing criteria, which has shown excellent reliability. The healing was rated by two independent reviewers and when disagreements were noted a third reviewer was brought in to facilitate group consensus on healing. Results: 52 lesions in 49 patients were included in the study. 26 right knees, 26 left knees with 41 lesions located on the medial femoral condyle and 11 lesions located on the lateral femoral condyle. The mean age of the subjects was 12.5 (10 - 17) years old. 30 subjects were male, 19 were female. All lesions were categorized as immobile lesions based off the ROCK Arthroscopy Classification. The average OCD lesion size was 407 mm2 (132 - 899 mm2), respectively. The mean amount of BMAC® used per OCD lesion was 60 mL (45 - 120 mL). 40 lesions (76.9%) were rated as healed at a mean of 10.6 (2 - 32) months. 10 lesions (18.9%) were rated as 25-75% healed and 3.8% were rated at 0 - 25% healed at latest follow-up. 76.5% of large lesions were rated as healed at final follow-up. Whereas 77.8% of small lesions were rated as healed at final follow-up. There were three complications (1 rash from skin glue, 1 suture abscess, and 1 contact dermatitis from surgical cleansing prep) however no complications were noted from the surgical intervention or BMAC®. Conclusion: Overall healing rates with surgical treatment of OCD lesions that have failed non-operative interventions are variable. For immobile lesions, mainstay treatment options include retroarticular and transarticular drilling. Based off previous definitions of lesion size, the mean lesion size in our cohort would be categorized as “large” with 65% of our lesions falling into this category. Previously published series have shown that large lesions are significantly less likely to heal. Despite this we showed a 76.5% healing rate for large lesions. Overall, the adjuvant supplementation of BMAC® as back-fill for retrograde drilling of large OCD lesions of the knee has shown excellent results with no serious complications associated with its use. Future randomized trials are necessary to evaluate the comparative effectiveness of this treatment method.

scholarly journals Genu valgum deformity – correction by a wedgeless implantless femoral “V” osteotomy

2021 ◽  
Vol 87 (2) ◽  
pp. 247-254
Author(s):  
Amrit Goyal ◽  
Vikas Gupta ◽  
Meenakshi Goyal ◽  
Rajesh Chandra ◽  
Vinod K Sharma
Keyword(s):  
Internal Fixation ◽  
Mechanical Axis ◽  
Deformity Correction ◽  
Image Intensifier ◽  
Valgus Knee ◽  
Axis Deviation ◽  
Mechanical Axis Deviation ◽  
Tibiofemoral Angle ◽  
Average Value ◽  
Intermalleolar Distance

Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar “V” osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.

A computer assessment of the effect of hindfoot alignment on mechanical axis deviation

2014 ◽  
Vol 113 (1) ◽  
pp. 126-132 ◽  
Author(s):  
Naven Duggal ◽  
Gabrielle M. Paci ◽  
Abhinav Narain ◽  
Leandro Grimaldi Bournissaint ◽  
Ara Nazarian
Keyword(s):  
Mechanical Axis ◽  
Axis Deviation ◽  
Computer Assessment ◽  
Hindfoot Alignment ◽  
Mechanical Axis Deviation

scholarly journals Osteochondral Allograft Transplantation of the Knee in “Ideal” Candidates: Clinical Outcomes and Graft Survivorship

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0050
Author(s):  
William Bugbee
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Young Patients ◽  
Osteochondral Allograft ◽  
Functional Improvement ◽  
Patient Specific ◽  
Osteochondral Lesions ◽  
Small Lesion

Objectives: Osteochondral allograft (OCA) transplantation of the knee is an effective treatment for chondral and osteochondral lesions, but graft survivorship and clinical outcomes vary by patient-specific factors. Fresh OCA are often used for large or complex lesions or in the revision cartilage repair setting, but recent literature suggests that the most ideal candidates for OCA transplantation may be young patients with a small lesion on the femoral condyle or trochlea due to osteochondritis dissecans or chondral trauma. The purpose of this study was to assess outcomes following OCA transplantation in a cohort of “ideal” candidates. Methods: We identified 91 patients (97 knees) who underwent primary OCA transplantation for osteochondritis dissecans (88%) or a traumatic chondral injury (12%), were age 30 years or younger, and had an isolated lesion(s) of the femoral condyle or trochlea less than 8 cm2. Mean age was 20 years and 70% were male. Lesions were located on the femoral condyle (85%) or trochlea (15%). One graft was used in 85% of knees and two grafts were used in 15%. Mean total graft area was 5.2 cm2. Evaluation included pain, function, satisfaction, and reoperations. OCA failure was defined as revision allografting or conversion to arthroplasty. Median follow-up was 5.7 years (range 2-17 years). Results: Seventeen knees (18%) underwent reoperations. Two knees (2%) were classified as OCA failures (one revision OCA at 2.7 years and one conversion to unicompartmental arthroplasty at 10.2 years). Survivorship was 99% at 5 and 10 years. Pain and function improved (Table 1.), and 93% of patients were satisfied with the results of the OCA transplantation. Conclusion: In this cohort of “ideal” cartilage repair patients undergoing OCA transplantation, graft survivorship and clinical outcomes were excellent, with high satisfaction, pain relief, and functional improvement. Outcomes were equal or superior to other cartilage repair techniques. [Table: see text]

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