scholarly journals Current Practice of Analysis and Treatment of underlying Varus Deformity in Patients with Cartilage Defects of the medial Femoral Condyle: Data of the German Cartilage Registry (KnorpelRegister DGOU)

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Svea Faber ◽  
Johannes Zellner ◽  
Alfred Hochrein ◽  
Gunter Spahn ◽  
Philipp Niemeyer
Keyword(s):  
Cartilage Repair ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Combined Treatment ◽  
Varus Deformity ◽  
Outcome Evaluation ◽  
Medial Femoral Condyle ◽  
Tibial Osteotomy ◽  
Leg Axis ◽  
Preoperative Analysis

Aims and Objectives: In the context of cartilage repair, identification of the underlying pathologies depends on detailed preoperative evaluation. High tibial osteotomy (HTO) for varus deformities is one of the most common concomitant treatments, though scientific evidence about efficiency of concomitant HTO is still limited. The present study was initiated to describe preoperative analysis of alignment and to analysis outcome comparing patients with combined cartilage repair and HTO with those who received cartilage repair procedures alone. Materials and Methods: The multicenter data (3855 data sets on April 15, 2018) was provided by the attending physician and a self-reported outcome analysis (KOOS). Inclusion criteria: Existence of a leg full length portrait, a single defect at the medial femoral condyle, either no accompanying surgery or a HTO and information on leg axis misalignment. For outcome evaluation patients were divided into three different groups with regard to the extent of varus deformity: MILD (0-4° varus), MODERATE (5-9° varus) and SEVERE (> 10°). Statistical Analysis was performed using SPSS (IBM) Version 23. For detection of significances between different groups one-way ANOVA test was applied. P-values < 0.05 were considered statistical significant. Results: In 55.1% (n=2125) of the patients a full leg weight-bearing radiographs has been performed preoperatively. Out of these 834 (39%) cases with isolated defects of the medial femoral condyle have been identified of which 179 received HTO in combination with the cartilage repair procedure (21.5%), while 411 cases have been treated with isolated cartilage repair (49.3%). From the remaining 385 patients, 256 patients were considered MILD (67,3%), 113 MODERATE (29.5%) and 4.2% (n=16) SEVERE. Incidence of HTO significantly depended on the degree of varus deformity for mild (19% HTO) and moderate (83% HTO) deformity, but there was no significance between the moderate and severe (81% HTO) group. Significant differences of the KOOS score could be shown preoperatively between the mild (mean: 57.3), as well as moderate (mean: 55.95), and the severe group (mean 39.53) and six months postoperatively between the mild (mean: 71.48) and the severe (mean: 52.6) group. Conclusion: The present analysis of a large patients cohort extracted from the German Cartilage Registry (KnorpelRegister DGOU) demonstrates that, against common guidelines, full-leg weigth-bearing radiographs are not conducted on a regular basis in patients assigned for cartilage repair procedures. In those cases with detailed preoperative analysis of alignment, the degree of deformity seems to influence the decision, whether a realignment procedure (HTO) is performed. For the moderate subgroup a trend towards better clinical outcome was found for combined treatment in terms of realignment and cartilage repair in comparison to cartilage repair alone. Since there was no difference in the MILD subgroup, more evidence is needed to proof, whether those patients benefit from a HTO or not.

Comparison of Clinical Outcome following Cartilage Repair for Patients with Underlying Varus Deformity with or without Additional High Tibial Osteotomy: A Propensity Score–Matched Study Based on the German Cartilage Registry (KnorpelRegister DGOU)

Cartilage ◽  
2020 ◽  
pp. 194760352098234
Author(s):  
Svea Faber ◽  
Peter Angele ◽  
Johannes Zellner ◽  
Gerrit Bode ◽  
Alfred Hochrein ◽  
...  
Keyword(s):  
Propensity Score ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Femoral Condyle ◽  
Varus Deformity ◽  
Medial Femoral Condyle ◽  
Cartilage Defects ◽  
Tibial Osteotomy ◽  
Matched Study

Background Even though realignment procedures have gained popularity as concomitant techniques in cartilage repair approaches with underlying malalignment, the clinical efficacy has not been proven to full extent. Methods Out of 5474 patients from the German Cartilage Registry, 788 patients with focal cartilage defects on the medial femoral condyle having received either no accompanying surgery or high tibial osteotomy (HTO) were identified. After a 1:1 propensity score matching, outcome of 440 patients was evaluated using KOOS (Knee Injury and Osteoarthritis Outcome Score), VAS (visual analogue scale), and satisfaction during the 3-year follow-up. Results Patients having received a concomitant HTO had significantly higher postoperative KOOS values (12 months: 67.26 ± 15.69 vs.75.10 ± 16.12, P = 0.001; 24 months: 67.14 ± 23.85 vs. 77.11 ± 16.50, P = 0.010; 36 months: 74.40 ± 16.57 vs. 81.75 ± 14.22, P = 0.023) and lower pain levels (6 months: 3.43 ± 2.18 vs. 2.89 ± 2.15, P = 0.009; 12 months: 3.64 ± 2.20 vs. 2.17 ± 1.96, P < 0.001; 24 months: 4.20 ± 3.12 vs. 2.94 ± 2.45, P = 0.005; 36 months: 3.20 ± 2.18 vs. 2.02 ± 1.98, P = 0.003). One and 3 years postoperatively, concomitant HTO led to significantly higher satisfaction in patients. These advantages of accompanying HTO were also seen in the group of patients with a varus deformity of 5° or more, in which pain levels without concomitant HTO even increased during the 3-year follow-up. Conclusion The results of the present study underline the importance and safety of concomitant HTO in patients with cartilage defects and varus deformity. HTO should therefore be considered and recommended generously in patients with focal cartilage defects of the medial femoral condyle and varus deformity.

Return to Sport Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation

2020 ◽  
Vol 48 (8) ◽  
pp. 1945-1952 ◽  
Author(s):  
Joseph N. Liu ◽  
Avinesh Agarwalla ◽  
David R. Christian ◽  
Grant H. Garcia ◽  
Michael L. Redondo ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Femoral Condyle ◽  
Varus Deformity ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Return To Sports ◽  
Tibial Osteotomy ◽  
Allograft Transplantation ◽  
Chondral Defects

Background: Young patients with symptomatic chondral defects in the medial compartment with varus malalignment may undergo opening wedge high tibial osteotomy (HTO) with concomitant osteochondral allograft transplantation (OCA) (HTO + OCA). Although patients have demonstrated favorable outcomes after HTO + OCA, limited information is available regarding return to sporting activities after this procedure. Purpose: To evaluate (1) the timeline to return to sports (RTS), (2) patient satisfaction, and (3) reasons for discontinuing sporting activity after HTO + OCA, and to identify predictive factors of RTS. Study Design: Case series; level of evidence, 4. Methods: Consecutive patients who underwent HTO + OCA for varus deformity and medial femoral condyle focal chondral defects with a minimum 2-year follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire, satisfaction questionnaire, visual analog scale for pain, and Single Assessment Numerical Evaluation. Results: Twenty-eight patients with a mean age of 36.97 ± 7.52 years were included at mean follow-up of 6.63 ± 4.06 years. Fourteen patients (50.0%) required reoperation during the follow-up period, with 3 (10.7%) undergoing knee arthroplasty. Twenty-four patients participated in sports within 3 years before surgery, with 19 patients (79.2%) able to return to at least 1 sport at a mean 11.41 ± 6.42 months postoperatively. However, only 41.7% (n = 10) were able to return to their preoperative level. The most common reasons for sports discontinuation (n = 20; 83.3%) were a desire to prevent further damage to the knee (70.0%), persistent pain (55.0%), persistent swelling (30.0%), and fear (25.0%). Conclusion: In young, active patients with varus deformity and focal medial femoral condyle chondral defects, HTO + OCA enabled 79.2% of patients to RTS by 11.41 ± 6.42 months postoperatively. However, only 41.7% of patients were able to return to their preinjury level or better. It is imperative that patients be appropriately educated to manage postoperative expectations regarding sports participation after HTO + OCA.

scholarly journals Mosaic arthroplasty of the medial femoral condyle in horses — An experimental study

2014 ◽  
Vol 62 (2) ◽  
pp. 155-168 ◽  
Author(s):  
Gábor Bodó ◽  
Gábor Vásárhelyi ◽  
László Hangody ◽  
László Módis
Keyword(s):  
Hyaline Cartilage ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Medial Femoral Condyle ◽  
The Other ◽  
Bearing Surface ◽  
Femoral Trochlea ◽  
Osteochondral Grafts ◽  
Mosaic Arthroplasty

One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations.

Evaluation and comparison of cartilage repair tissue of the patella and medial femoral condyle by using morphological MRI and biochemical zonal T2 mapping

2008 ◽  
Vol 19 (5) ◽  
pp. 1253-1262 ◽  
Author(s):  
Goetz H. Welsch ◽  
Tallal C. Mamisch ◽  
Sebastian Quirbach ◽  
Lukas Zak ◽  
Stefan Marlovits ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
T2 Mapping ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Repair Tissue

scholarly journals Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Matteo Guzzini ◽  
Cosma Calderaro ◽  
Marco Guidi ◽  
Carolina Civitenga ◽  
Germano Ferri ◽  
...  
Keyword(s):  
Distal Femur ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Donor Site ◽  
Pedicled Flap ◽  
Medial Femoral Condyle ◽  
Full Weight Bearing ◽  
Genicular Artery ◽  
Reconstruction Of Bone Defects

Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too.Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure.Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion.

scholarly journals How Does Delayed Excision of Symptomatic Medial Plica Affect the Outcomes?

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0018
Author(s):  
Hasan Bombaci ◽  
Mehmet Kuyumcu ◽  
Tamer Coskun ◽  
Emre Kaya
Keyword(s):  
Femoral Condyle ◽  
Weight Bearing ◽  
Medial Femoral Condyle ◽  
Time Range ◽  
Small Series ◽  
Chondral Damage ◽  
Medial Plica ◽  
Flexion Extension ◽  
Group 2 ◽  
Group 1

Objectives: Medial plica (MP) is usually asymptomatic, however has the potential to cause impingement on the medial femoral condyle when it is prominent or thickened. The incidence of MP has been reported up to 79.9%. Very few of them become symptomatic over time. Due to delay in seeking medical assistance or extended conservative treatment, surgery may be delayed in some of the patients and this might cause increased chondral damage. The purpose of this study is to compare the outcomes of patients who received early surgery with patients undergoing delayed surgery one year after the onset of symptoms. Methods: Sixteen knees of the 14 patients (7 male, 7 female), who underwent arthroscopic MP excision between 2007 and 2011 were included in this retrospective study. In six patients had right, six patients had left and in two patients had both knees involved. Plicas, which were seen in patients with ligament injury were excluded from the study. Mean age was 42.9 years (range; 23-62). All patients complained of pain but some had mechanical symptoms such as friction during flexion-extension. Patients were evaluated with visual analogue scale (VAS) and Lysholm scores pre-operatively and at the last examination. The knees which were operated on within the first year (range; 1-12 months) after being symptomatic were grouped as Group 1 and the ones operated on after that time (range; 18-180 months) Group 2. More advanced chondral lesions were in the second group. Two groups were compared statistically by using “paired t test” in terms of VAS and Lysholm scores at the last control examination. Results: All patients had cartilaginous degeneration of various degrees on the surface medial femoral condyle facing the MP. Pre-operative (5.62±1.66) and final follow-up mean VAS (2.31±2.02) scores and mean Lysholm scores (65.62±13.82 and 83.43±15.51, respectively) were significantly different (p<0.005). Mean VAS score was 2.00 (±2.39) in Group 1 and 2.62 (±1.68) in Group 2 at final evaluation. Mean Lysholm scores were 81.25 (±20.04) and 85.62 (±10.16) respectively for Groups 1 and 2. Both of these differences were not statistically significant(p>0.05). Conclusion: All patients obtained satisfactory outcomes after arthroscopic MP excision. MP is usually asymptomatic but, when it is large and its free edge impinges on the superior anteromedial and medial portion of the medial femoral condyle, it might cause chondral damage leading to full thickness cartilage lesions. When it becomes symptomatic, chondral damage quite often is already advanced. This small series revealed that, even late arthroscopic excision of the MP relieves symptoms but, chondral damage persists even though the patient becomes asymptomatic. The reasons of this might be; 1) the region of lesion is outside of weight bearing zone or 2) the origin of pain might be stretched MP before excision.

scholarly journals Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110466
Author(s):  
Jörg Harrer ◽  
Max Schenke ◽  
Christoph Lutter ◽  
Jörg Dickschas ◽  
Matthias Feucht ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Varus Deformity ◽  
Joint Line ◽  
Full Weight Bearing ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Partial Weight Bearing ◽  
Angle Stable ◽  
Angle Stable Plate ◽  
Partial Weight

Background: Lower extremity alignment-correcting procedures for unicompartmental osteoarthritis are experiencing a rapid rise. Medial open-wedge high tibial osteotomy (MOW-HTO) thereby represents the most common technique among osteotomies but is limited in cases of severe malalignment. Some cases make a double-level osteotomy necessary. Indications: If planning of malalignment correction using a MOW-HTO results in a mechanical medial proximal tibial angle (mMPTA) of more than 93° (causing an oblique joint line), double-level osteotomy is indicated to avoid nonphysiological knee kinematics. Technique Description: After clinical examination and detailed analysis of malalignment (full-weight-bearing long-leg radiograph: hip-knee-angle [HKA], mMPTA, mechanical lateral distal femoral angle [mLDFA], joint line convergence angle [JLCA]), as well as individualized planning of the correction, the surgical procedure starts with an arthroscopy to evaluate the cartilage conditions and eventually treat intraarticular pathologies. Then, the femoral supracondylar correction is performed (closed wedge, biplanar osteotomy [ to increase bony healing]) according to the presurgical planning by resecting the osteotomy wedge with the measured length. K-wires are placed to check the correction. An angle-stable plate is used for osteosynthesis. The wedge taken out will be used as bone stock for the MOW-HTO afterward. The biplanar open-wedge tibial osteotomy is then performed subsequently using a medial tibial approach and an angle-stable plate. Opening of the osteotomy is then performed and double checked with intraoperative fluoroscopy using an alignment rod. Postoperative partial weight bearing for 6 weeks is recommended. Results: In recent literature, only few publications report on results of double-level osteotomies. Babis et al reports that it is a valuable procedure for patients with large varus deformity. Nakayama et al noted a significant improvement in patient-registered clinical outcomes in early postoperative evaluation of 20 patients. Schröter et al reports on 37 knees and findings include good clinical results, despite progressive osteoarthritis. Discussion/Conclusion: In cases of severe malalignment, adequate axis correction may require a double-level osteotomy. Exact preoperative planning is essential. Results reported in recent publications are promising. By splitting 1 large correction into 2 smaller ones, complications like hinge fracture and delayed bone healing are lowered.

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