scholarly journals Managing intra-articular deformity in high Tibial osteotomy: a narrative review

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Grégoire Micicoi ◽  
Raghbir Khakha ◽  
Kristian Kley ◽  
Adrian Wilson ◽  
Simone Cerciello ◽  
...  
Keyword(s):  
Soft Tissue ◽  
High Tibial Osteotomy ◽  
Clinical Evidence ◽  
Corrective Osteotomy ◽  
Narrative Review ◽  
Tibial Osteotomy ◽  
Surrounding Soft Tissue ◽  
Joint Line Convergence Angle ◽  
Leg Alignment ◽  
Soft Tissue Laxity

Abstract The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee. The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery. The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome. This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA. We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy. Level of clinical evidence IV, narrative review.

scholarly journals A Systematic Review on Selected Complications of Open-Wedge High Tibial Osteotomy from Clinical and Biomechanical Perspectives

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Elaheh Elyasi ◽  
Guillaume Cavalié ◽  
Antoine Perrier ◽  
Wilfrid Graff ◽  
Yohan Payan
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
High Tibial Osteotomy ◽  
Medial Collateral Ligament ◽  
Surgical Planning ◽  
Tibial Slope ◽  
Patellar Height ◽  
Tibial Osteotomy ◽  
Collateral Ligament ◽  
Posterior Tibial

Background. The wedge opened during high tibial osteotomy defines the alignment correction in different body planes and alters soft tissue insertions. Although multiple complications of the surgery can be correlated to this, there is still a lack of consensus on the occurrence of those complications and their cause. The current study is aimed at clarifying this problem using a combined medical and biomechanical perspective. Methods. We conducted a systematic review of the literature on selective complications of the surgery correlated with the angles of the opened wedge. Search topics covered tibial slope alteration, patellar height alteration, medial collateral ligament release, and model-based biomechanical simulations related to surgical planning or complications. Findings. The selection process with the defined inclusion/exclusion criteria led to the collection of qualitative and quantitative data from 38 articles. Medial collateral ligament tightness can be a valid complication of this surgery; however, further information about its preoperative condition seems required for better interpreting the results. The posterior tibial slope significantly increases, and the patellar height (using the Blackburne-Peel ratio) significantly decreases in the majority of the selected studies. Model-based biomechanical studies targeting surgical planning are mostly focused on the lower-limb alignment principles and tibiofemoral contact balancing rather than surgical complications. Interpretation. Increased posterior tibial slope, patellar height decrease, and medial collateral ligament tightness can occur due to alterations in different body planes and in soft tissue insertions after wedge opening. This study clarified that information about preoperative alignment in all body planes and soft-tissue conditions should be considered in order to avoid and anticipate these complications and to improve per surgery wedge adaptation. The findings and perspective of this review can contribute to improving the design of future clinical and biomechanical studies.

Extra-abdominal Desmoid Fibromatosis in the Foot

2011 ◽  
Vol 101 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Alan A. MacGill ◽  
Vincent R. Milione ◽  
Laura G. Sullivan
Keyword(s):  
Soft Tissue ◽  
Clinical Evidence ◽  
Surgical Excision ◽  
Wide Excision ◽  
High Rate ◽  
Desmoid Tumors ◽  
Surrounding Soft Tissue ◽  
Desmoid Fibromatosis ◽  
Extra Abdominal Desmoid ◽  
Local Surgical Excision

Extra-abdominal desmoid tumors account for 0.03% of all neoplasms and rarely present in the foot. They are benign but locally aggressive, and wide local surgical excision is the treatment of choice owing to the high rate of recurrence in the lower extremities. Invasiveness into the surrounding soft-tissue structures often makes wide excision difficult without compromise of function. We describe a 34-year-old woman with a large, pedal, extra-abdominal desmoid fibroma treated by wide local surgical excision with minimal complications postoperatively and no clinical evidence of recurrence at 28 months. (J Am Podiatr Med Assoc 101(1): 70–74, 2011)

scholarly journals Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Takahiro Ogino ◽  
Ken Kumagai ◽  
Shunsuke Yamada ◽  
Tomotaka Akamatsu ◽  
Shuntaro Nejima ◽  
...  
Keyword(s):  
Soft Tissue ◽  
High Tibial Osteotomy ◽  
Mechanical Axis ◽  
Tibial Osteotomy ◽  
Axis Deviation ◽  
Open Wedge ◽  
Correction Angle ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy

Abstract Background The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). Methods A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. Results CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P <  0.05), and a greater soft tissue correction than OWHTO (P <  0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P <  0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. Conclusions The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.

The Effect of Mechanical Leg Alignment on Cartilage Restoration With and Without Concomitant High Tibial Osteotomy

2020 ◽  
Vol 36 (8) ◽  
pp. 2204-2214
Author(s):  
Jakob Ackermann ◽  
Gergo Merkely ◽  
Dillon Arango ◽  
Alexandre Barbieri Mestriner ◽  
Andreas H. Gomoll
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Cartilage Restoration ◽  
Leg Alignment
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