scholarly journals Does arthroscopic patellar denervation with high tibial osteotomy improve anterior knee pain?

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Mohamed Kamel Mohamed Said ◽  
Hatem G. Said ◽  
Hesham Elkady ◽  
Mahmoud Kamel Mohamed Said ◽  
Islam Karam-Allah Ramadan ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Kujala Score ◽  
Group A ◽  
Level I ◽  
Group B ◽  
Anterior Knee

Abstract Purpose Patellofemoral (PF) joint osteoarthritis (OA) is a major cause of anterior knee pain. Combined PF and medial tibiofemoral (TF) OA is common in older adults. We evaluated the effect of arthroscopic patellar denervation (PD) in patients with combined TF and PFOA after malalignment correction. Methods Forty-five patients [females/males, 27/18; age, 30–59 years (45.5 ± 8.50); mean body mass index, 25.15 ± 3.04 kg/m2] were treated in our department from March 2017 to March 2019. The patients were randomised into 2 groups: group A included 22 patients who underwent open-wedge high tibial osteotomy (OWHTO) and arthroscopic PD and group B included 23 patients who underwent OWHTO without denervation. The effect of denervation was statistically and clinically evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Kujala (anterior knee pain score) score. Results After 24 months, 40 patients were available for the final follow-up. The final values of KOOS and the Kujala score were significantly different between the groups (p < 0.001). For group A, the average KOOS improved from 42.73 to 72.38 (p < 0.001) and the Kujala score improved from 42 to 74.1 (p < 0.001), whereas in group B, the average KOOS improved from 39.22 to 56.84 (p < 0.001) and the Kujala score improved from 39.7 to 56.4 (p < 0.001). Conclusion Adding arthroscopic PD to OWHTO relieves anterior knee pain in patients with combined TF and PFOA and improves knee joint function and quality of life. Level of evidence Level I prospective randomised control clinical trial.

Patellofemoral Alignment and Anterior Knee Pain After Closing- and Opening-Wedge Valgus High Tibial Osteotomy

2012 ◽  
Vol 28 (8) ◽  
pp. 1087-1093 ◽  
Author(s):  
Il-Hyeon Song ◽  
Eun-Kyoo Song ◽  
Hyoung-Yeon Seo ◽  
Keun-Bae Lee ◽  
Ji-Hyeon Yim ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Patellofemoral Alignment ◽  
Anterior Knee

scholarly journals Early Patellofemoral Function of Unilateral TKA with Medial Pivot Prostheses is Superior than with Conventional Posterior-Stabilized Prostheses

2019 ◽  
Author(s):  
Zhen Wang ◽  
Yuqing Zhang ◽  
Changrong Ding ◽  
Xiaoyu Cai ◽  
Liang Gao ◽  
...  
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Systematic Evaluation ◽  
Control Group ◽  
Study Group ◽  
Posterior Stabilized ◽  
Medial Pivot ◽  
Group A ◽  
Group B ◽  
Anterior Knee

Abstract PurposeThe purpose of this study was to provide a systematic evaluation of the patellofemoral joint design of Medial Pivot Prosthesis, which incorporates a variety of “Patella-friendly” design features, by comparing clinical and radiographic results with another prosthesis. MethodsEarly clinical and radiographic results of patients who underwent unilateral TKA with Medial Pivot Prosthesis (The study group, including 126 cases) and conventional Posterior-Stabilized Prosthesis (The control group) were retrospectively compared. Postoperative complications, including anterior knee pain, maltracking, patellar clunk or crepitus (PCC), were evaluated.ResultsThe postoperative Kujala score and its improvement from baseline in the study group (Group A) were significantly higher than those in the control group(Group B). The range of motion (ROM) in group A, including the improvement in ROM, was significantly inferior to group B. In the 90-degree Merchant view, the patellar tilt in group A was smaller than that in group B. Two cases of PCC and 3 cases of anterior knee pain were noted in group A, and 9 cases and 6 cases, respectively, were observed in group B. The incidence of PCC was significantly lower in group A. There were no significant between-group differences in the patella tilt angle at 30 or 60° or in the postoperative patellar translation at 30, 60 or 90°. No between-group difference in posterior condyles angle (PCA) was observed. The KSS scores and WOMAC scores between the two groups were similar.ConclusionThe medial pivot prosthesis could achieve satisfactory outcomes with superior patellofemoral performance attributed to its “patella-friendly” design characteristics compared to the conventional posterior-stabilized prosthesis.

Congenital internal rotation deformity of the distal femur presenting as patellofemoral instability and pain

2019 ◽  
Vol 4 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Xinyuan Zhang ◽  
John Attenello ◽  
Marc R Safran ◽  
David W Lowenberg
Keyword(s):  
Internal Rotation ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Distal Femur ◽  
Case Series ◽  
Patellofemoral Instability ◽  
Level Of Evidence ◽  
Femoral Antetorsion ◽  
Derotational Osteotomy ◽  
Anterior Knee

ObjectivesFemoral antetorsion, defined as the angle of rotation of the femoral head and neck axis in relation to the transcondylar axis of the distal femur, is a cause for patellofemoral instability and anterior knee pain. Most clinical reports do not distinguish between antetorsion of the femur distal to the isthmus and anteversion of the proximal femur, which is another cause of femoral internal rotational deformity.MethodsThis retrospective observational case series evaluated four cases in three female patients who underwent evaluation of surgical intervention for chronic anterior knee pain since childhood. Physical examination and radiographic images supported the diagnosis of internal rotation deformity at the distal femora in all four cases. Distal femoral derotational osteotomy of 45°, 60° and 30° were performed, respectively. Kujala scoring system for patellofemoral pathology was used to assess the change in knee symptoms before and after the osteotomies.ResultsThis study demonstrated successful treatment of the resultant knee symptoms from femoral antetorsion with distal femur derotational osteotomy in all three patients.ConclusionsPatellofemoral syndrome is multifactorial, and the true anatomic reason for each patient’s individual pathology must be determined before surgery proceeds.Level of evidenceLevel V.

scholarly journals Risk factors of cartilage regeneration in patients who underwent high tibial osteotomy combined with microfracture

2019 ◽  
Author(s):  
Jong Keun Seon ◽  
Pramod Shaligram Ingle ◽  
Eun-Kyoo Song ◽  
Kyu-Jin Cho ◽  
Seung-Min Na ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Functional Outcomes ◽  
Cartilage Regeneration ◽  
Cartilage Lesion ◽  
Lateral Compartment ◽  
Tibial Osteotomy ◽  
Second Look ◽  
Group A ◽  
Group B

Abstract Background: One of the option for treating unicompartmental osteoarthritis (OA) is high tibial osteotomy (HTO). HTO which can shift the mechanical axis to the lateral compartment, can performed with microfracture which provides cells capable of producing cartilage. And this procedure is one of the common combinations that orthopaedic surgeons are in practice recently. The purpose of this study was to evaluate the degree of regeneration of cartilage after performing microfracture (MF) with high tibial osteotomy (HTO) after 2- year follow up and identify the factors influencing the regeneration of cartilage after the procedure. We also evaluated whether the regenerated cartilage status affects clinical outcomes. Methods: A total of 81 cases that underwent second-look arthroscopy at the time of plate removal after MF and HTO with a minimum two-year follow-up were included. The patients were divided into two groups according to femoral cartilage regeneration. Multivariable logistic regression analyses were performend to identify independent factors that influence cartilage regeneration. We also compared differences in functional outcomes between the two groups. Results: On the femoral side, grade I cartilage regeneration was found in seven (8.6%), grade II in 19 (23.5%), grade III in 26 (32.1%), and grade IV in 29 cases (35.8%), resulting in 26 (32.1%) patients belonging to well regenerated group (group A) and 55 (67.9%) to the poorly regenerated group (group B). Among factors, the size of the cartilage lesion (P=.011) and the presence of kissing lesions (P=.027) significantly affected cartilage regeneration. There were no statistically significant differences between group A and group B in terms of KSS and WOMAC scores. Conclusions: A large cartilage defect and the presence of kissing lesions are associated with poor cartilage regeneration after combined MF and HTO surgery. However, the quality of regenerated cartilage does not affect functional outcomes in patients with MF and HTO. Keywords: High tibial osteotomy, Microfracture, Second-look arthroscopy, Cartilage regeneration, risk factor

Comparison of Bone Healing in Open-Wedge High Tibial Osteotomy between the Use of Allograft Bone Chips with Autologous Bone Marrow and the Use of Allograft Bone Chips Alone for Gap Filling

2019 ◽  
Vol 33 (06) ◽  
pp. 576-581
Author(s):  
Hee-June Kim ◽  
Il Seo ◽  
Ji-Yeon Shin ◽  
Kang San Lee ◽  
Kyeong-Hyeon Park ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Tibial Osteotomy ◽  
Autologous Bone Marrow ◽  
Clinical Results ◽  
Tibial Osteotomy ◽  
Allograft Bone ◽  
Open Wedge ◽  
Group A ◽  
Autologous Bone ◽  
Group B

AbstractThe present study aimed to evaluate whether the use of allograft bone chips mixed with autologous bone marrow (BM) in the high tibial osteotomy (HTO) gap could improve the radiological and clinical results of HTO. This study analyzed 36 patients who underwent HTO with locking plate (mean age: 58.0 years). Allograft bone chips mixed with autologous BM aspirated from anterior superior iliac spine were used in 19 patients (group A) and allograft chips only were used in 17 patients (group B). The radiological and clinical results between two groups were compared during examination at 6 weeks, 3 months, 6 months, and 12 months after surgery. Clinical evaluations involving the Hospital for Special Surgery score, Knee Society knee score, and function score were performed at each assessment point. The osteotomy filling and osteoconductivity using the modified van Hemert's score were compared in each period. The clinical results were not different between the groups at all assessment points. Osteotomy filling was higher at 6 weeks and 3 months in group A than in group B (p = 0.004 and 0.005, respectively). Osteoconductivity was higher at 6 weeks and 3 months in the most medial ¼ zone in group A than in group B (p = 0.025 and 0.031, respectively). Our data shows it is beneficial to mix the allograft bone chips mixed with autologous BM after open-wedge HTO.

scholarly journals Risk factors of poor cartilage regeneration in patients who underwent high tibial osteotomy combined with microfracture

2019 ◽  
Author(s):  
Ik-Sun Choi ◽  
Pramod Shaligram Ingle ◽  
Jong Keun Seon ◽  
Eun-Kyoo Song ◽  
Kyu-Jin Cho ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Functional Outcomes ◽  
Cartilage Regeneration ◽  
Cartilage Lesion ◽  
Lateral Compartment ◽  
Tibial Osteotomy ◽  
Second Look ◽  
Group A ◽  
Group B

Abstract Background: One of the option for treating unicompartmental osteoarthritis (OA) is high tibial osteotomy (HTO). HTO which can shift the mechanical axis to the lateral compartment, can performed with microfracture which provides cells capable of producing cartilage. And this procedure is one of the common combinations that orthopaedic surgeons are in practice recently. The purpose of this study was to evaluate the degree of regeneration of cartilage after performing microfracture (MF) with high tibial osteotomy (HTO) after 2- year follow up and identify the factors influencing the regeneration of cartilage after the procedure. We also evaluated whether the regenerated cartilage status affects clinical outcomes. Methods: A total of 81 cases that underwent second-look arthroscopy at the time of plate removal after MF and HTO with a minimum two-year follow-up were included. The patients were divided into two groups according to femoral cartilage regeneration. Multivariable logistic regression analyses were performend to identify independent factors that influence cartilage regeneration. We also compared differences in functional outcomes between the two groups. Results: On the femoral side, grade I cartilage regeneration was found in seven (8.6%), grade II in 19 (23.5%), grade III in 26 (32.1%), and grade IV in 29 cases (35.8%), resulting in 26 (32.1%) patients belonging to well regenerated group (group A) and 55 (67.9%) to the poorly regenerated group (group B). Among factors, the size of the cartilage lesion (P=.011) and the presence of kissing lesions (P=.027) significantly affected cartilage regeneration. There were no statistically significant differences between group A and group B in terms of KSS and WOMAC scores. Conclusions: A large cartilage defect and the presence of kissing lesions are associated with poor cartilage regeneration after combined MF and HTO surgery. However, the quality of regenerated cartilage does not affect functional outcomes in patients with MF and HTO. Keywords: High tibial osteotomy, Microfracture, Second-look arthroscopy, Cartilage regeneration, risk factor

scholarly journals Anterior Knee Pain Risk Differs Between Male and Female Military Tactical Athletes

2020 ◽  
Author(s):  
Neal R Glaviano ◽  
Michelle C Boling ◽  
John J Fraser
Keyword(s):  
Relative Risk ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Military Occupation ◽  
Service Members ◽  
Future Research ◽  
Level Of Evidence ◽  
Training Requirements ◽  
Chronic Knee Pain ◽  
Anterior Knee

Background: Anterior knee pain (AKP) is commonly diagnosed in military members and is a threat to operational readiness. AKP includes a range of conditions, with localized pain around the patella being a frequent location of pain and disability. Mechanical overuse is one suggested etiology for many of these conditions, suggesting occupational demands in the military may influence AKP frequency amongst the service members. Previous research suggests females are at a greater risk for AKP, however, it is unknown how occupation affects AKP risk. Study Design: Epidemiological cohort. Level of Evidence: Level 2. Methods: The Defense Medical Epidemiology Database was queried for the number of individuals with ICD-9 diagnosis codes on their initial encounter from 2006 to 2015. Diagnoses were categorized into anterior or retropatellar pain, patellar instability, knee tendinopathy, as well the sum of the three groups which was defined as AKP. Relative risk (RR) and chi-square statistics were calculated in the assessment of sex and occupational category. Regressions were calculated to determine association between service branch, sex, and AKP across time. Results: From 2006-2018, a total of 151, 263 enlisted and 14,335 officer services members were diagnosed with AKP. The incidence rate was 13.2 in enlisted members and 6.2 in in officers. Females were significantly at greater risk of developing AKP compared to males within both the enlisted (relative risk=1.32) and officer (relative risk=2.01) service members. Differences in risk were also noted across military occupation for both enlisted and officer service members, p<.05. Conclusion: Sex and military occupation were salient factors for AKP risk. Evaluation of training requirements and developing interventions programs across military occupation could serve as a focus for future research aiming to decrease the incidence of chronic knee pain.

scholarly journals Older age increases the risk of revision and perioperative complications after high tibial osteotomy for unicompartmental knee osteoarthritis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sun-Ho Lee ◽  
Hyoung-Yeon Seo ◽  
Hae-Rim Kim ◽  
Eun-Kyoo Song ◽  
Jong-Keun Seon
Keyword(s):  
Survival Rate ◽  
High Tibial Osteotomy ◽  
Revision Rate ◽  
Perioperative Complications ◽  
Young Patients ◽  
Charlson Comorbidity Index Score ◽  
Tibial Osteotomy ◽  
Old Patients ◽  
Group A ◽  
Group B

AbstractAmong various patient risk factors affecting survival after high tibial osteotomy (HTO), the ideal age limit for HTO is unclear. This study was performed to evaluate the effect of age on survival rate and complications after HTO for medial unicompartmental osteoarthritis. Among of 61,145 HTO patients from Korean National Health Insurance database, 41,112 patients underwent the procedure before the age of 60 years (Group A), 13,895 patients between the age of 60 and 65 years (Group B), and 6138 patients after the age of 65 years (Group C). We compared the survival rate in person-years among the three groups from the date of primary surgery until subsequent total knee arthroplasty. Perioperative complications were also recorded. The adjusted hazard ratio (HR) were calculated using the multivariable Cox proportional hazard regression model, adjusting for the potential confounders: age, sex, type of medical insurance, region of residence, hospital type, comorbidities, and Charlson comorbidity index score. The total number of HTO increased 6.5-fold, especially in patients aged > 65 years (by 8.2-fold) from 2008 to 2018. The overall revision rate was 4.2% in Group A, 6.4% in Group B, and 7.3% in Group C. The 5- and 10-year revision rate was significantly lower in Group A (p < 0.001), but no difference between Groups B and C. After adjusting for potential confounders, multivariable regression analysis revealed that revision rate was significantly lower in Group A than Group B (HR: 0.57; p < 0.0001), but no difference between Groups B and C. The incidence of complications was also significantly lower in Group A than in other groups. The inferior survival rate and more perioperative complications after HTO was found in old patients (aged ≥ 60 years) than in young patients. Therefore, the patient age is one of the predicting factors for a high risk of failure after HTO.

scholarly journals Patelloplasty in total knee arthroplasty with circumpatellar denervation versus without denervation – a randomized prospective study

Arthroplasty ◽  
2020 ◽  
Vol 2 (1) ◽  
Author(s):  
S. R. K. Deekshith ◽  
K. J. Reddy ◽  
R. Raviteja
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Kujala Score ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean ◽  
Anterior Knee

Abstract Introduction Anterior knee pain is one of the major problems in total knee arthroplasty (TKA) and is often etiologically associated with a patellofemoral parts etiology. There is no consensus as to etiology or treatment. Denervation of the patella by electrocautery and patelloplasty along with removal of osteophytes have been used for treatment of anterior knee pain in TKA. The purpose of our study was to compare, in terms of the anterior knee pain and clinical outcomes of patelloplasty in total knee arthroplasty (TKA), patellar denervation by electrocautery and non-patellar-denervation treatment in a 2 year follow-up. Materials and methods This study was conducted in a total of 108 patients, who underwent TKA at our institution between June 2015 and December 2016. Patients age 55 to 80 years, who are suffering from osteoarthritis, rheumatoid arthritis of knee were included in this study. Patients were randomly allocated into patelloplasty with denervation group and non-denervation group. The denervation of the patella was done in electrocautery group using a monopolar coagulation diathermy set to 50 W. (Valleylab Inc., Boulder, CO). Postoperatively, patients were assessed at regular intervals of 3, 6, 9, 12, 24 months. To assess patient outcomes, we used questionnaires to determine the Knee Society score (KSS - knee and function scores), a specific patellofemoral pain questionnaire (Kujala score) range of motion (ROM) and a visual analogue scale (VAS) to assess anterior knee pain. Results The data obtained were analyzed using SPSS version 17.0. Continuous variables were expressed as mean ± SD. Of the 108 patients, 9 patients were lost to follow-up. Among the remaining 99 patients, 50 were included in denervation group and 49 in non-denervation group. In our study, there was no statistically significant difference in Mean KUJALA score preoperatively (p > 0.05). Postoperatively, the mean KUJALA score was significantly higher in denervation group at 3, 6, 9, 12, 24 months of follow-up when compared to TKR with no denervation (p < 0.05). There was no statistically significant difference in Mean VAS score preoperatively (p > 0.05). However, 6, 12 and 24 months after the operation, the mean VAS score was significantly lower in denervation group. There was no statistically significant difference in Mean KSS score preoperatively and postoperatively (p > 0.05). The mean ROM was significantly higher in denervation group than in the group of TKR with no denervation (p < 0.05). Conclusion In our study, less postoperative anterior knee pain, increased range of motion, significantly lower VAS scores were seen in the denervation group compared with non-denervation group. Circumferential denervation of patella during primary TKA along with patellar resurfacing is a safe procedure that improves patient satisfaction, decreases anterior knee pain and improves range of flexion in the postoperative period and at postoperative follow-ups.

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.

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