scholarly journals Realignment Surgery for Anterior Translation of Talus after Malunited Ankle Fracture

2019 ◽  
Author(s):  
Xingchen Li ◽  
Kai Rong ◽  
Yang Xu ◽  
Yuan Zhu ◽  
Xiangyang Xu
Keyword(s):  
Soft Tissue ◽  
Ankle Joint ◽  
Ankle Fracture ◽  
Sagittal Plane ◽  
Tibial Osteotomy ◽  
Ankle Osteoarthritis ◽  
Anterior Translation ◽  
Functional Scores ◽  
Weber Type ◽  
The Mean

Abstract Background: It is challenging for the clinical management of malunited ankle fracture. The aim of this study is to evaluate the clinical outcome of realignment surgery for anterior translation of talus after malunited ankle fracture and to analyze its. Methods: A total of 11 patients with anterior translation of talus after malunited ankle fractures underwent corrective osteotomy in our institute were retrospectively reviewed. All patients were evaluated with radiological parameters and clinical functional scores. There were 4 patients with Weber type A fracture, 4 patients with Pilon type B fracture and 3 patients with Weber type C fracture. 8/11 patients had impaction on the anterior distal tibial plafond, intra-articular distal tibial osteotomy was performed in these patients, additional bony correction and soft tissue surgery were also performed to achieve congruent ankle joint. Results: The mean age at surgery was 32.8 ± 10.8 (range,16-48) years. The mean follow-up time was 50.5 ± 23.6 (range, 16-80) months. The mean AOFAS-AH score increased from 28.2 ± 19.1preoperatively to 72.5 ± 8.1 points postoperatively(p<0.05), the mean lateral talar station(LTS) improved from 9.2 ± 3.7 preoperatively to 1.5 ± 1.4 mm postoperatively(p<0.05). 10/11 patients had improvement or no worsening ankle osteoarthritis on sagittal plane, while 1 patient had advanced ankle osteoarthritis. Conclusion: A congruent ankle joint in sagittal plane could be achieved by corrective osteotomies with additional soft tissue procedures. The realignment surgery was a valuable treatment option for the salvage of anterior translation of talus after malunited ankle fracture.

scholarly journals Anterior distal tibial plafond-plasty for the treatment of posttraumatic ankle osteoarthritis with anterior translation of the talus

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xingchen Li ◽  
Yang Xu ◽  
Changjun Guo ◽  
Chonglin Yang ◽  
Yuan Zhu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Sagittal Plane ◽  
Ankle Osteoarthritis ◽  
Anterior Translation ◽  
Vas Score ◽  
Orthopedic Surgeons ◽  
Tibial Plafond ◽  
Age At Surgery ◽  
Valuable Treatment ◽  
Weber Type

AbstractPosttraumatic ankle osteoarthritis (OA) represents a significant challenge to orthopedic surgeons, especially in cases of anterior talar translation and concomitant impaction of the anterior distal tibial plafond. The aim of this study was to evaluate the clinical outcomes of an intra-articular osteotomy for the management of these patients. A total of 21 patients meeting our criteria were retrospectively reviewed. Sixteen patients sustained initial pilon fractures, while five patients had Weber type C ankle fractures. Anterior distal tibial plafond-plasty was performed to address the impaction and anterior translation of the talus. The American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were utilized as clinical outcomes. The lateral talar station (LTS), tibial lateral surface (TLS) angle, tibial anterior surface angle and talocrural angle were evaluated pre- and postoperatively. The modified Kellgren-Lawrence score was used for the evaluation of sagittal ankle OA. The average age at surgery was 35 years, and the average follow-up duration was 34 months. The AOFAS hindfoot score increased from 26 to 71 (p < 0.01), and the VAS score improved from 7 to 2 (p < 0.01). The LTS improved from 9.0 to 2.3 mm (p < 0.01), and the TLS angle improved from 72° to 81° (p < 0.01). Of the 21 patients, 18 showed improvement in or no worsening of ankle OA on the sagittal plane, while 3 developed advanced ankle OA. A congruent ankle joint on the sagittal plane could be achieved by anterior distal tibial plafond-plasty. This is a valuable treatment option for the salvage of posttraumatic ankle OA with anterior translation of the talus.

Factors Affecting the Clinical Outcomes of Surgically Treated Ankle Fractures Associated with the Posterior Malleolar Fragment

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Mehmet Kuyumcu ◽  
Emre Bilgin ◽  
Hasan Bombacı
Keyword(s):  
Clinical Outcomes ◽  
Fragment Size ◽  
Statistical Significance ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Ankle Osteoarthritis ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean

Background This study was performed to determine the factors that influence the clinical outcomes of surgically treated ankle fractures associated with the posterior malleolus (PM). Methods We evaluated 42 fractures of 42 patients. Posterior malleolus fracture size was calculated using computed tomography. Posterior malleolar fractures with a size less than 10% were left nonfixated. The decision for larger fragments was performed using fluoroscopy following the fixation of other components. If the joint was found to be congruent, the PM was left nonfixated. Otherwise, the PM was reduced and fixated. Clinical outcomes were evaluated based on Weber, Freiburg, and American Orthopaedic Foot and Ankle Society scores. Ankle osteoarthritis was determined according to the Canadian Orthopaedic Foot and Ankle Society classification. The effect of PM fixation, age, PM fragment size, waiting period before surgery, presence of ankle dislocation, and number of injured malleoli on clinical outcomes were assessed. Statistical significance was set at a value of P &lt; .05. Results The mean patients age was 48.5 ± 14.9 years (range, 20–84 years) and the mean follow-up was 23.7 ± 8.6 months (range, 12–56 months). Fixation of the PM was performed solely in 12 patients. Postoperative displacement of the PM and articular step were less than 2 mm in all fractures. Statistically significant worse outcomes were demonstrated based on functional scores in the patients with a PM size greater than or equal to 25% (P = .042, P = .038, and P = .048, respectively) and in patients aged 60 years or older (P = .005, P = .007, and P = .018, respectively). However, there was no significant difference between functional scores and the other factors. Ankle osteoarthritis was observed at a higher rate in patients with PM size greater than or equal to 25% and in patients aged 60 years or older. Conclusions Clinical outcomes of the patients are mainly influenced by the patient's age and PM fragment size. However, if the tibiotalar joint is congruent, comparable results can be obtained in PM fixated or nonfixated patients.

scholarly journals Medium- and long-term results of high tibial osteotomy in patients with primary and secondary knee osteoarthritis with varus deformity

2019 ◽  
Vol 13 (2) ◽  
pp. 38-46
Author(s):  
V. E. Byalik ◽  
S. A. Makarov ◽  
L. I. Alekseeva ◽  
E. I. Byalik
Keyword(s):  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
The Body ◽  
Long Term Results ◽  
Tibial Osteotomy ◽  
Female Ratio ◽  
Knee Oa ◽  
Functional Scores ◽  
The Mean

The most common operation for knee osteoarthritis (OA) is total knee arthroplasty (TKA); however, the latter is associated with the development of severe complications. This was the reason for the revival of the interest of orthopedic traumatologists in high tibial osteotomy (HTO), the essence of which is to transfer the load away from the affected medial part of the knee joint (KJ) to the intact lateral one.Objective: to evaluate the medium- and long-term results of open-wedge (OW) HTO in primary and secondary I–III stage knee OA.Patients and methods. The Laboratory of Orthopedic Rheumatology and Rehabilitation, V.A. Nasonova Research Institute of Rheumatology, performed 10 OW HTOs in 9 patients in 2005 to 2009 and 21 more OW HTOs in 19 patients in 2014 to 2018 (a total of 31 operations). The male/female ratio was 2.5:1. The mean age of the patients was 57.6±12.5 years; the body mass index (BMI) was 28.5±3.6 kg/m2 ; the correction angle was 11.7±2.5°. Preoperative planning was performed using the Miniaci method; the X-ray stage of knee OA was evaluated according to the Kellgren–Lawrence classification. OW HTO was carried out. For assessment of its results, the investigators determined the degree of pain using a visual analogue scale (VAS) and the KJ status by the Knee Society Score (KSS) scale. The results were assessed at one (n=31), 3.5±0.6 (n=28), and 8.5±1.3 (n=10) years.Results and discussion. There was a tendency to worsen surgical results over time. The mean VAS values for pain at 1, 3.5, and 8.5 years were as follows: 9.8±10.3; 21.2±16.2 and 38±15.5 mm, respectively. In the same periods, the KSS functional scores were 83.6±14.8, 85.2±12.6, and 80.5±14.2; the objective scores were 80.7±8.5, 75.2±12.7, and 67.8±16.3. There was a strong correlation between the severity of pain and the functional and objective KSS scores (-0.78, -0.81 years, and -0.91 at 1, 3.5, and 8.5 years, respectively; p<0.05). At 3.5±0.6 years, the survival rate after OW HTO was 96.6%. None of the patients examined at 8.5±1.3 years after OW HTO needed TKA. The surgical result was studied in 2 patients at 14 years; one patient underwent TKA, the other refused surgical intervention, the result was satisfactory.Conclusion. OW HTO has limited indications for use. However, in patients who are allowed to undergo this operation, pain syndrome can be relieved, by maintaining and/or improving KJ function; in most cases, TKA can be delayed for more than 10 years. 

scholarly journals Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

2019 ◽  
Author(s):  
Koji Nozaka ◽  
Naohisa Miyakoshi ◽  
Takeshi Kashiwagura ◽  
Yuji Kasukawa ◽  
Hidetomo Saito ◽  
...  
Keyword(s):  
Ankle Joint ◽  
External Fixator ◽  
Weight Bearing ◽  
Tibial Osteotomy ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Circular External Fixator ◽  
Joint Distraction ◽  
Tibiotalar Arthrodesis

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

scholarly journals Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

2020 ◽  
Author(s):  
Koji Nozaka ◽  
Naohisa Miyakoshi ◽  
Takeshi Kashiwagura ◽  
Yuji Kasukawa ◽  
Hidetomo Saito ◽  
...  
Keyword(s):  
Ankle Joint ◽  
External Fixator ◽  
Weight Bearing ◽  
Tibial Osteotomy ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Circular External Fixator ◽  
Joint Distraction ◽  
Tibiotalar Arthrodesis

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes

2021 ◽  
pp. 036354652110030
Author(s):  
Shota Hoshika ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Shoulder Instability ◽  
American Football ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Rotator Interval ◽  
Functional Scores ◽  
The Mean ◽  
Tissue Stabilization

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes. Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability Study Design: Case series; Level of evidence, 4. Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated. Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002). Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.

scholarly journals Comparison of Treatment between Distal Tibial Osteotomy without Fibular Osteotomy and Tibiotalar Arthrodesis for Medial Ankle Arthritis in Older Individuals

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Koji Nozaka ◽  
Takeshi Kashiwagura ◽  
Hideji Kura
Keyword(s):  
Physical Component Score ◽  
Tibial Osteotomy ◽  
Older Individuals ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Component Score ◽  
Sf 36 ◽  
Circular External Fixator ◽  
Tibiotalar Arthrodesis ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. Distal tibial osteotomy without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years, but patient satisfaction has yet to be compared between the two treatments. Objective: To compare distal tibial osteotomy and tibiotalar arthrodesis for ankle osteoarthritis (stage IIIb and above under the Takakura classification) in older individuals. Methods: Subjects and Method: A total of 35 patients aged>60 years old who showed medial ankle arthritis were examined. Patients were either treated with tibiotalar arthrodesis (n=18) or distal tibial osteotomy (n=17). The patients’ mean age was 72.1 years (range, 60–81 years) in the tibiotalar arthrodesis group and 67.2 years (range, 60–80 years) in the distal tibial osteotomy group. For distal tibial osteotomy, a circular external fixator was used in all cases. Osteotomy was performed after performing synovectomy and microfracture surgery using ankle arthroscopy. At the time of fixation with a circular external fixator, foot ring (calcaneal) fixation was also performed. In addition, joint distraction was performed, and distraction arthroplasty was also simultaneously performed. Results: The mean preoperative VAS score was 8.2 for tibiotalar arthrodesis (TA) and 8.0 for distal tibial osteotomy (DTO). The mean postoperative VAS score was 1.9 for TA and 1.7 for DTO. The mean preoperative AOFAS score was 40.1 for TA and 43.1 for DTO. The mean postoperative AOFAS score was 86.2 for TA and 90.0 for DTO. The mean preoperative SF-36 physical component score was 30.5 for TA and 38.5 for DTO. The mean preoperative SF-36 mental component score was 33.5 for TA and 37.5 for DTO. The mean postoperative SF-36 physical component score was 42.5 for TA and 56.4 for DTO. It was significantly higher with the DTO (p<0.05). Conclusion: The mean postoperative SF-36 mental component score was 44.0 for TA and 59.7 for DTO. It was significantly higher with the DTO (p<0.05).Superior SF-36 scores were obtained for DTO compared to TA. The fact that the Japanese lifestyle involves tatami mats was thought to have contributed to the superiority of DTO in patient satisfaction.

scholarly journals Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

2019 ◽  
Author(s):  
Koji Nozaka ◽  
Naohisa Miyakoshi ◽  
Takeshi Kashiwagura ◽  
Yuji Kasukawa ◽  
Hidetomo Saito ◽  
...  
Keyword(s):  
Ankle Joint ◽  
External Fixator ◽  
Weight Bearing ◽  
Activity Level ◽  
Tibial Osteotomy ◽  
Ankle Osteoarthritis ◽  
Distraction Arthroplasty ◽  
Circular External Fixator ◽  
Joint Distraction ◽  
Tibiotalar Arthrodesis

Abstract Background Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. Tibiotalar arthrodesis is possible to have high levels of pain-free function, however there is loss of ankle joint movement and a risk of arthrosis of adjacent joints in the future. Distraction arthroplasty is a simple method with a possibility of the joint cartilage repair but current results are mixed with reports of patients with better pain scores and some without any improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years, However, as far as we know, there are no reports on DTO with joint distraction using a circular external fixator. The purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis.Materials and Methods A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Then angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, the stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery.Results Antero-posterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus in ankle stress radiography significantly improved (P < 0.05). In addition, signal changes in magnetic resonance imaging (MRI) improved in all patients. Visual Analogue Scale (VAS ) and The American Orthopaedic Foot & Ankle Society (AOFAS) scores also improved significantly (P < 0.05). No severe complications were observed.Conclusion DTO with joint distraction may be useful for older patients with a high physical activity level as joint preserving surgery for medial ankle osteoarthritis.

Discrepancy in the Distribution Patterns of Subchondral Bone Density Across the Ankle Joint After Medial Opening-Wedge and Lateral Closing-Wedge High Tibial Osteotomy

2021 ◽  
pp. 036354652110622
Author(s):  
Shinji Matsubara ◽  
Tomohiro Onodera ◽  
Koji Iwasaki ◽  
Ryosuke Hishimura ◽  
Masatake Matsuoka ◽  
...  
Keyword(s):  
Bone Density ◽  
Stress Distribution ◽  
Ankle Joint ◽  
Subchondral Bone ◽  
Distribution Patterns ◽  
Tibial Osteotomy ◽  
Ankle Osteoarthritis ◽  
Medial Region ◽  
Opening Wedge ◽  
Subchondral Bone Density

Background: High tibial osteotomy (HTO) changes the alignment and dynamics of the ankle joint; however, differences in the stress distribution of the ankle joint after opening-wedge HTO (OWHTO) and closing-wedge HTO (CWHTO) are not understood. It is believed that subchondral bone density of the articular surface reflects the pattern of cumulative stress distribution across the joint surface. Purpose: To clarify the effects of OWHTO and CWHTO on the distribution patterns of subchondral bone density across the ankle joint using computed tomography (CT)–osteoabsorptiometry. Study Design: Cohort study; Level of evidence, 4. Methods: Radiographic and CT data of 18 cases who underwent OWHTO (OW group), 12 cases who underwent CWHTO (CW group), and 11 cases with unilateral anterior cruciate ligament injury serving as controls were retrospectively reviewed. The subchondral bone density of the distal tibia was assessed in the 3 groups using CT-osteoabsorptiometry. The distal tibial surface of the ankle joint was divided into 4 parts in the coronal direction, and the percentage of the high-density area (%HDA) to each subregion was compared before and after HTO. Results: Preoperatively, comparing %HDA among the 3 groups, there were no significant differences in any regions. In the OW group, postoperative %HDA in the most medial region was significantly increased compared with preoperative %HDA (49.3% to 53.0%; P = .011), and postoperative %HDA in the most lateral region was significantly decreased (21.4% to 17.2%; P = .003). On the other hand, in the CW group, postoperative %HDA in the most medial region was significantly decreased (55.7% to 35.7%; P = .001), and %HDA in the second lateral region was significantly increased (23.6% to 29.2%; P = .002). Conclusion: The ankle distribution pattern of subchondral bone density shifted significantly medially after OWHTO without fibular osteotomy, whereas the distribution pattern shifted laterally after CWHTO with fibular osteotomy. When the OWHTO is performed for patients with medial ankle osteoarthritis, surgeons should pay attention to potential postoperative progression of ankle osteoarthritis due to medial shift of the stress distribution in the ankle joint.

The Kaplan Fibers of the Iliotibial Band Can Be Identified on Routine Knee Magnetic Resonance Imaging

2019 ◽  
Vol 47 (12) ◽  
pp. 2895-2903 ◽  
Author(s):  
Lachlan Batty ◽  
Jerome Murgier ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
Julian A. Feller ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Joint Line ◽  
Coronal Plane ◽  
Iliotibial Band ◽  
Resonance Imaging ◽  
Lateral Gastrocnemius ◽  
The Mean

Background: The Kaplan fibers (KFs) of the iliotibial band have been suggested to play a role in anterolateral rotational instability of the knee, particularly in the setting of an anterior cruciate ligament (ACL) rupture. Description of the normal magnetic resonance imaging (MRI) anatomy of the KFs may facilitate subsequent investigation into the MRI signs of injury. Purpose: To assess if the KF complex can be identified on 3-T MRI using standard knee protocols. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: 3-T MRI scans of 50 ACL-intact knees were reviewed independently by a musculoskeletal radiologist and 2 orthopaedic surgeons. Identification of the KFs was based on radiological diagnostic criteria developed a priori. Identification of the KFs in the sagittal, coronal, and axial planes was recorded. Interobserver reliability was assessed using the Kappa statistic. Detailed anatomy including distance to the joint line and relationship to adjacent structures was recorded. Results: The mean patient age was 43 years (range, 15-81 years), 58% were male, and 50% were right knees. The KFs were identified by at least 2 reviewers on the sagittal images in 96% of cases, on the axial images in 76% of cases, and on the coronal images in 4% of cases. The mean distance from the KF distal femoral insertion to the lateral joint line was 50.1 mm (SD, 6.6 mm) and the mean distance to the lateral gastrocnemius tendon origin was 10.8 mm (SD, 8.6 mm). The KFs were consistently identified immediately anterior to the superior lateral geniculate artery on sagittal imaging. Interobserver reliability for identification was best in the sagittal plane (Kappa 0.5) and worst in the coronal plane (Kappa 0.1). Conclusion: The KF complex can be identified on routine MRI sequences in the ACL-intact knee; however, there is low to moderate interobserver reliability. Imaging in the sagittal plane had the highest rate of identification and the coronal plane the lowest. There is a consistent relationship between the most distal KF femoral attachment and the lateral joint line, lateral gastrocnemius tendon, and superior lateral geniculate artery.

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