scholarly journals OSTEONECROSIS OF THE KNEE

2019 ◽  
Vol 141 (3-4) ◽  
pp. 81-90
Keyword(s):  
Subchondral Bone ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Cartilage Damage ◽  
Core Decompression ◽  
Tibial Osteotomy ◽  
Bone Marrow Stimulation ◽  
Opening Wedge ◽  
Secondary Osteoarthritis ◽  
Artificial Graft

Spontaneous osteonecrosis of the knee (SONK) is the most common type of knee osteonecrosis. It causes subchondral bone damage and in the majority of cases leads to cartilage damage and secondary osteoarthritis. The etiology is commonly explained with two main theories, vascular and traumatic. Vascular theory is based on disrupture of bone blood supply which causes local ischaemia and subchondral bone necrosis. Traumatic theory suggests the development of subchondral insufficiency fractures due to mechanical overload, which causes local oedema, ischaemia and necrosis. SONK typically appears in middle age and older women, with acute onset of sharp pain in the medial femoral condyle without predisposing trauma. Considering that the characteristic radiological signs are not seen on conventional radiography until advanced stage, magnetic resonance imaging is the gold standard in diagnostics. Treatment depends on the size and stage of the osteonecrotic lesion. Small osteonecrotic lesions are usually successfully treated non-operatively, which is based primarily on protected weight bearing and physical therapy. Medium osteonecrotic lesions are treated either non-operatively or operatively, while large osteonecrotic lesions are almost always treated operatively. Most commonly used joint preserving procedures include arthroscopic bone marrow stimulation using microfracture technique, core decompression, osteochondral autologous or homologous transplantation, artificial graft transplantation, and medial opening-wedge high tibial osteotomy. The treatment of choice after subchondral bone collapse is knee arthroplasty.

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.

scholarly journals Clinical Experience Using a 3D-Printed Patient-Specific Instrument for Medial Opening Wedge High Tibial Osteotomy

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jesse Chieh-Szu Yang ◽  
Cheng-Fong Chen ◽  
Chu-An Luo ◽  
Ming-Chau Chang ◽  
Oscar K. Lee ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Ct Scanning ◽  
Tibial Slope ◽  
Patient Specific ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Time Saving ◽  
X Ray ◽  
Specific Instrument

Purpose. High tibial osteotomy (HTO) has been adopted as an effective surgery for medial degeneration of the osteoarthritis (OA) knee. However, satisfactory outcomes necessitate the precise creation and distraction of osteotomized wedges and the use of intraoperative X-ray images to continually monitor the wedge-related manipulation. Thus HTO is highly technique-demanding and has a high radiation exposure. We report a patient-specific instrument (PSI) guide for the precise creation and distraction of HTO wedge. Methods. This study first parameterized five HTO procedures to serve as a design rationale for an innovative PSI guide. Preoperative X-ray and computed tomography- (CT-) scanning images were used to design and fabricate PSI guides for clinical use. The weight-bearing line (WBL) of the ten patients was shifted to the Fujisawa’s point and instrumented using the TomoFix system. The radiological results of the PSI-guided HTO surgery were evaluated by the WBL percentage and tibial slope. Results. All patients consistently showed an increased range of motion and a decrease in pain and discomfort at about three-month follow-up. This study demonstrates the satisfactory accuracy of the WBL adjustment and tibial slope maintenance after HTO with PSI guide. For all patients, the average pre- and postoperative WBL are, respectively, 14.2% and 60.2%, while the tibial slopes are 9.9 and 10.1 degrees. The standard deviations are 2.78 and 0.36, respectively, in postoperative WBL and tibial slope. The relative errors of the pre- and postoperative WBL percentage and tibial slope averaged 4.9% and 4.1%, respectively. Conclusion. Instead of using navigator systems, this study integrated 2D and 3D preoperative planning to create a PSI guide that could most likely render the outcomes close to the planning. The PSI guide is a precise procedure that is time-saving, radiation-reducing, and relatively easy to use. Precise osteotomy and good short-term results were achieved with the PSI guide.

scholarly journals Meniscal and Cartilage Changes on Serial MRI After Medial Opening-Wedge High Tibial Osteotomy

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110479
Author(s):  
Han Gyeol Choi ◽  
Yu Suhn Kang ◽  
Joo Sung Kim ◽  
Han Sang Lee ◽  
Yong Seuk Lee
Keyword(s):  
Tibial Plateau ◽  
Femoral Condyle ◽  
Relaxation Times ◽  
Lateral Compartment ◽  
Tibial Osteotomy ◽  
T2 Relaxation ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Serial Mri

Background: Assessments of the effects of realignment using opening-wedge high tibial osteotomy (OWHTO) on the medial, lateral, and patellofemoral compartments have been limited to cartilage evaluations. Purpose/Hypothesis: The purpose was to evaluate the effects of OWHTO on the meniscus and cartilage of each compartment as a cooperative unit (meniscochondral unit) using serial magnetic resonance imaging (MRI). It was hypothesized that (1) favorable changes in the meniscochondral unit would occur in the medial compartment and (2) that changes in the patellofemoral and lateral compartments would be negligible. Study Design: Case series; Level of evidence, 4. Methods: Included were 36 knees that underwent OWHTO from March 2014 to February 2016 and had postoperative serial MRI. The MRI was performed at 19.9 ± 7.4 and 52.3 ± 8.3 months postoperatively, and the cartilage and meniscal changes were evaluated by highlighting the regions of interest. We evaluated the T2 relaxation times of each cartilage and meniscal area, the cross-sectional area of the menisci, and the extrusion of the medial meniscus (MM). The meniscochondral unit was assessed using subgroup analyses according to the status of the MM. Results: Significant decreases were seen in T2 relaxation times in the medial femoral condyle (MFC) ( P < .001) and medial tibial plateau (MTP) ( P = .050), and significant increases were seen in the lateral femoral condyle (LFC) ( P = .036). The change was more prominent in the MFC compared with the MTP and LFC ( P = .003). No significant changes were observed in the lateral tibial plateau, patella, or trochlear groove. The area of the lateral meniscus (body and posterior horn) was decreased compared with preoperative MRI ( P < .001 for both). The extent of MM extrusion decreased between the preoperative, first follow-up, and second follow-up MRIs ( P < .001). Conclusion: OWHTO affected the medial compartment positively, the lateral compartment negatively, and the patellofemoral compartment negligibly. The effects were more prominent and consistent in the medial than in the lateral compartment.

Medial Opening Wedge High Tibial Osteotomy With Early Full Weight Bearing

2009 ◽  
Vol 25 (1) ◽  
pp. 46-53 ◽  
Author(s):  
Ryohei Takeuchi ◽  
Hiroyuki Ishikawa ◽  
Masato Aratake ◽  
Haruhiko Bito ◽  
Izumi Saito ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise

2008 ◽  
Vol 16 (11) ◽  
pp. 1030-1037 ◽  
Author(s):  
Ryohei Takeuchi ◽  
Masato Aratake ◽  
Haruhiko Bito ◽  
Izumi Saito ◽  
Ken Kumagai ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy
Sign in / Sign up

Export Citation Format

Share Document