Knee
soroosh naghdi; mahmud karimi mobarake; amirreza sadeghifar; mohamad sheibani; salman azarsina; peyman mohammadhosseiniazar
Abstract
Introduction:Genu varum is a type of knee deformity. In this deformity lower limb mechanical axis, moves inward to the knee centre. In genu varum mechanical axis usually lies through the medial of the knee joint. In this deformity, the patient's lower limbs become bow shape. One of the best techniques ...
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Introduction:Genu varum is a type of knee deformity. In this deformity lower limb mechanical axis, moves inward to the knee centre. In genu varum mechanical axis usually lies through the medial of the knee joint. In this deformity, the patient's lower limbs become bow shape. One of the best techniques for genu varum correction is high tibial osteotomy that this procedure can change some index include posterior tibial slope (PTS), and insall-salvati index (ISI).Method:Our study was a cross-sectional study performed on patients with genu varum before and after a step cut of the high tibia osteotomy. The method of examining the posterior tibia slope was that before and after the high tibia osteotomy by Step Cut-MCL sparing method, a simple radiographic image in true lateral view (True lateral) was taken from the knee of patients. The significance level of P Value <0.05 was considered. Result:In this study 21 patients ( 11 male and 10 female ) were enrolled. Mean age was 36.19 ± 10.17 year-old. Mean PTS pre operation was 11.48 ± 1.94 degrees and post operation was 11.48 ± 2.15 degrees. Conclusion:In our study, PTS increased after HTO that this increase was not statistically significant difference between men and women. In addition, we showed that this increase did not have significant relationship with age and BMI. In the present study, Insall-Salvati index showed no significant difference before and after the treatment.
Pediatrics
Marina R. Makarov, MD; Connor M. Smith, MD; Taylor J. Jackson, MD; Chan Hee Jo, Ph.D; John G JBirch, MD, FRCS(C)
Abstract
Introduction: Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.Methods: ...
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Introduction: Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.Methods: The study included 55 children with unilateral Blount disease. Preoperative radiographs were analyzed to characterize the condition as infantile or adolescent and measure femoral/tibial lengths and mechanical lateral distal femoral angles (mLDFA). Results: There were 26 patients with infantile and 29 with adolescent Blount disease. Adolescent patients were significantly older (14.4 ± 2.0 vs. 9.2 ±2.4; p<0.01). Black race was prevalent in both groups (69-79%). The adolescent group was predominantly male (25/29; 86%), while the infantile group was predominantly female (15/26; 58%, p<0.01). Leg length inequality in adolescent patients was significantly greater than in the infantile group (2.8 ± 2.0 vs.1.5 ± 1.1cm; p<0.01) with ipsilateral femoral shortening (1.8 ± 1.8 cm) accentuating tibial shortening (1.0 ± 1.1cm). Patients with infantile Blount disease had more pronounced tibial discrepancy (2.0 ± 1.1 cm; p<0.01) but modest overgrowth of the ipsilateral femur (0.5 ± 0.7; p<0.01) partially compensating ipsilateral tibial shortening. There was a significant difference in tibial:femoral ratios between the groups (p<0.01). The infantile group had on average normal mLDFA (88°), most adolescent patients had accentuating distal femoral varus deformity (96° ± 5°; p<0.01).Conclusions: Patients with unilateral infantile and adolescent Blount disease demonstrated distinctly different adaptation of the ipsilateral femur. Concomitant ipsilateral femoral changes aggravate angular deformity and leg length discrepancy in adolescent Blount disease.
Mahmood Karimi Mobarakeh, MD; Mohsen Mardani-Kivi, MD; Ali Akbar Keikha, MD; Keyvan Hashemi-Motlagh, MD; Khashayar Saheb-Ekhtiari, MD
Abstract
Background: One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique, the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy ...
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Background: One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique, the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy with or without releasing MCL.Methods: In a prospective clinical trial, 59 patients with symptomatic genu varum between 16-50 years of age who were candidates of tibial osteotomy were divided into open wedge surgery with (30 patients, 40 knees) or without MCL release (29 patients, 36 knees). The outcome was studied comparing the stability in valgus, pattelar height slope of tibial plateau, and also the knee score (KSS) in a 17.4 months (3-24 months) follow-up.Results: The patients from MCL preserving group, with mean age of 26.7±9 improved their scores of 53.5±15.2 to 81.9±13.4. The cases from MCL-releasing group with mean age of 25.5±8.4 improved the score of 52.4±14.6 to 65.4+17.8. The rates of surgical complication and valgus instability were lower in MCL preserving ones, but tibial slope remained unchanged in either group.Conclusions: Both techniques lead to an improvement in the KSS score however it was more significant in MCL preserving group with lower complication and without valgus instability.
Fardin Mirzatolouei, MD; Majid Mohseni Kabir, MD
Abstract
Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning ...
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Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning of femoral component. The aim of this study was to compare the accuracy of femoral component rotation after TKA, using either PCL or TEA reference points. Methods: In a retrospective study, 42 consecutive TKA candidates with severe varus knees were divided into two groups: In group I posterior condylar line, and in group II transepicondylar axis was considered as the primary landmark for rotational positioning. Erosion of medical femoral condylar was recorded in millimeters. One year after operation all the patients underwent CT scan and the angles between TEA and PCL of the prosthesis was meausured. The degree of knee flexion and also WOMAC scores were recorded. Results : The female gender was prominent in both groups (81% in group 1, 85.7% in group II). There was no significant femoral condylar erosion in either group. The mean Womac score in group 1 was 71.4±17.51 and 72.07±15.48 in group II (p < /i>=.9). The degree of external rotation according to condylar twisting angle was 3.35±1.74 in group 1 and 1.9±1.7 in group 2 (p < /i>=.009). Conclusions: In severe Knee-varus deformity, TEA landmark gives more external rotation position for femoral component, despite of lack of significant erosion in femoral condyle.
Seyyed Morteza KazemiSeyyed Morteza Kazemi; Seyyed Mohammad Qoreishi; Mahdi Bahari Mehrabani; Farshad Safdari
Abstract
Background: It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity, as one of the complications following high tibial osteotomy. In this study, we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with ...
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Background: It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity, as one of the complications following high tibial osteotomy. In this study, we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with a group of normal subjects.
Methods: 75 patients with primary genu varum and 75 normal persons, contributed to a case-control study. The medial distal femoral mechanical angle (MDFMA), medial proximal tibial mechanical angle (MPTMA) and joint diversion angle (JDA) were measured and compared between the two groups. The percentage of patients with >3 degrees in both distal of femur and proximal of tibia were determined.
Results: The mean of MDFMA and MPTMA was significantly lower and the mean of JDA was significantly higher in genu varum group compared to normal group (p < /em>3 degrees.
Conclusions: The alignment of distal femur and proximal tibia is significantly different in patients with primary genu varum and normal controls. Abnormal alignment of joint line is a common finding in both primary genu varum and normal people but more commonly in the cases of genu varum. As double level osteotomy may be required in many patients with genu varum, it is important to investigate distal of femur alignment before high tibial osteotomy
Mahmood Karimi Mobarakeh; Mohsen Mardani Kivi; Sohrab Keyhani; Hadi Safaee
Abstract
Background: High tibia osteotomy remains an acceptable method for prevention of medial comportment knee osteoarthritis. The conventional technique is a closing wedge osteotomy. We planned to study short-term results of a medial open wedge high tibia osteotomy using T-Buttress plate and a metal wedge. ...
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Background: High tibia osteotomy remains an acceptable method for prevention of medial comportment knee osteoarthritis. The conventional technique is a closing wedge osteotomy. We planned to study short-term results of a medial open wedge high tibia osteotomy using T-Buttress plate and a metal wedge. Methods: In this case series study, 60 patients (76 knees, 27 male and 33 female) underwent an open wedge high tibia osteotomy surgery using a T-Buttress plate and a metal wedge in a in a teaching hospital in Kerman-Iran. Patients were assessed clinically and radiographically including Modified Hospital for Special Surgery Knee Scoring System (HSSKS), anatomical and mechanical limb alignment, Insall-Salvati patellar height index and proximal tibia posterior slope angle. Results: The mean tibia-femoral angle changed from -6.8 to +4.33 degrees. 26(43.3%) patients needed iliac cancellous graft. The mean metal wedge size was 11.07 mm (8-15 mm). The mean Modified HSSKS promoted from 75.5 to 98.73. The observed complications were: fracture in five, intraarticular screw penetration in four (one in proximal tibia-fibular joint), infection in two and under-correction in one patient. There was no non-:::union:::, proneal nerve injury, over-correction, plate failure, deep vein thrombosis and bone graft donor site complication. The mean posterior tibia slope changed from 8.05±1.95 to 8.68±1.54 degrees and patellar height index changed from 1.06 to .97. Conclusion: This procedure is a safe and reliable technique and lessened the need for an autograft. Significant improvement in score of Modified HSSKS was seen post operatively.
