Iranian Journal of Orthopedic Surgery

Abstract Abstract
Performing total knee arthroplasty (TKA) in patients with extra-articular deformities presents complex and significant surgical challenges that can have both direct and indirect impacts on treatment outcomes. These deformities often require more meticulous planning and tailored surgical strategies to maintain biomechanical alignment of the joint and ensure optimal patient function. Among these strategies are intra-articular corrections and extra-articular osteotomies, with the choice depending on the specific characteristics of the patient and the severity of the deformity. In this context, advanced technologies such as computer-assisted surgery and robotic systems have emerged as innovative tools that enhance accuracy in surgical planning and execution, minimize the risk of surgical errors, and facilitate improved clinical outcomes. This article provides a comprehensive review of current best practices and emerging trends in managing TKA for patients with extra-articular deformities, while also emphasizing the importance of multidisciplinary preoperative planning, advanced imaging assessment, and patient-specific risk evaluation. It further discusses structured decision-making algorithms to guide the selection of appropriate corrective techniques, with careful attention to soft-tissue balance, implant positioning, and long-term stability. Collectively, these considerations aim to optimize functional outcomes, reduce complications, and improve implant longevity in this challenging patient population.

Abstract Background: Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure to restore the stability of the knee. However, there is still no consensus on the optimal approach for determining the position of the tibial and femoral tunnels. In this study, we aimed to evaluate the effect of endobutton positioning on the clinical outcomes of the patients who underwent ACL reconstruction.
Methods: We evaluated 100 adult patients who underwent single-bundle ACL reconstruction surgery at our institution. The patients were categorized based on the position of the femoral endobutton observed in lateral and AP radiographs. We investigated the relationship between the position of the femoral endobutton in lateral and AP radiographs and the clinical outcomes of range of motion (ROM), Pivot Shift examination, and knee function scores at the 6-month follow-up.
Results: The Intermediate group had the largest number of patients, but there were no significant differences in the clinical examination results and knee function among these groups. Although the majority of individuals fell into the <39% group, there were no significant differences in clinical outcomes and knee function across these groups.
Conclusion: In conclusion, our study found no significant relationship between the position of the femoral endobutton as determined by radiography and the clinical examination results and knee function. These findings suggest that further research is needed to better understand the optimal approach for determining the position of the tibial and femoral tunnels and the appropriate grip for ACL reconstruction.