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The reserch of sports activities after open wedge high tibial osteotomy
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
Conclusion: The medial rotatory with button locked irreducible knee dislocation is a special knee dislocation, the MRBLIKD is emphasize the injured structures at the medial, the situation of locked and irreduction of KD. Prompt open reduction or reduction under the arthroscopy assist is the treatment of choice. Keywords: knee dislocation, button, medial rotatory, arthroscopy
Knee - Ligament > PCL/PLRI EP-220 INCIDENCE OF POSTERIOR CRUCIATE LIGAMENT INJURY Gang Chen, Tianfu Yang, Weili Fu, Xin Tang, Qi Li, Jian Li, Jian Li. Department of Orthopaedics And Sports Medicine, West China Hospital, Sichuan University, China Purposes: We sought to determine: (1) patient-specific factors and concomitant injuries of PCL in the general Chinese population; (2) the differences between the two types of injury. Methods: A total of 423 patients with PCL injury diagnosed between January 2006 and December 2015 in a single center were retrospectively studied. We enrolled 417 cases and excluded 6 cases due to incomplete records. The patient-specific factors were analyzed, including gender, side, onset age, duration and cause. We analyzed 11 types of concomitant injury around the knee, including bone fractures, ligament injuries, vascular damage, nerve injuries and meniscus tears, and compared the gender differences. All the cases were divided into substance tear group and avulsion fracture group. Finally, patients with isolated substance tear or avulsion fracture were compared with respect to patient-specific factors. Results: (1) patient-specific factors and concomitant injuries of PCL in the general Chinese population; Patients with PCL injury were mainly males (404, 72.9%) with a peak onset age of 30 to 49 years (236, 56.6%). Traffic injury was the predominant cause (225, 54%), followed by routine accidental injury (137, 32.9%). Patient-specific factors were not significantly different between the genders. Isolated PCL injuries accounted for about 1/ 3 of all cases (145, 34.8%). Among the concomitant injuries, anterior cruciate ligament (ACL) was the most frequently involved (191, 45.8%), followed by medial collateral ligament (125, 30%) and posterolateral complex (103, 24.7%). Except for lateral meniscus tear (LMT) (p ¼ 0.019) and tibial nerve injury (TNI) (p ¼ 0.034), most of the concomitant injuries showed no significant difference between genders.(2) the differences between the two types of injury. PCL substance tear was more common than AF (299 vs. 118, 71.7% vs. 28.3%, respectively). Patient-specific factors including gender, side and age of onset showed no significant difference between the two groups, but duration and cause of injury showed significant difference (p ¼ 0.010, p ¼ 0.004, respectively).The incidence of isolated AF was higher than that of isolated substance tear (67.8% vs. 21.7%). Significant differences in the duration and cause of injury were found between the 2 groups (p ¼ 0.002, p ¼ 0.008, respectively). Conclusions: Middle-aged males were mainly involved in traffic-related PCL injuries. ACL injury was the most common injury. Substance tear was the main injury type, often accompanied with concomitant injury. AF was mainly isolated. The differences between the two injury patterns might be related to the degree of violence. The treatment of concomitant injuries should receive higher attention, especially in patients with LST. Keywords: posterior cruciate ligament, avulsion fracture, ligament substance tear, patient-specific factor
Knee - Ligament > PCL/PLRI EP-287 ARTHROSCOPIC POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH REMNANT-PRESERVATION Chen Chongmin, Sun Yu. Department of Shenyang Hosptal of Orthopaedics, Shenyang, China Objective: To evaluate the clinical value of arthroscopic posterior cruciate ligament(PCL)reconstruction with remnant preservation in enhancing the
85
stability, the revascularization of the graft, and preserving proprioceptive function. Methods: From January 2009 to January 2012,82 cases of PCL rupture were treated with single-bundle PCL reconstruction in which the ligament remnants were preserved. The tibial remnant and the synovial shell were preserved as much as possible. Grafts were pulled intra-articularly through the tibial remnant under arthroscopic visualization. All patients were followed up for more than one year as scheduled. Lysholm,Tegner and International Knee Documentation Committee (IKDC)rating scale were used to evaluate the curative effects at the last follow-up. Results: At the last follow-up,64 patients(94.1%)had negative anti-Lachman results, and 62 patients had 1 degree positive posterior drawer test results. All patients showed a negative pivot shift test and a normal range of motion. The average Lysholm score was (61.2 ±7.6) before operation and (91.7±3.7) at the last follow-up(t¼2.935, P¼0.002).The average Tegner score was (3.7 ±1.4) before operation and (6.7±1.1) at the last followup(t¼2.289, P¼0.012).The average IKDC score was (65.1±7.9) before operation and (92.4±4.5)at the last follow-up (t¼3.186, P¼0.001). Conclusion: Techniques combining remnant-preserving transtibial singlebundle PCL reconstruction resulted in somewhat better stanblity outcomes. It is beneficial for the graft revascularization and rehabilitation of proprioceptive function. Keywords: posterior cruciate ligament, reconstruction, remnant preservation, arthroscopy
Knee - Osteotomy > High tibial osteotomy EP-014 OUTCOME OF HIGH TIBIAL OBLIQUE ROTATIONAL OSTEOTOMY Hitoshi Kanmura 1, Yuji Arai 2, Shuji Nakagawa 2, Hiroaki Inoue 2, Shinichiro Nakamura 1, Toshikazu Kubo 2. 1 Department of Orthopaedics, Fukuchiyama City Hospital, Japan; 2 Department of Orthopaedics, Kyoto Prefectural University of Medicine, Japan Backgrounds: The purpose of this study is to report clinical results of the high tibial oblique rotational osteotomy (HTORO). Materials and Methods: The subjects were 9cases (2men and 7women) which performed HTORO from February 2005 to August 2009. Outcome measures were pre-postoperatively femoral-tibial angle, patellofemoral joint congruity, range of motion, Lysholm score, the time to complete bone union. Results: The Femoral-tibial angle was corrected from 183.4 degrees to 171.9 degrees. The patellaofemoral joint congruity was improved at 6 knees of 10 knees. Lysholm score improved from 72.1 points to 89 points. All cases was provided bone union. Discussion: One advantage of HTORO is that bone union is easy to be provided to correct transformation. The other advantage is that the osteotomy site is more strongly fixed because the lateral proximal and distal bone cortex came in contact. The tibial tuberosity moved to the medial side, and so there are possibilities to be effective for the osteoarthritis of the patellofemoral joint. Conclusion: HTORO might let both the symptom of the patellofemoral joint and medial knee osteoarthritis relieve. Keywords: osteotomy, medial knee OA, patellofemoral joint OA
Knee - Osteotomy > High tibial osteotomy EP-028 THE RESERCH OF SPORTS ACTIVITIES AFTER OPEN WEDGE HIGH TIBIAL OSTEOTOMY Katsunari Ohsawa, Ryouhei Takeuchi, Hiroyuki Ishikawa, Yuuichiro Yamaguchi. Department of Joint Surgery, Yokosuka City Hospital, Japan Background: Open wedge high tibial osteotomy (OWHTO) is a wellestablished method for the treatment of medial unicompartmental osteoarthritis of the knee, which has shown good midterm results. It is indicated for relatively young and high sports activity population. The purpose of this study is whether elderly patients who underwent OWHTO can keep doing their sports activities.
86
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
Materials and Methods: 30 patients (43knees) who underwent OWHTO were evaluated. 6 patients underwent simultaneous bilateral OWHTO.All cases had performed sports activities before surgery. The mean age at the operation was 68 ± 4.8 years (range 53-78), the average follow-up period was 27.2 ± 6.8 months (range 12-43).We investigated KOOS Score, sports events (multiple answers allowed), continuation rate, returning time, self evaluation of sports skills, satisfaction level in sports. Results: KOOS Score improved from the preoperative average of 66.3 ± 13.0 points to 83.6 ± 10.8 points after surgery. Sports events (including exercises 10 cases, walking 7, golf 5, swimming 4, tennis 3, table tennis, jogging, volleyball, climbing 2, bowling 1, skiing 1, softball 1, rugby 1, athletics 1) were a total of 42 cases. There were unable to continue following cases with volleyball 2, gymnastics 2, rugby 1, golfing 1, walking 1, swimming 1, athletics 1. The continuation rate in the number of events was 78.6%. Average self-assessment of sports skills was -1.4 ± 36.3% (-70 +80), average satisfaction level in sports 59.6 ± 32.5% (0 - 100), and the time of returning to sports was 9.5 ± 5.4 months (2 - 21) after surgery. Discussion: The continuation rate in the number of events was high (78.6%), and KOOS score was improved, suggesting that pain improvement was sufficient. On the other hand, the self-assessment of sports skills was as low as -1.4%. I supposed this was due to alignment change of the lower limbs after OWHTO. (Conclusion) The sports continuation rate after OWHTO showed a high value of 78.6%. On the other hand, self-evaluation of sports skills was as low as -1.4%. In conclusion, Satisfaction level in sports after surgery was 59.6%, which was a good result for elderly patients. Keywords: OWHTO, Sports activity
Knee - Osteotomy > High tibial osteotomy EP-033 2 CASES OF THE DOUBLE LEVEL OSTEOTOMY (DLO) (FOR SEVERE VARUS AND VALGUS KNEE DEFORMITY) Kazumasa Inoue, Yasuaki Tamaki, Makoto Yakeuchi. Department of Orthopedics, Mitoyo General Hospital, Japan Aim and Background: For the patients suffering from severe knee deformity which requires angle correction more than 20 degrees , we have to choose carefully the most adequate knee correction osteotomy procedure. The aim of this report is to address the results of the double level osteotomy (DLO) . Material: Case 1: 64 years old female, severe varus deformed knee Femoro Tibial Angle (FTA) 198 degrees Case 2: 69 years old female , severe valgus deformed knee Femoro Tibial Angle (FTA) 155 degrees Method: Japan Orthopedic Surgery Association (JOA) Score was used to evaluate the clinical results. Radiographic evaluation consisted of (1) FTA, (2) Weight Bearing Line Ratio (WBL-R), (3), posterior tibial slopes(PTS), and (4) Caton Deschamps Index(CDI) for checking patella height, (5) medial proximal tibial angle (MPTA) to check the joint-line obliquity . (Surgical procedure ) Case1: Lateral closed Distal Femor Osteotomy (DFO) and Medial open High Tibial Osteotomy (HTO) Case2: Lateral open Distal Femor Osteotomy (DFO) and Medial closed High Tibial Osteotomy (HTO) Results: Case 1: JOA score improved from 30 points to 80 points after surgery. FTA , WBL-R and MPTA were corrected post operatively. (FTA :196 degrees to 170 degrees , WBL-R : -25% to 63% , MPTA : 79 degrees to 89 degrees). PTS and CDI did not change remarkably (PTS : 3.0 degrees to 3.3 degrees , CDI : 0.93 to 0.93) after surgery. Case 2: JOA score improved from 60 points to 80 points after surgery. FTA , WBL-R and MPTA were corrected post operatively. (FTA : 155 degrees to 177 degrees , WBL-R : 115% to 49% , MPTA : 96 degrees to 88.5 degrees). PTS and CDI did not change remarkably (PTS : 4.1 degrees to 3.9 degrees , CDI : 0.69 to 0.71) after surgery. Discussion: Open wedge HTO and closed wedge HTO are often performed for the varus knee deformity. To correct the valgus knee deformity, DFO is a reliable procedure.
But these single osteotomy procedures (HTO, DHO) might not be suitable to correct the alignment of the severe knee deformity like this report , because single osteotomy alone tends to result in the mal position of the joint-obliquity. Conclusion: DLO could provide the adequate alignment correction to the knee joint with severe deformity, and did not influence PTS and patella height. It also seemed that DLO might be able to retain the joint-line obliquity after the large alignment correction like this report. Keywords: osteotomy, knee
Knee - Osteotomy > High tibial osteotomy EP-054 DOES HIGH TIBIAL OSTEOTOMY ACCELERATES LATERAL COMPARTMENTAL OSTEOARTHRITIS IN PATIENTS WITH DISCOID MENISCUS? Jehyoung Yeo 1, Youngjoo Shin 1, 2, Donghyun Lee 1, Jongkeun Seon 1, Eunkyoo Song 1. 1 Department of Orthopedic Surgery, Chonnam National University Bitgoeul Hospital, South Korea; 2 Department of Orthopedics, Tuntun Hospital, Gwangju, South Korea Introduction: High tibial osteotomy relieves pressure from medial compartment by shifting weight bearing axis on lateral compartment. However, in presence of discoid meniscus, the consequence of this increased load is unknown. We planned the study with the aim. We therefore carried out this study with a hypothesis that a high tibial osteotomy would accelerate the progression of lateral compartment osteoarthritis in patients with complete discoid meniscus Methods: It was a retrospective case control study. The records of all patients with high tibial osteotomy from 2008 to 2012 were evaluated for complete lateral discoid meniscus. Cases to control were chosen in ratio 1:2. Results: Records of 674 patients, who underwent a High Tibial Osteotomy from 2008 to 2012, were analyzed. 21 cases with discoid meniscus and 42 controls with matched age, sex, BMI pre-operative deformity and post operative correction to discoid cases were studied. Pre-operative lateral compartment status were similar in both groups as assessed on on Kellgran-Lawrance classification on radiographs and Outerbridge classification during arthroscopic HTO (p¼0.656). However, postoperatively significantly higher patients (4 patients) developed lateral compartment osteoarthritis in discoid group, compared to none in control group (p¼.001). Conclusion: High tibial osteotomy could result in accelerated lateral compartment osteo-arthritis in patients with complete discoid meniscus and the procedure should be used with caution in such patients. Keywords: High tibial osteotomy, discoid meniscus, alignment, lateral compartment osteoarthritis
Knee - Osteotomy > High tibial osteotomy EP-091 THE INFLUENCE OF DIFFERENT HINGE POSITION ON HTO. -COMPARISON OF MEDIAL OPEN-WEDGE OSTEOTOMY & LATERAL CLOSED-WEDGE OSTEOTOMY.Choi Young Lac, Hwang Sun Chul. Department of Orthopedic, Gyeongsang National University, South Korea Purpose and Hypothesis: The purpose of this study was to identify significance of the hinge position through comparison between medial openwedge osteotomy and lateral closed-wedge osteotomy and to determine the ideal hinge position to minimize the effect of high tibial osteotomy on posterior tibial slope (PTS), medial proximal tibial angle (MPTA). Methods: It is performed that 32 cadavaric knees (16 right knees, 16 left knees) using medial open-wedge osteotomy using either the standard hinge position (8 knees) or a low hinge position (8 knees) and lateral closed-wedge osteotomy using either the standard hinge position (8 knees) or a low hinge position (8 knees). In medial open-wedge osteotomy, to define the standard hinge position, we drew a line from 3-cm inferior to the medial tibial plateau towards the fibular head and located the
Conclusion: The medial rotatory with button locked irreducible knee dislocation is a special knee dislocation, the MRBLIKD is emphasize the injured structures at the medial, the situation of locked and irreduction of KD. Prompt open reduction or reduction under the arthroscopy assist is the treatment of choice. Keywords: knee dislocation, button, medial rotatory, arthroscopy
Knee - Ligament > PCL/PLRI EP-220 INCIDENCE OF POSTERIOR CRUCIATE LIGAMENT INJURY Gang Chen, Tianfu Yang, Weili Fu, Xin Tang, Qi Li, Jian Li, Jian Li. Department of Orthopaedics And Sports Medicine, West China Hospital, Sichuan University, China Purposes: We sought to determine: (1) patient-specific factors and concomitant injuries of PCL in the general Chinese population; (2) the differences between the two types of injury. Methods: A total of 423 patients with PCL injury diagnosed between January 2006 and December 2015 in a single center were retrospectively studied. We enrolled 417 cases and excluded 6 cases due to incomplete records. The patient-specific factors were analyzed, including gender, side, onset age, duration and cause. We analyzed 11 types of concomitant injury around the knee, including bone fractures, ligament injuries, vascular damage, nerve injuries and meniscus tears, and compared the gender differences. All the cases were divided into substance tear group and avulsion fracture group. Finally, patients with isolated substance tear or avulsion fracture were compared with respect to patient-specific factors. Results: (1) patient-specific factors and concomitant injuries of PCL in the general Chinese population; Patients with PCL injury were mainly males (404, 72.9%) with a peak onset age of 30 to 49 years (236, 56.6%). Traffic injury was the predominant cause (225, 54%), followed by routine accidental injury (137, 32.9%). Patient-specific factors were not significantly different between the genders. Isolated PCL injuries accounted for about 1/ 3 of all cases (145, 34.8%). Among the concomitant injuries, anterior cruciate ligament (ACL) was the most frequently involved (191, 45.8%), followed by medial collateral ligament (125, 30%) and posterolateral complex (103, 24.7%). Except for lateral meniscus tear (LMT) (p ¼ 0.019) and tibial nerve injury (TNI) (p ¼ 0.034), most of the concomitant injuries showed no significant difference between genders.(2) the differences between the two types of injury. PCL substance tear was more common than AF (299 vs. 118, 71.7% vs. 28.3%, respectively). Patient-specific factors including gender, side and age of onset showed no significant difference between the two groups, but duration and cause of injury showed significant difference (p ¼ 0.010, p ¼ 0.004, respectively).The incidence of isolated AF was higher than that of isolated substance tear (67.8% vs. 21.7%). Significant differences in the duration and cause of injury were found between the 2 groups (p ¼ 0.002, p ¼ 0.008, respectively). Conclusions: Middle-aged males were mainly involved in traffic-related PCL injuries. ACL injury was the most common injury. Substance tear was the main injury type, often accompanied with concomitant injury. AF was mainly isolated. The differences between the two injury patterns might be related to the degree of violence. The treatment of concomitant injuries should receive higher attention, especially in patients with LST. Keywords: posterior cruciate ligament, avulsion fracture, ligament substance tear, patient-specific factor
Knee - Ligament > PCL/PLRI EP-287 ARTHROSCOPIC POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH REMNANT-PRESERVATION Chen Chongmin, Sun Yu. Department of Shenyang Hosptal of Orthopaedics, Shenyang, China Objective: To evaluate the clinical value of arthroscopic posterior cruciate ligament(PCL)reconstruction with remnant preservation in enhancing the
85
stability, the revascularization of the graft, and preserving proprioceptive function. Methods: From January 2009 to January 2012,82 cases of PCL rupture were treated with single-bundle PCL reconstruction in which the ligament remnants were preserved. The tibial remnant and the synovial shell were preserved as much as possible. Grafts were pulled intra-articularly through the tibial remnant under arthroscopic visualization. All patients were followed up for more than one year as scheduled. Lysholm,Tegner and International Knee Documentation Committee (IKDC)rating scale were used to evaluate the curative effects at the last follow-up. Results: At the last follow-up,64 patients(94.1%)had negative anti-Lachman results, and 62 patients had 1 degree positive posterior drawer test results. All patients showed a negative pivot shift test and a normal range of motion. The average Lysholm score was (61.2 ±7.6) before operation and (91.7±3.7) at the last follow-up(t¼2.935, P¼0.002).The average Tegner score was (3.7 ±1.4) before operation and (6.7±1.1) at the last followup(t¼2.289, P¼0.012).The average IKDC score was (65.1±7.9) before operation and (92.4±4.5)at the last follow-up (t¼3.186, P¼0.001). Conclusion: Techniques combining remnant-preserving transtibial singlebundle PCL reconstruction resulted in somewhat better stanblity outcomes. It is beneficial for the graft revascularization and rehabilitation of proprioceptive function. Keywords: posterior cruciate ligament, reconstruction, remnant preservation, arthroscopy
Knee - Osteotomy > High tibial osteotomy EP-014 OUTCOME OF HIGH TIBIAL OBLIQUE ROTATIONAL OSTEOTOMY Hitoshi Kanmura 1, Yuji Arai 2, Shuji Nakagawa 2, Hiroaki Inoue 2, Shinichiro Nakamura 1, Toshikazu Kubo 2. 1 Department of Orthopaedics, Fukuchiyama City Hospital, Japan; 2 Department of Orthopaedics, Kyoto Prefectural University of Medicine, Japan Backgrounds: The purpose of this study is to report clinical results of the high tibial oblique rotational osteotomy (HTORO). Materials and Methods: The subjects were 9cases (2men and 7women) which performed HTORO from February 2005 to August 2009. Outcome measures were pre-postoperatively femoral-tibial angle, patellofemoral joint congruity, range of motion, Lysholm score, the time to complete bone union. Results: The Femoral-tibial angle was corrected from 183.4 degrees to 171.9 degrees. The patellaofemoral joint congruity was improved at 6 knees of 10 knees. Lysholm score improved from 72.1 points to 89 points. All cases was provided bone union. Discussion: One advantage of HTORO is that bone union is easy to be provided to correct transformation. The other advantage is that the osteotomy site is more strongly fixed because the lateral proximal and distal bone cortex came in contact. The tibial tuberosity moved to the medial side, and so there are possibilities to be effective for the osteoarthritis of the patellofemoral joint. Conclusion: HTORO might let both the symptom of the patellofemoral joint and medial knee osteoarthritis relieve. Keywords: osteotomy, medial knee OA, patellofemoral joint OA
Knee - Osteotomy > High tibial osteotomy EP-028 THE RESERCH OF SPORTS ACTIVITIES AFTER OPEN WEDGE HIGH TIBIAL OSTEOTOMY Katsunari Ohsawa, Ryouhei Takeuchi, Hiroyuki Ishikawa, Yuuichiro Yamaguchi. Department of Joint Surgery, Yokosuka City Hospital, Japan Background: Open wedge high tibial osteotomy (OWHTO) is a wellestablished method for the treatment of medial unicompartmental osteoarthritis of the knee, which has shown good midterm results. It is indicated for relatively young and high sports activity population. The purpose of this study is whether elderly patients who underwent OWHTO can keep doing their sports activities.
86
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
Materials and Methods: 30 patients (43knees) who underwent OWHTO were evaluated. 6 patients underwent simultaneous bilateral OWHTO.All cases had performed sports activities before surgery. The mean age at the operation was 68 ± 4.8 years (range 53-78), the average follow-up period was 27.2 ± 6.8 months (range 12-43).We investigated KOOS Score, sports events (multiple answers allowed), continuation rate, returning time, self evaluation of sports skills, satisfaction level in sports. Results: KOOS Score improved from the preoperative average of 66.3 ± 13.0 points to 83.6 ± 10.8 points after surgery. Sports events (including exercises 10 cases, walking 7, golf 5, swimming 4, tennis 3, table tennis, jogging, volleyball, climbing 2, bowling 1, skiing 1, softball 1, rugby 1, athletics 1) were a total of 42 cases. There were unable to continue following cases with volleyball 2, gymnastics 2, rugby 1, golfing 1, walking 1, swimming 1, athletics 1. The continuation rate in the number of events was 78.6%. Average self-assessment of sports skills was -1.4 ± 36.3% (-70 +80), average satisfaction level in sports 59.6 ± 32.5% (0 - 100), and the time of returning to sports was 9.5 ± 5.4 months (2 - 21) after surgery. Discussion: The continuation rate in the number of events was high (78.6%), and KOOS score was improved, suggesting that pain improvement was sufficient. On the other hand, the self-assessment of sports skills was as low as -1.4%. I supposed this was due to alignment change of the lower limbs after OWHTO. (Conclusion) The sports continuation rate after OWHTO showed a high value of 78.6%. On the other hand, self-evaluation of sports skills was as low as -1.4%. In conclusion, Satisfaction level in sports after surgery was 59.6%, which was a good result for elderly patients. Keywords: OWHTO, Sports activity
Knee - Osteotomy > High tibial osteotomy EP-033 2 CASES OF THE DOUBLE LEVEL OSTEOTOMY (DLO) (FOR SEVERE VARUS AND VALGUS KNEE DEFORMITY) Kazumasa Inoue, Yasuaki Tamaki, Makoto Yakeuchi. Department of Orthopedics, Mitoyo General Hospital, Japan Aim and Background: For the patients suffering from severe knee deformity which requires angle correction more than 20 degrees , we have to choose carefully the most adequate knee correction osteotomy procedure. The aim of this report is to address the results of the double level osteotomy (DLO) . Material: Case 1: 64 years old female, severe varus deformed knee Femoro Tibial Angle (FTA) 198 degrees Case 2: 69 years old female , severe valgus deformed knee Femoro Tibial Angle (FTA) 155 degrees Method: Japan Orthopedic Surgery Association (JOA) Score was used to evaluate the clinical results. Radiographic evaluation consisted of (1) FTA, (2) Weight Bearing Line Ratio (WBL-R), (3), posterior tibial slopes(PTS), and (4) Caton Deschamps Index(CDI) for checking patella height, (5) medial proximal tibial angle (MPTA) to check the joint-line obliquity . (Surgical procedure ) Case1: Lateral closed Distal Femor Osteotomy (DFO) and Medial open High Tibial Osteotomy (HTO) Case2: Lateral open Distal Femor Osteotomy (DFO) and Medial closed High Tibial Osteotomy (HTO) Results: Case 1: JOA score improved from 30 points to 80 points after surgery. FTA , WBL-R and MPTA were corrected post operatively. (FTA :196 degrees to 170 degrees , WBL-R : -25% to 63% , MPTA : 79 degrees to 89 degrees). PTS and CDI did not change remarkably (PTS : 3.0 degrees to 3.3 degrees , CDI : 0.93 to 0.93) after surgery. Case 2: JOA score improved from 60 points to 80 points after surgery. FTA , WBL-R and MPTA were corrected post operatively. (FTA : 155 degrees to 177 degrees , WBL-R : 115% to 49% , MPTA : 96 degrees to 88.5 degrees). PTS and CDI did not change remarkably (PTS : 4.1 degrees to 3.9 degrees , CDI : 0.69 to 0.71) after surgery. Discussion: Open wedge HTO and closed wedge HTO are often performed for the varus knee deformity. To correct the valgus knee deformity, DFO is a reliable procedure.
But these single osteotomy procedures (HTO, DHO) might not be suitable to correct the alignment of the severe knee deformity like this report , because single osteotomy alone tends to result in the mal position of the joint-obliquity. Conclusion: DLO could provide the adequate alignment correction to the knee joint with severe deformity, and did not influence PTS and patella height. It also seemed that DLO might be able to retain the joint-line obliquity after the large alignment correction like this report. Keywords: osteotomy, knee
Knee - Osteotomy > High tibial osteotomy EP-054 DOES HIGH TIBIAL OSTEOTOMY ACCELERATES LATERAL COMPARTMENTAL OSTEOARTHRITIS IN PATIENTS WITH DISCOID MENISCUS? Jehyoung Yeo 1, Youngjoo Shin 1, 2, Donghyun Lee 1, Jongkeun Seon 1, Eunkyoo Song 1. 1 Department of Orthopedic Surgery, Chonnam National University Bitgoeul Hospital, South Korea; 2 Department of Orthopedics, Tuntun Hospital, Gwangju, South Korea Introduction: High tibial osteotomy relieves pressure from medial compartment by shifting weight bearing axis on lateral compartment. However, in presence of discoid meniscus, the consequence of this increased load is unknown. We planned the study with the aim. We therefore carried out this study with a hypothesis that a high tibial osteotomy would accelerate the progression of lateral compartment osteoarthritis in patients with complete discoid meniscus Methods: It was a retrospective case control study. The records of all patients with high tibial osteotomy from 2008 to 2012 were evaluated for complete lateral discoid meniscus. Cases to control were chosen in ratio 1:2. Results: Records of 674 patients, who underwent a High Tibial Osteotomy from 2008 to 2012, were analyzed. 21 cases with discoid meniscus and 42 controls with matched age, sex, BMI pre-operative deformity and post operative correction to discoid cases were studied. Pre-operative lateral compartment status were similar in both groups as assessed on on Kellgran-Lawrance classification on radiographs and Outerbridge classification during arthroscopic HTO (p¼0.656). However, postoperatively significantly higher patients (4 patients) developed lateral compartment osteoarthritis in discoid group, compared to none in control group (p¼.001). Conclusion: High tibial osteotomy could result in accelerated lateral compartment osteo-arthritis in patients with complete discoid meniscus and the procedure should be used with caution in such patients. Keywords: High tibial osteotomy, discoid meniscus, alignment, lateral compartment osteoarthritis
Knee - Osteotomy > High tibial osteotomy EP-091 THE INFLUENCE OF DIFFERENT HINGE POSITION ON HTO. -COMPARISON OF MEDIAL OPEN-WEDGE OSTEOTOMY & LATERAL CLOSED-WEDGE OSTEOTOMY.Choi Young Lac, Hwang Sun Chul. Department of Orthopedic, Gyeongsang National University, South Korea Purpose and Hypothesis: The purpose of this study was to identify significance of the hinge position through comparison between medial openwedge osteotomy and lateral closed-wedge osteotomy and to determine the ideal hinge position to minimize the effect of high tibial osteotomy on posterior tibial slope (PTS), medial proximal tibial angle (MPTA). Methods: It is performed that 32 cadavaric knees (16 right knees, 16 left knees) using medial open-wedge osteotomy using either the standard hinge position (8 knees) or a low hinge position (8 knees) and lateral closed-wedge osteotomy using either the standard hinge position (8 knees) or a low hinge position (8 knees). In medial open-wedge osteotomy, to define the standard hinge position, we drew a line from 3-cm inferior to the medial tibial plateau towards the fibular head and located the