An Acute Oblique Osteotomy and Suture Ligation Procedure to Shorten the Fibula in Lateral Closing-Wedge High Tibial Osteotomy

Yasuda, Kazunori; Kondo, Eiji; Ueda, Daisuke; Onodera, Jun; Yabuuchi, Koji; Tanabe, Yoshie; Iwasaki, Norimasa; Yagi, Tomonori

doi:10.1016/j.eats.2020.05.008

Cited by 8 publications

(13 citation statements)

References 12 publications

(33 reference statements)

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“…In 2016, we developed the acute oblique osteotomy (AO) procedure, in which a simple osteotomy is made at the central portion of the fibular shaft in an acutely inclined frontal plane. 26 In our experience, this procedure was easy and safe, but bone union at the osteotomy site was occasionally delayed. Therefore, in 2018 we developed the AO and ligation (AO/L) procedure.…”

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confidence: 73%

High Rate of Radiographic Union at the Fibular Osteotomy Site With No Complications After an Acute Oblique Osteotomy and Ligation Procedure to Shorten the Fibula in High Tibial Osteotomy

Ueda¹,

Yasuda²,

Kaibara

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: A fibular shortening osteotomy is needed to perform lateral closing-wedge high tibial osteotomy (LCW-HTO). To achieve this shortening, we have recently developed an acute oblique osteotomy and ligation (AO/L) procedure for the center of the fibular shaft, based on the AO procedure. Purpose: To compare the 2-year follow-up outcomes between the AO/L procedure and the AO procedure. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective comparative cohort study was conducted involving 83 patients (83 knees) who underwent shortening osteotomy of the fibula in LCW-HTO between April 2017 and March 2019. The first consecutive 41 knees (AO group) underwent fibular osteotomy with the AO procedure. The remaining 42 knees (AO/L group) underwent fibular osteotomy with the AO/L procedure. All of the patients were evaluated for at least 2 years postoperatively via clinical and radiological assessments. To determine the time needed for complete union at the osteotomy site, we evaluated the radiographs using a radiographic union score for tibial fractures, which was modified for fibular osteotomy. Comparison of outcomes between the 2 groups was performed using the Student t test for continuous variables and the Mann-Whitney U test or Fisher exact test for discrete variables. Results: Around the fibular osteotomy site, no perioperative complications were found in either group. The radiographic union score was significantly higher in the AO/L group than in the AO group ( P < .0001 at 2, 3, and 6 months; P = .0290 at 12 and 24 months). The union rate at the fibular osteotomy site was significantly higher in the AO/L group (97.6%) than in the AO group (82.9%) at 12 months ( P = .0290). Conclusion: The AO/L procedure significantly accelerated the formation of bridging callus at the fibular osteotomy site and provided a significantly higher union rate compared with the AO procedure. Both AO/L and AO procedures were free from perioperative complications. These results suggest that the AO/L procedure is clinically useful as an osteotomy procedure to shorten the fibula in LCW-HTO.

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confidence: 73%

High Rate of Radiographic Union at the Fibular Osteotomy Site With No Complications After an Acute Oblique Osteotomy and Ligation Procedure to Shorten the Fibula in High Tibial Osteotomy

Ueda¹,

Yasuda²,

Kaibara

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…The details of the iV osteotomy procedure have been described (see Video Supplement). 36,76 A longitudinal incision was made at the posterolateral aspect of the middle lower leg. A long oblique osteotomy was made at the central portion of the fibula.…”

Section: Surgical Procedures Of Iv-htomentioning

confidence: 99%

“…A long oblique osteotomy was made at the central portion of the fibula. 76 A 10-cm anterolateral curved skin incision was made at the proximal tibia. The anteromedial and posterolateral periosteums were peeled from the tibia along the medial and lateral osteotomy lines.…”

Section: Surgical Procedures Of Iv-htomentioning

confidence: 99%

“…35,42 Second, the bone mass is reduced in the lateral tibial plateau, resulting in difficulty of potential total knee arthroplasty. 5,36,76 Third, several investigators have indicated that the complication rate of the CW-HTO is high, such as delayed union, correction loss, and compartment syndrome. 5,66,70 Therefore, an alternative HTO procedure without these disadvantages should be developed for knee osteoarthritis (OA) with moderate or severe varus deformity.…”

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confidence: 99%

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Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy

Kondo

Yabuuchi²,

Joutoku

et al. 2022

Am J Sports Med

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Background: Recent studies have reported that medial opening wedge (OW) high tibial osteotomy (HTO) induces patella baja, resulting in degenerative changes in the patellofemoral joint. We have developed an inverted V-shaped (iV) HTO, which is classified as a neutral wedge osteotomy. Hypotheses: The study hypotheses were as follows: (1) patellar height, posterior tibial slope, and tibial length will not change between pre- and postoperative evaluations after iV-HTO; (2) the lateral shift ratio of the patella and the distance between the tibial tubercle and the trochlear groove may be significantly decreased after iV-HTO. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 191 patients (220 knees) who underwent HTO for medial osteoarthritis were enrolled retrospectively in this study: 107 knees underwent OW-HTO and 113 knees underwent iV-HTO. Clinical and radiological evaluations were performed before and at least 3 years after surgery. Results: Postoperatively, the mean Caton-Deschamps ratio was significantly decreased ( P < .0001) from 0.95 to 0.79 in the OW group, while there were no significant changes in the iV group. The mean posterior tibial slope was significantly increased ( P < .0001) from 8.5° to 10.5° in the OW group, while there were no significant differences in the iV group. Although the entire leg length was significantly increased ( P < .0003) in both groups after HTO, there were no significant differences in tibial length between the pre- and postoperative periods in the iV group. Regarding the congruity of the patellofemoral joint, the mean lateral shift ratio did not significantly change in the OW group, whereas it was significantly decreased ( P = .0012) from 11.5% to 8.8% in the iV group. The mean tibial tubercle–trochlear groove distance was significantly decreased ( P < .0001) from 12.8 to 9.7 mm in the iV group, while it was significantly increased in the OW group ( P < .0001). Concerning the clinical outcome, the Japanese Orthopaedic Association (JOA) and Lysholm knee scores at final follow-up (OW vs iV: JOA, 91.2 vs 90.1; Lysholm, 92.5 vs 89.0) were significantly increased ( P < .0001) as compared with the preoperative values (OW vs iV: JOA, 68.3 vs 66.8; Lysholm, 67.9 vs 61.0). Conclusion: Patellar height, posterior tibial slope, and tibial length did not change after the iV-HTO, while they were significantly changed after the OW-HTO. Although the preoperative degrees of varus knee and patellofemoral osteoarthritis were more severe in the iV group than the OW group, the iV-HTO led to altered patellofemoral joint congruity.

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“…The surgery was performed as described in the previous studies [ 8 , 9 , 10 ]. At first, an arthroscopy was performed and no abnormal intra-articular abnormalities were detected ( Fig.…”

Section: Case Reportmentioning

confidence: 99%

Inversed V-shaped High Tibial Osteotomy for Severe Varus Deformity due to Blount Disease: A Case Report

Hayashi¹,

Tsukisaka²,

Aoki³

et al. 2021

JOCR

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Introduction: Blount disease is a growth disorder of the medial proximal tibial physis causing a multi-planar deformity of the lower limb. Several types of surgical approaches have been described for the correction of angular deformity including external fixation, opened-/closed- wedge high tibial osteotomy (HTO), and tibial condylar valgus osteotomy. However, they are associated with various disadvantages such as limb length discrepancy, risk of infections, and delayed union at the osteotomy site, especially in cases of severe varus deformity. Case Report: We report a case of a 16-year-old boy with unilateral severe genu varum caused by Blount disease. Considering that the current case, the patient was severely obese and a highly active young boy with severe unilateral genu varum, with the epiphyseal line almost closed, and with no abnormalities with respect to the intra-articular anatomical structures, inverted V-shaped HTO was applied. After the treatment, the boy was not only able to perform his daily activities but was also able to participate in sports quite early. Although the required correction angle was quite large, inverted V-shaped HTO successfully corrects the deformity with minimal disadvantages Conclusion: Inverted V-shaped HTO would be selected as one of the effective treatments for a severely obese, young, and highly active patient suffering from severe genu varum caused by Blount disease. Keywords: Blount disease, genu varum, obesity, high tibial osteotomy (HTO), inverted V-shaped high tibial osteotomy (iVHTO).

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An Acute Oblique Osteotomy and Suture Ligation Procedure to Shorten the Fibula in Lateral Closing-Wedge High Tibial Osteotomy

Cited by 8 publications

References 12 publications

High Rate of Radiographic Union at the Fibular Osteotomy Site With No Complications After an Acute Oblique Osteotomy and Ligation Procedure to Shorten the Fibula in High Tibial Osteotomy

High Rate of Radiographic Union at the Fibular Osteotomy Site With No Complications After an Acute Oblique Osteotomy and Ligation Procedure to Shorten the Fibula in High Tibial Osteotomy

Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy

Inversed V-shaped High Tibial Osteotomy for Severe Varus Deformity due to Blount Disease: A Case Report

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