Distal Femoral Osteotomy and Lateral Meniscus Allograft Transplant

Leong, Natalie L.; Southworth, Taylor M.; Cole, Brian J.

doi:10.1016/j.csm.2019.02.007

Cited by 10 publications

(5 citation statements)

References 18 publications

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“…The following study by Leong et al 7 in The Clinical Journal of Sports Medicine in 2019 assessed much of the recent literature on lateral meniscal allograft transplantation with distal femoral osteotomy using the lateral rather than the transpatellar approach. Although most patients demonstrated improved outcomes and return to sport, there were wide variations in allograft survival at long-term follow-up.…”

Section: Video Transcriptmentioning

confidence: 99%

Lateral Meniscal Allograft Transplantation With Distal Femoral Osteotomy

Meeks

Ulrich

Duerr

et al. 2023

Video Journal of Sports Medicine

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Background: Meniscal allograft transplantation improves functional and patient-reported outcomes in patients with meniscal deficiency without significant osteoarthritis. In addition, it is known that valgus malalignment of the knee can lead to meniscal and chondral damage, and surgery is often indicated to restore the mechanical axis and slow progression of osteoarthritis. Indications: Indications for this procedure include patients with symptomatic lateral meniscal deficiency with associated valgus deformity of the knee. Patient’s age must be less than 50 years, body mass index less than 35 kg/m2, meniscal deficiency, and ipsilateral pain with or without swelling. Ligament tears, focal cartilage loss, and malalignment are not contraindications if also corrected. Technique Description: We begin by removing the remaining lateral meniscus, taking care to leave a small peripheral rim of meniscus. A transpatellar tendon arthrotomy is performed, and the meniscal allograft is passed through the arthrotomy and into the knee. An inside-out repair is performed using vertical mattress sutures. The sutures are tightened and tied with the knee at 30° to 40° of flexion. The distal femoral osteotomy is then performed. An approach is made to the lateral femur, where initial guidewires are placed using fluoroscopic guidance. The initial saw cut is made about 75% of the way across the femur, and an osteotome is used to complete the osteotomy. Care is taken to preserve the far medial cortex. An adjustable wedge osteotome is placed to open the lateral cortex in accordance with the preoperative template. The cortical wedge is fashioned using the tibial allograft from the meniscal transplant and is placed into the osteotomy. The osteotomy is secured using a locking plate with locking screws, and this is confirmed in safe position using fluoroscopy prior to the conclusion of the case. Results: Patients will have effective deformity correction and alleviation of pain. Many patients can return to sport without restrictions following appropriate rehabhilitation. Conclusion: Lateral meniscal allograft transplantation with distal femoral opening wedge osteotomy is an effective treatment for symptomatic lateral meniscal insufficiency with associated valgus deformity of the knee in patients without osteoarthritis. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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Section: Video Transcriptmentioning

confidence: 99%

Lateral Meniscal Allograft Transplantation With Distal Femoral Osteotomy

Meeks

Ulrich

Duerr

et al. 2023

Video Journal of Sports Medicine

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“…Meniscal root pathology carries similar consequences in the tibiofemoral joint as complete Surgical Techniques meniscal deficiency. 5 Both meniscal root repair and distal femoral osteotomy are complex procedures in their own right, each of which is not without its own risks as well. When addressed in concert, many factors must be considered.…”

Section: Video Transcriptmentioning

confidence: 99%

Opening-Wedge Distal Femoral Osteotomy With Concomitant Medial Meniscal Root Repair

Braaten

Banovetz

Homan

et al. 2023

Video Journal of Sports Medicine

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Background: Valgus malalignment leads to excessive loading of the lateral compartment and has been associated with lateral compartment meniscal injuries and early-onset knee osteoarthritis. Distal femoral osteotomy (DFO) is a treatment option that allows correction of the mechanical access to offload the lateral compartment. Lateral opening-wedge distal femoral osteotomy and medial meniscal root repairs are both aimed to address the pathologic biomechanics of the tibiofemoral joint and when successful can delay or even prevent progression to end-stage osteoarthritic changes in the lateral and medial compartment, respectively. Indications: Distal femoral osteotomy is indicated for patients with normal metabolic bone health and valgus malalignment who may present with concurrent lateral meniscal injury, symptomatic lateral compartment arthritis, or a chronic medial collateral ligament tear/laxity. Technique Description: Long-leg alignment radiographs and preoperative magnetic resonance images are required to evaluate the degree of mechanical access deviation and to evaluate for soft tissue injury, as there is often concomitant lateral meniscal or cartilage pathology present. This technique demonstrates the optimal order of surgical steps for DFO with a concurrent medial meniscal root repair. The senior author’s preferred order is to first perform the open lateral approach and expose the lateral cortex for the placement of plate prior to arthroscopic work and excess fluid extravasation. Intra-articular work is then performed with a diagnostic arthroscopy followed by medial meniscal root repair. Finally, the osteotomy and subsequent internal fixation are performed. Results: The literature on opening-wedge DFO outcomes is heterogeneous, with variable rates of successful outcomes and complications. Saithna et al reported that International Knee Documentation Committee and the pain subdomain of Knee injury and Osteoarthritis Outcome Scores significantly improved postoperatively following lateral opening-wedge DFOs in patients with lateral compartment osteoarthritis. The 10-year success rate of varus-producing DFO has been reported to be 64% to 85%. Discussion: We describe a technique for correction of a valgus deformity with opening-wedge DFO and concurrent meniscal root repair. This surgical technique effectively restores the native femoral and tibial axis with appropriate load distribution and also concurrently restores the appropriate function of the medial meniscus which allows axial force dispersion via hoop stresses for the medial compartment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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“…Leong ve ark. [43] distal femoral osteotomin 10 yıllık uzun dönem sonuçlarının farklı çalışmalarda grafiye göre avantajlıdır. Mekanik aks grafisi ile alt ekstremite dizilimi değerlendirilip cerrahi planlama yapılır (Şekil 6a).…”

Section: Dfo'nun Ek Kıkırdak Ve Menisküs Prosedürleriyle Birlikte Uygulanmasıunclassified

Diz çevresi osteotomilerinde güncel yaklaşımlar

Akşahin¹,

Tağrıkulu²

2020

TOTBID

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Diz osteoartriti tedavisinde artroskopik cerrahi debridman, yüksek tibial osteotomi, distal femoral osteotomi, unikompartmantal diz artroplastisi ve total diz artroplastisi gibi bir takım cerrahi alternatifler mevcuttur. [6,7] Özellikle genç yaş grubunda diz osteoartrit progresyonunu (ilerlemesini) durdurmak amaçlı daha biyolojik bir tedavi alternatifi olan dizilim düzeltici osteotomiler yapılagelmektedir. Jackson'ın 1958'de ilk kez proksimal tibia ve distal femur osteotomilerini tanımlamasından bu yana osteotomi teknikleri modifiye edilerek güncelliğini korumaktadır. [8] Bu osteotomilere ek olarak günümüzde fibular osteotomi ile medial kompartman artrozunda dekompresyon tekniği de tanımlanmıştır. [4]

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Distal Femoral Osteotomy and Lateral Meniscus Allograft Transplant

Cited by 10 publications

References 18 publications

Lateral Meniscal Allograft Transplantation With Distal Femoral Osteotomy

Lateral Meniscal Allograft Transplantation With Distal Femoral Osteotomy

Opening-Wedge Distal Femoral Osteotomy With Concomitant Medial Meniscal Root Repair

Diz çevresi osteotomilerinde güncel yaklaşımlar

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