Osteotomies about the Knee for Tibiofemoral Malalignment in the Athletic Patient

Gardiner, Aaron; Sevilla, Gerardo R Gutiérrez; Steiner, Mark E.; Richmond, John C.

doi:10.1177/0363546509335193

Cited by 25 publications

(14 citation statements)

References 61 publications

(96 reference statements)

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“…High tibial osteotomies are commonly accepted as an effective treatment for painful arthritis in the varus knee 19 . A recent biomechanical study showed that correction to between 6° and 10° of anatomic valgus completely unloads the medial compartment 32 .…”

Section: Discussionmentioning

confidence: 99%

Association of Meniscal Status, Lower Extremity Alignment, and Body Mass Index With Chondrosis at Revision Anterior Cruciate Ligament Reconstruction

et al. 2015

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Background Knees undergoing revision ACL reconstruction (rACLR) have a high prevalence of articular cartilage lesions. Hypothesis The purpose of this study was to test the hypothesis that the prevalence of chondrosis at the time of rACLR is associated with meniscus status and lower extremity alignment. Study design Cross sectional study. Methods Data from the prospective Multicenter ACL Revision Study (MARS) cohort was reviewed to identify patients with pre-operative lower extremity alignment films. Lower extremity alignment was defined by the weight bearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weight bearing compartment was recorded at the time of surgery. Multivariable proportional odds models were constructed and adjusted for relevant factors in order to examine which risk factors were independently associated with the degree of medial and lateral compartment chondrosis. Results The cohort included 246 patients with lower extremity alignment films at the time of rACLR. Average (SD) patient age was 26.9 (9.5) years with a BMI of 26.4 (4.6). The medial compartment had more chondrosis (Grade 2/3: 42%, Grade 4: 6.5%) than the lateral compartment (Grade 2/3: 26%, Grade 4: 6.5%). Disruption of the meniscus was noted in 35% of patients on the medial side and 16% in the lateral side. The average (SD) WBL was measured to be 0.43 (0.13). Medial compartment chondrosis was associated with BMI (p=0.025), alignment (p=0.002), and medial meniscus status (p=0.001). None of the knees with the WBL lateral to 0.625 had Grade 4 chondrosis in the medial compartment. Lateral compartment chondrosis was significantly associated with age (p=0.013) and lateral meniscus status (p<0.001). Subjects with ‘intact’ menisci were found to decrease their odds of having chondrosis by 64–84%. Conclusions The status of articular cartilage in the tibiofemoral compartments at the time of rACLR is related to meniscal status. Lower extremity alignment and BMI are associated with medial compartment chondrosis. Clinical relevance Providers and patients should be aware of the association of meniscal integrity, alignment and BMI with chondrosis at the time of rACLR. Further research into the potential benefits of interventions to optimize these parameters is warranted.

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Section: Discussionmentioning

confidence: 99%

Association of Meniscal Status, Lower Extremity Alignment, and Body Mass Index With Chondrosis at Revision Anterior Cruciate Ligament Reconstruction

et al. 2015

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“…Chronic repetitive stressing of the ACL graft may cause late failure from attenuation. 10 Therefore, revision ACL reconstruction seemed unlikely to have long-term success without correction of the tibial malalignment.…”

Section: Discussionmentioning

confidence: 99%

“…Decreasing the tibial slope decreases the posterior vector of force of the distal femur with weight bearing and thus may be favorable after ACL reconstruction. 10 The importance of the tibial slope must be considered when osteotomies are planned prior to ACL reconstruction, and care must be taken to avoid an increase in the tibial slope. The mechanical axis of the lower extremity…”

Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction Failure After Tibial Shaft Malunion

LaFrance¹,

Gorczyca²,

Maloney³

2012

Orthopedics

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Anterior cruciate ligament (ACL) reconstruction is common, with >100,000 procedures performed each year in the United States. Several factors are associated with failure, including poor surgical technique, graft incorporation failure, overly aggressive rehabilitation, and trauma. Tibial shaft fracture is also common and frequently requires operative intervention. Failure to reestablish the anatomic alignment of the tibia may cause abnormal forces across adjacent joints, which can cause degenerative joint disease or attritional failure of the surrounding soft tissues. This article describes a case of ACL reconstruction failure after a tibial fracture that resulted in malunion. Excessive force across the graft from lower-extremity malalignment and improper tunnel placement likely contributed to the attritional failure of the graft. This patient required a staged procedure for corrective tibial osteotomy followed by revision ACL reconstruction. This article describes ACL reconstruction failure, tibial shaft malunions, their respective treatments, the technical details of each procedure, and the technical aspects that must be considered when these procedures are done in a staged manner by 2 surgeons.

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“…The isolated use of HTO as a temporizing measure for symptomatic medial gonarthrosis has diminished over the past few decades. 29 However, several studies have shown that HTO remains a durable procedure for patients returning to intense activity or impact physical activity with unicompartmental disease, 7 particularly in military cohorts where knee arthroplasty may not be prudent. The emerging role of HTO as a chondroprotective measure has also been increasingly recognized, and its surgical indications have expanded to complement a variety of joint-preserving procedures for young patients with subtle malalignment and concomitant knee pathology.…”

mentioning

confidence: 99%

“…27 Despite its growing acceptance among younger patients, there are limited reports on clinical outcomes after HTO in this patient subset, 11,14,20 particularly in more highdemand cohorts. 7,23,28,30 The existent literature varies widely by patient demographics, surgical indications, length of follow-up, surgical technique, and presence of associated procedures, and many studies primarily focus on conversion to knee arthroplasty as an isolated endpoint in assessing the success after HTO. 4,12 Few studies to date have evaluated patient-reported and functional outcomes in athletic populations after HTO, 9,23 and no study has reported on the ability of HTO to return patients to occupations requiring strenuous physical performance.…”

mentioning

confidence: 99%