scholarly journals High Tibial Osteotomy With Miniaci Planning Using Manual and Semiautomated Digital Measures

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110329
Author(s):  
Grégoire Micicoi ◽  
Pierre Martz ◽  
Christophe Jacquet ◽  
Levi Reina Fernandes ◽  
Raghbir Khakha ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Gold Standard ◽  
Preoperative Planning ◽  
Joint Line ◽  
Tibial Osteotomy ◽  
Anatomical Landmarks ◽  
X Rays ◽  
Interobserver Reproducibility ◽  
Optimal Procedure ◽  
Joint Line Obliquity

Background: Inadequate deformity analysis and planning before high tibial osteotomy (HTO) may result in correction errors with unsatisfactory clinical results. Indications: The purpose of this article is to describe the deformity analysis and preoperative planning before HTO. This surgery is effective for young patients with compartmental mild knee osteoarthritis. A partial deformity analysis without considering the femoral or intra-articular deformity may lead to overcorrection or excessive joint line obliquity. Preoperative planning using the Miniaci method with manual or semiautomated digital measures may help to prevent these types of errors. Technique Description: Landmarks are used at the proximal femoral side, distal condyles, proximal tibial plateau, and talus borders to define angles automatically on PeekMed software. Fujisawa point is determined to be 50% of the length of the proximal tibia, and Miniaci method is performed after defining the weightbearing line. The method can be performed manually or semiautomatically with the software. In this last case, the optimal procedure to be done to correct the malalignment is proposed by the software which automatically does the opening of the osteotomy to match the desired weightbearing axis and displays the size of the wedge in millimeters. Results: The intraobserver and interobserver reproducibility were performed by 2 different analyses and 2 different observers. The precision of the measures was confirmed based on computed tomographic (CT) scan 3-dimensional measures defined as the gold standard. All the intraobserver and interobserver reproducibility correlation coefficients and precision were satisfactory compared with the gold standard. Hip-knee-ankle angle may vary because of weightbearing situations between CT and long-axis x-rays. Discussion/Conclusion: The interest of semiautomated software for angular value measurements is now well recognized, and the inclusion of anatomical landmarks allows accurate and reproducible angular value measurements. Automatic knee osteotomy planning analyzes the metaphyseal deformity of both the tibia and the femur, and the software suggests the optimal procedure with the degree of openness to obtain the desired mechanical axis without creating excessive joint line obliquity

scholarly journals The actual knee function was not influenced by joint line obliquity after open-wedge high tibial osteotomy

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 4 ◽  
Author(s):  
Mitsuaki Kubota ◽  
Youngji Kim ◽  
Taisuke Sato ◽  
Junichiro Yamaguchi ◽  
Ryuichi Ohno ◽  
...  
Keyword(s):  
Muscle Strength ◽  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Joint Line ◽  
Knee Function ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Radiological Parameters ◽  
Joint Line Obliquity ◽  
Wedge High Tibial Osteotomy

Purpose: Excessive joint line obliquity (JLO) after open-wedge high tibial osteotomy (OWHTO) induces detrimental stress on the articular cartilage. The purpose of this article is to assess the correlation between JLO and the clinical results after OWHTO. Methods: 68 patients were followed up for more than 1 year. JLO was assessed using a long-leg standing anteroposterior radiograph. The knee osteoarthritis outcome score (KOOS) and KSS (Knee Society score) objective knee score were assessed as clinical scores. The Weight-bearing line ratio (WBLR), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint line convergence angle (JLCA) were assessed as radiological parameters. The timed up-and-go (TUG) test and single-leg standing (SLS) test were performed, and the isometric muscle strength of the quadriceps and hamstrings was assessed to evaluate the knee function. The primary outcomes were the correlations between the JLO and the clinical score, radiological parameters and knee function after OWHTO. The secondary objective of this study was to detect the factor with the greatest influence on JLO. Results: There were significant correlations between the postoperative JLO and the KOOS in the subcategories of pain, activities of daily living (ADL), and sports and recreation (r = −0.311, −0.302, −0.282, p = 0.011, 0.014, 0.022, respectively). However, the postoperative JLO was not significantly correlated with the KSS, knee function, or muscle strength. The preoperative LDFA and postoperative MPTA were factors influencing increased JLO after OWHTO. Discussion: There was no significant correlation between the JLO and the actual knee function. The preoperative LDFA and postoperative MPTA were factors that influenced the increase in JLO after OWHTO.

Analysis of Knee Joint Line Obliquity after High Tibial Osteotomy

2016 ◽  
Vol 29 (08) ◽  
pp. 649-657 ◽  
Author(s):  
Kwang-Jun Oh ◽  
Young Ko ◽  
Ji Bae ◽  
Suk Yoon ◽  
Jae Kim
Keyword(s):  
Knee Joint ◽  
High Tibial Osteotomy ◽  
Joint Line ◽  
Tibial Osteotomy ◽  
Joint Line Obliquity

scholarly journals Pulsed Electromagnetic Field Therapy Improves Osseous Consolidation after High Tibial Osteotomy in Elderly Patients—A Randomized, Placebo-Controlled, Double-Blind Trial

2019 ◽  
Vol 8 (11) ◽  
pp. 2008 ◽  
Author(s):  
Patrick Ziegler ◽  
Andreas K. Nussler ◽  
Benjamin Wilbrand ◽  
Karsten Falldorf ◽  
Fabian Springer ◽  
...  
Keyword(s):  
Electromagnetic Field ◽  
Elderly Patients ◽  
High Tibial Osteotomy ◽  
Bone Healing ◽  
Placebo Treatment ◽  
Tibial Osteotomy ◽  
X Rays ◽  
Pulsed Electromagnetic Field ◽  
Pulsed Electromagnetic ◽  
Pemf Treatment

Extremely low-frequency pulsed electromagnetic field (ELF-PEMF) therapy is proposed to support bone healing after injuries and surgical procedures, being of special interest for elderly patients. This study aimed at investigating the effect of a specific ELF-PEMF, recently identified to support osteoblast function in vitro, on bone healing after high tibial osteotomy (HTO). Patients who underwent HTO were randomized to ELF-PEMF or placebo treatment, both applied by optically identical external devices 7 min per day for 30 days following surgery. Osseous consolidation was evaluated by post-surgical X-rays (7 and 14 weeks). Serum markers were quantified by ELISA. Data were compared by a two-sided t-test (α = 0.05). Device readouts showed excellent therapy compliance. Baseline parameters, including age, sex, body mass index, wedge height and blood cell count, were comparable between both groups. X-rays revealed faster osseous consolidation for ELF-PEMF compared to placebo treatment, which was significant in patients ≥50 years (∆mean = 0.68%/week; p = 0.003). Findings are supported by post-surgically increased bone-specific alkaline phosphatase serum levels following ELF-PEMF, compared to placebo (∆mean = 2.2 µg/L; p = 0.029) treatment. Adverse device effects were not reported. ELF-PEMF treatment showed a tendency to accelerate osseous consolidation after HTO. This effect was stronger and more significant for patients ≥50 years. This ELF-PEMF treatment might represent a promising adjunct to conventional therapy supporting osseous consolidation in elderly patients.

scholarly journals Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jae-Young Park ◽  
Chong Bum Chang ◽  
Dong-Wan Kang ◽  
Sohee Oh ◽  
Seung-Baik Kang ◽  
...  
Keyword(s):  
Linear Regression ◽  
Knee Joint ◽  
High Tibial Osteotomy ◽  
Linear Regression Analysis ◽  
External Validation ◽  
Joint Line ◽  
Line Orientation ◽  
Tibial Osteotomy ◽  
Correction Angle ◽  
Anatomical Alignment

Abstract Background Maintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO. Methods A total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution. Results After HTO, KJLO increased from − 0.8° to 2.9° (P < 0.001). Based on the multivariable linear regression analysis, an equation was derived that can estimate postoperative KJLO after HTO; postoperative KJLO(°) = 1.029 + 0.560 × preoperative KJLO(°) + 0.310 × preoperative tibia plateau inclination(°) + 0.463 × aimed correction angle(°). The adjusted coefficients of determination value for this equation was 0.721. The equation also showed good calibration and predictability in external validation with predicted squared correlation coefficient of 0.867. Conclusions This study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO.

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