Intra-Articular Osteotomy for Genu Valgum in the Knee with a Lateral Compartment Deficiency

Feldman, David S.; Goldstein, Rachel Y.; Kurland, Adam M.; Taha, Abdel Majid Sheikh

doi:10.2106/jbjs.o.00308

Cited by 15 publications

(8 citation statements)

References 11 publications

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“…Intra-articular deformity correction, when done well, can successfully reorient an incongruous joint, but the surgeries are technically demanding and associated with high rates of complications. 4,5 If the decision to accept a secondary deformity is made, the surgeon must consider the potential for long-term complications. Even before the development of degenerative arthropathy, knee joint line obliquity may result in shear stresses and secondary instability.…”

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confidence: 99%

“…Even before the development of degenerative arthropathy, knee joint line obliquity may result in shear stresses and secondary instability. 5 This would cause abnormal pressure distribution between the femur and tibia, notably increases on the lateral or medial tibial spines, together with a shear displacement of the femur on the tibia in the direction of the obliquity. However, the amount of obliquity that can be tolerated before the joint becomes Keywords ► deformity correction ► osteotomies ► knee joint obliquity ► secondary deformity ► secondary…”

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confidence: 99%

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Biomechanical Implications of an Oblique Knee Joint Line

et al. 2017

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Surgical correction of multiapical deformities of the lower limb requires careful preoperative planning. Surgeons must account for the potential creation of secondary deformity, such as knee joint line obliquity, and the risks associated with accepting these changes in limb alignment. In this study, we evaluate the effect of knee joint obliquity on tibial plateau contact pressures and knee instability. Three cadaveric knees were dissected and put through biomechanical testing to simulate loading of an oblique knee joint. We observed < 1 mm femoral displacement (proxy measure of instability) between 15 degrees of varus tilt and 10 degrees of valgus tilt, and greater increases in tibial plateau contact pressures with valgus tilt than with varus tilt. Our results suggest that, if the creation of a secondary coronal plane deformity at the knee joint cannot be avoided, up to 15 degrees of varus or 10 degrees of valgus alignment can be tolerated by an otherwise structurally normal knee.

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confidence: 99%

Biomechanical Implications of an Oblique Knee Joint Line

et al. 2017

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“…Several reports have described intra-articular corrective osteotomies in adults for malunion of intra-articular fractures in the upper extremities, but only one report has described such treatment in children [ 2 ]. Almost all cases involved injury, the one exception is a report of intra-articular osteotomy by Feldman et al [ 8 ], who described the treatment of genu valgum in a child with lateral compartment deficiency. It seems that this procedure is still not commonly performed in children.…”

Section: Discussionmentioning

confidence: 99%

Extra-Articular Corrective Osteotomy for Malunion of Intra-Articular Fracture of the Elbow in a Child: A Case Report

Shibayama¹,

Kawamura²,

Iwasaki³

2022

JOCR

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Introduction: Malunion of intra-articular fracture of the elbow in children is uncommon and may be difficult to treat. Intra-articular corrective osteotomies are still not commonly performed in children, and the main reason is the concern regarding the risk of osteonecrosis. We present a case of extra-articular corrective osteotomy for malunion after open reduction and internal fixation for fracture dislocation of the elbow. Case Report: An 8-year-old boy was injured by a fall and he underwent an operation the day after the injury with diagnosis of lateral condyle fracture of the right humerus. He was referred to our department 4 months after the operation due to restricted range of motion. His elbow exhibited cubitus varus, and range of motion was 80° of flexion, −30° of extension, 55° of pronation, and 85° of supination. Plain radiographs showed malunion, a Baumann angle of 3°, and a tilting angle of 5°. We diagnosed this injury not as lateral condyle fracture but as posterolateral dislocation with Milch type 1 lateral condyle fracture associated with osteochondral flap fracture of the coronoid process with computed tomography images at the time of injury. Because the patient was only 8 years old, we decided to perform an extra-articular corrective osteotomy to encourage bone remodeling and improve the flexion range of motion. After the operation, the range of motion improved as 130° of flexion, −30° of extension, 85° of pronation, and 90° of supination 4 years after the operation. Plain radiographs showed that the epiphysis of the capitellum was closed, and the trochlea presented a fishtail deformity. Conclusion: We obtained relatively good outcomes with extra-articular corrective osteotomy, and long-term follow-up is necessary. Especially in the elbow, the injury itself may cause fishtail deformity due to avascular necrosis of the trochlea, and if an additional osteotomy is performed, the risk increases. Although there is concern about the occurrence of secondary osteoarthritis, we expect that the intra-articular deformity would be remodeled due to the patient’s young age if normal elbow movement could be obtained.

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“…To address the intra-articular defect, Paley 10 was the first to mention intra-articular osteotomy for the treatment of valgus deformity and instability secondary to lateral femoral condylar hypoplasia. Feldman et al 11 reported a retrospective report of five patients who had lateral femoral condylar hypoplasia with or without concomitant lateral hemiplateau depression treated by intra-articular osteotomy. Intra-articular osteotomy provided satisfactory correction of the genu valgum without the creation of an oblique joint line.…”

Section: Discussionmentioning

confidence: 99%

“…Intra-articular osteotomy provided satisfactory correction of the genu valgum without the creation of an oblique joint line. 11 However, in this case, a bone tunnel for PLC reconstruction would require an intact lateral femoral condyle, tibial plateau, and fibular head. Intra-articular osteotomy would violate the passage of the bone tunnel needed for the LaPrade procedure.…”

Section: Figurementioning

confidence: 97%

Posterolateral Complex Reconstruction With Distal Femoral Varus Opening-Wedge Osteotomy for Unstable Neglected Multiligamentous Knee Injury With Valgus Malalignment

et al. 2021

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We presented a case of a 25-year-old woman with early posttraumatic degenerative change to the articular cartilage accompanied with valgus malalignment despite receiving anterior cruciate ligament reconstruction after a multiligamentous injury sustained 2 years earlier. Rapid deteriorating valgus malalignment may result from chronic instability and intra-articular bone loss. Simultaneous distal femoral varus osteotomy and posterolateral complex reconstruction were performed during a single surgery. Six months after the surgery, the patient could walk briskly and climb stairs without any discomfort. Salvage procedures and biological reconstruction could be the primary choice for young patients to recover their knee function while avoiding joint replacement. Motor vehicle collisions and sport-related injuries are the two most common causes of multiligamentous knee injuries (MLKIs). 1,2 MLKI is defined as the disruption of at least two of the four major stabilizing ligaments of the knee. In acute multiligament knee injury patients, detailed evaluation with physical examination, MRI, stress radiographs, and angiography are necessary if the ankle-brachial index is less than 0.9. 3 Any missed ligament injury will result in incomplete preoperative planning, and associated lesions can compromise the newly reconstructed ligament because of residual instability. Furthermore, failure to completely address all contributing factors to knee instability will change the knee kinematics. 3 It is also well known that chronic valgus instability and valgus malalignment cannot be controlled by ligament reconstruction alone. 4 Reconstructing the ligaments and obtaining the correct mechanical alignment are advised for repairing MLKIs, especially in young patients. Although there are several treatment choices for osteoarthritis, arthroplasty is not suitable for osteoarthritis in young patients.Much of the existing literature has focused on the evaluation and treatment choices for chronic posterolateral complex (PLC) deficiency in varus knee deformities. [5][6][7] No case report has discussed a coexisting valgus deformity with PLC insufficiency. Given the rarity of these injuries and the lack of literature

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Intra-Articular Osteotomy for Genu Valgum in the Knee with a Lateral Compartment Deficiency

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 15 publications

References 11 publications

Biomechanical Implications of an Oblique Knee Joint Line

Biomechanical Implications of an Oblique Knee Joint Line

Extra-Articular Corrective Osteotomy for Malunion of Intra-Articular Fracture of the Elbow in a Child: A Case Report

Posterolateral Complex Reconstruction With Distal Femoral Varus Opening-Wedge Osteotomy for Unstable Neglected Multiligamentous Knee Injury With Valgus Malalignment

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