Managing intra-articular deformity in high Tibial osteotomy: a narrative review

Micicoi, Grégoire; Khakha, Raghbir; Kley, Kristian; Wilson, Adrian; Cerciello, Simone; Ollivier, Matthieu

doi:10.1186/s40634-020-00283-1

Cited by 68 publications

(50 citation statements)

References 53 publications

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“…Increased JLCA equates to intra-articular deformity [ 24 ], and has been reported to worsen long-term clinical outcomes after HTO [ 13 , 20 , 24 ]. In this situation, concomitant TCVO may be able to reduce the JLCA [ 9 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

et al. 2023

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Purpose The purpose of this study was to examine the relationship between preoperative Ahlbäck radiographic classification grade and the clinical outcomes of double level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity. Methods The study population comprised a consecutive series of 99 knees (68 patients) for which DLO was performed and follow-up results for a minimum of two years were available. The Ahlbäck radiographic classification system was used to determine the osteoarthritic grade. The following radiological parameters for alignment and bone geometry were measured: mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint-line convergence angle (JLCA), and mechanical tibiofemoral angle (mTFA). Clinical results were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) subjective score preoperatively and at 2 years after surgery. Difference between preoperative and postoperative measurements as well as relationship between Ahlbäck grade and radiological/clinical results were statistically assessed. Results The average age of the study participants was 60.9 ± 6.2 years and the mean follow-up period was 45.4 ± 15.2 months. Each of the radiological parameters exhibited preoperative abnormal values. Knees with Ahlbäck grade 3 and 4 osteoarthritis exhibited significantly greater JLCA and mTFA than grade 1 knees. Two years post-surgery, all radiological parameter values measured within a normal range. Clinical evaluation showed significant improvement in KOOS after surgery. Analysis of the relationship between Ahlbäck grade and clinical score showed that the 2-year postoperative KOOS scores in grade 3 and 4 osteoarthritic knees were significantly lower than grade 1 knees (with the mean 2-year KOOS scores of 350.0 ± 79.9, 317.9 ± 78.3, and 420.2 ± 42.9, respectively). Conclusions While DLO may produce significant radiological and clinical improvement in knees with joint space obliteration, Ahlbäck grade 3 and 4 osteoarthritic knees associated with larger JLCA and mTFA showed less satisfactory clinical results compared to grade 1 knees. Level of Evidence: IV case series.

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Section: Discussionmentioning

confidence: 99%

Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

et al. 2023

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“…Recientemente, un grupo de estudio en osteotomías 14 definió una fórmula simple para determinar el valor a sustraer a la corrección planificada del eje coronal, con el fin de evitar sobrecorrección producida a consecuencia de la variación del ángulo de convergencia de la línea articular (ACLA): [ángulo a corregir planificado] – [(ACLA-2)/2]. Por otra parte, se ha estudiado que la deformidad intraarticular puede corregirse mediante osteotomía convencional a valores aceptables (ACLA ≤ 5°) si el valor del ACLA preoperatorio es ≤ 6°.…”

Section: Principios Biomecánicos En La Planificación De Una Deformida...unclassified

Conceptos actuales en osteotomías en doble nivel alrededor de la rodilla

Díaz-Allende¹,

Partarrieu-Stegmeier²,

Colmenares-Sandoval

et al. 2022

Revista Chilena de Ortopedia y Traumatología

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ResumenCon la osteotomía en un solo nivel, se puede lograr la corrección del eje de la extremidad en pacientes con deformidades combinadas femoral y tibial, pero de forma simultánea generará una alteración patológica de oblicuidad de la interlínea articular, lo que conducirá a elongación ligamentaria, inestabilidad, degeneración condral y, en última instancia, comprometerá su sobrevida y los resultados funcionales. En virtud del análisis de la literatura más reciente, podemos concluir que existe un número significativo de pacientes que requieren de un procedimiento combinado para lograr un objetivo biomecánico óptimo. La finalidad de una osteotomía en doble nivel alrededor de la rodilla consiste en restablecer la anatomía normal, descargar el compartimiento afectado, normalizar los ángulos mecánicos y la orientación de la interlínea articular. Los ejes fisiológicos pueden restablecerse a través de un análisis preoperatorio exhaustivo, respetando principios biomecánicos y fijación estable con placas bloqueadas. Es un procedimiento demandante y con indicaciones en evolución, que progresivamente se ha instaurado como una alternativa de tratamiento justificada en estudios clínicos y biomecánicos para el manejo de deformidades severas alrededor de la rodilla.

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“…It is defined as the angle between the tangent to the most distal part of the medial and lateral femoral condyle and the subchondral plate of the tibial plateau. An angle greater than 2 degrees suggests either a significant intra-articular deformity or lateral soft tissue laxity [28]. Failure to take this into account when planning osteotomy can lead to a significant overcorrection.…”

Section: 2mentioning

confidence: 99%