The Effect of Mechanical Leg Alignment on Cartilage Restoration With and Without Concomitant High Tibial Osteotomy

Ackermann, Jakob; Merkely, Gergő; Arango, Dillon; Mestriner, Alexandre Barbieri; Gomoll, Andreas H.

doi:10.1016/j.arthro.2020.04.019

Cited by 27 publications

(29 citation statements)

References 30 publications

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“…Varus malalignment has been demonstrated to play an important role in development of medial knee joint cartilage degeneration and thus predispose for medial knee osteoarthritis [ 11 , 18 , 29 , 45 , 52 ]. Hence, surgical correction of varus malalignment by valgus producing osteotomy to unload the medial compartment is indicated in moderate medial knee osteoarthritis [ 5 , 18 ] or in combination with cartilage regenerative [ 1 , 19 ] or meniscus replacing procedures [ 26 , 27 ]. While historically, correction of varus alignment has been predominantly described via high tibial osteotomy (HTO) [ 5 , 7 , 16 , 18 , 22 – 24 , 28 , 30 , 33 , 34 , 40 , 49 ], the dogma of an isolated tibial based deformity is recently being reevaluated [ 13 , 37 ].…”

Section: Introductionmentioning

confidence: 99%

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Rupp

Winkler

Lutz

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. Methods Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors’ institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. Results The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05). Conclusion Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. Level of evidence Prognostic study; Level IV.

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Section: Introductionmentioning

confidence: 99%

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Rupp

Winkler

Lutz

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Correction of the knee into slight valgus has previously been advocated when performing autologous chondrocyte implantation (ACI) or OCA transplantation in the medial femoral condyle. Conversely, Ackermann et al 16 recently found a significantly improved graft 5year survivorship rate after ACI (92% vs 55%, P ¼ .003) and a trend toward improved survivorship of OCA (P ¼ .272) in neutrally aligned knees compared with knees with slight valgus. Similarly, Hohloch et al 17 found that HTO and concomitant ACI in patients with a larger postoperative valgus angle led to higher postoperative pain levels and lower functional outcome scores.…”

Section: Malalignment and Cartilage Injury Treatment E627mentioning

confidence: 95%

Treatment of Malalignment and Cartilage Injury: High Tibial Osteotomy With a Concomitant Osteochondral Allograft to the Medial Femoral Condyle and Lateral and Medial Partial Meniscectomy

Jildeh

Comfort

Peebles

et al. 2022

Arthroscopy Techniques

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“…Biomechanical studies have demonstrated that a varus or valgus malalignment of the lower extremity results in significantly increased peak stresses. 13 Ackermann et al studied 235 patients who underwent a cartilage restoration procedure and found that patients with neutral alignment had significantly improved survivorship compared with those with mechanical malalignment. 13 Sagittal alignment should also be evaluated for posterior tibial slope.…”

Section: Imagingmentioning

confidence: 99%

“…13 Ackermann et al studied 235 patients who underwent a cartilage restoration procedure and found that patients with neutral alignment had significantly improved survivorship compared with those with mechanical malalignment. 13 Sagittal alignment should also be evaluated for posterior tibial slope. Shear force on the tibia and tibiofemoral contact force are linearly affected by posterior tibial slope, with increasing shear and contact forces as posterior tibial slope increases.…”

Section: Imagingmentioning

confidence: 99%

Treatment of Cartilage Defects of the Knee in Military Tactical Athletes: An Overview of Management and Clinical Outcomes

2022

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Cartilage defects of the knee are a common problem that can be caused by trauma or chronic repetitive overload and result in debilitating functional limitations. These consequences are of particular significance to military service members, who, by in large, are a group of young, active individuals with professional duties requiring full, unrestricted activity and function. The burden of knee chondral-related disease among military tactical athletes is well established, and systematic approach to the evaluation of a military member with suspected knee chondral pathology facilitates the execution of a surgical procedure that maximizes the likelihood of a return to duty. Despite advances in cartilage restoration surgery, chondral pathology of the knee remains a vexing problem and an omnipresent threat to military medical readiness and warfighter lethality.

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The Effect of Mechanical Leg Alignment on Cartilage Restoration With and Without Concomitant High Tibial Osteotomy

Cited by 27 publications

References 30 publications

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Treatment of Malalignment and Cartilage Injury: High Tibial Osteotomy With a Concomitant Osteochondral Allograft to the Medial Femoral Condyle and Lateral and Medial Partial Meniscectomy

Treatment of Cartilage Defects of the Knee in Military Tactical Athletes: An Overview of Management and Clinical Outcomes

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