Minimally invasive double-level osteotomy (DLP) surgery is performed in severe knee varus, when e... more Minimally invasive double-level osteotomy (DLP) surgery is performed in severe knee varus, when extraarticular deformity is identified in both the distal femur and proximal tibia. The main advantage is to maintain a horizontal joint line and avoid creating secondary anatomic deformities. This article considers the pearls and pitfalls in performing minimally invasive DLO surgery.
Double level osteotomy (femoral and tibial) (DLO) is a technically demanding procedure for which ... more Double level osteotomy (femoral and tibial) (DLO) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO) and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of 2 years. Methods: A single-center, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the Hip-Knee-Ankle Angle (ΔHKA), Medial Proximal Tibial Angle (ΔMPTA), Lateral Distal Femoral Angle (ΔLDFA) and Proximal Posterior Tibial Angle (ΔPPTA). Pre-and post-operative JLO was also evaluated. At 2 years follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables, the paired Student t test was used to estimate evolution of functional outcomes. Results: The mean ΔHKA was 1.3±0.5°, the mean ΔMPTA was 0.98±0.3°, the mean ΔLDFA was 0.94±0.2°; ΔPPTA was 0.45±0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4±0.2. At last follow-up it was recorded a significant improvement in all KOOS scores and 19 patients were enthusiastic, 2 satisfied and one moderately satisfied. Conclusion: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at 2 years follow-up
Operative Orthopadie Und Traumatologie, May 11, 2017
Frontalebenendeformitäten am distalen Femur in biplanarer Closed-wedge-Technik. Indikationen. Fem... more Frontalebenendeformitäten am distalen Femur in biplanarer Closed-wedge-Technik. Indikationen. Femorale metaphysäre Deformitäten in der Frontalebene. Kontraindikationen. Fortgeschrittene Knorpelschäden/totaler Meniskusverlust im kontralateralen Kompartiment, akute/chronische Entzündungen, ungenügende Weichteilverhältnisse, erhebliche Bewegungseinschränkung im Kniegelenk. Operationstechnik. Hautschnitt über Femurmetaphyse, begrenzte Freilegung des Knochens. Festlegung von primärer Osteotomie und aufsteigender biplanarer Osteotomie. Posterior zwei inkomplette Osteotomien des distalen Femurs zur
Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients ... more Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. Medial collateral ligament (MCL) release and posterior neurovascular structure protection during OW-HTO are steps that often induce stress and nervousness during surgery, especially for surgeons in the earlier stages of their learning curve. While is it well-known that the MCL should be released during OW-HTO, the standard retraction techniques pose challenges in visualization and instrument placement in the surgical field. We present our technique, which illustrates an alternative method to manage the MCL and safely protect the neurovascular structures using a second and more posterior surgical window during OW-HTO.
Revue de Chirurgie Orthopédique et Traumatologique, 2021
Resume Introduction Lorsque la deformation tibiale ou femorale n’est pas analysee avec precision,... more Resume Introduction Lorsque la deformation tibiale ou femorale n’est pas analysee avec precision, les osteotomies de correction peuvent aboutir a une interligne articulaire oblique. L’objectif de cette etude etait d’evaluer la deformation preoperatoire des patients planifies pour une osteotomie de correction et d’analyser les taux d’anomalies morphologiques du tibia et du femur obtenus apres le planning virtuel de correction realise a l’aide d’un logiciel de mesures 3D. Materiel et methode Les scanners de 327 patients programmes pour une osteotomie ont ete retrospectivement analyses. Chaque patient etait planifie a l’aide d’un logiciel et la correction virtuelle simulee etait validee par le chirurgien. Apres realisation de l’osteotomie virtuelle, les valeurs angulaires du tibia et du femur dans le plan coronal etaient considerees comme anormales si elles se trouvaient en dehors de l’intervalle de confiance a 97,5 % retrouvees pour des genoux non arthrosiques. Apres l’osteotomie virt...
Osteoarthritis is a very common cause of knee pain. It affects high percentages of patients above... more Osteoarthritis is a very common cause of knee pain. It affects high percentages of patients above 60 years of age [1] but is also seen in younger patients as a result of different etiologies including rheumatoid arthritis, a genetic predisposition, poor cartilage quality, or obesity.
Revue de Chirurgie Orthopédique et Traumatologique, 2021
Resume L’osteotomie femorale distale de valgisation voit ses indications s’elargir par une meille... more Resume L’osteotomie femorale distale de valgisation voit ses indications s’elargir par une meilleure comprehension des deformations segmentaires du membre inferieur. Historiquement, une deformation globale en varus etait corrigee dans le tibia et une deformation en valgus dans le femur. Cette approche consistant a realiser une correction « tout dans le tibia » pour un varus global peut neanmoins conduire a une morphologie postoperatoire anormale car non-anatomique avec creation d’un interligne oblique et potentiellement de contraintes de cisaillement cartilagineuses. Une technique originale d’osteotomie femorale de valgisation par fermeture laterale est decrite, celle-ci permet la correction d’un genu varum d’origine femorale ou mixte en cas d’osteotomie tibiale de valgisation associee. La technique detaillee permet de limiter le risque de fracture de charniere tout en ameliorant les suites postoperatoires.
Orthopaedics & Traumatology: Surgery & Research, 2021
The distal femoral valgisation osteotomy has a variety of indications due to enhanced understandi... more The distal femoral valgisation osteotomy has a variety of indications due to enhanced understanding of segmental deformities of the lower limb. Historically, an overall varus deformity was corrected at the tibia, and a valgus deformity at the femur. This approach of performing an "all in the tibia" correction for an overall varus can nevertheless lead to abnormal postoperative morphology because it is nonanatomical; creating joint line obliquity, and potentially shear stress on the cartilage. An original lateral femoral closing wedge osteotomy technique is described, allowing the correction of a genu varum of femoral or mixed origin, in the event of an associated tibial valgisation osteotomy. The detailed technique minimizes the risk of a hinge fracture while improving post-operative outcomes.
Knee osteoarthritis (OA) is the most common joint disorder worldwide. In particular, primary knee... more Knee osteoarthritis (OA) is the most common joint disorder worldwide. In particular, primary knee OA often presents with a varus malalignment. This increases the loads going through the medial compartment resulting in cartilage degeneration and symptomatic arthritis. High tibial osteotomy (HTO) is the workhorse surgical procedure for treating medial knee OA. When performed precisely in the hands of an experienced surgeon, HTO can delay or avoid knee arthroplasty. Of note, outcomes of knee arthroplasty are at best unpredictable in patients of younger age. Hence, there is a growing need for joint preservation procedures for younger patients presenting with knee OA, of which HTO is one. Through this article, the authors of whom all are joint preservation surgeons with a special interest in osteotomy hope to share from their experience as well as the available literature on the indications, perioperative planning, surgical technique, outcomes as well as pearls and pitfalls of HTO.
Double level osteotomy (femoral and tibial) (DLO) is a technically demanding procedure for which ... more Double level osteotomy (femoral and tibial) (DLO) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO) and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of 2 years. Methods: A single-center, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the Hip-Knee-Ankle Angle (ΔHKA), Medial Proximal Tibial Angle (ΔMPTA), Lateral Distal Femoral Angle (ΔLDFA) and Proximal Posterior Tibial Angle (ΔPPTA). Pre-and post-operative JLO was also evaluated. At 2 years follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables, the paired Student t test was used to estimate evolution of functional outcomes. Results: The mean ΔHKA was 1.3±0.5°, the mean ΔMPTA was 0.98±0.3°, the mean ΔLDFA was 0.94±0.2°; ΔPPTA was 0.45±0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4±0.2. At last follow-up it was recorded a significant improvement in all KOOS scores and 19 patients were enthusiastic, 2 satisfied and one moderately satisfied. Conclusion: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at 2 years follow-up
Orthopaedics & Traumatology: Surgery & Research, 2021
INTRODUCTION In cases where the femur or tibial deformity is not correctly analysed, the correcti... more INTRODUCTION In cases where the femur or tibial deformity is not correctly analysed, the corrective osteotomies may result in an oblique joint line. The aim of this study was to assess the preoperative deformity of patients due to undergo corrective osteotomy and the resulting abnormal tibial and femoral morphologies after the planned correction using 3D software. METHODS CT scans of 327 patients undergoing corrective osteotomy were retrospectively included. Each patient was planned using a software application and the simulated correction was validated by the surgeon. Following the virtual osteotomy, tibial and femoral coronal angular values were considered abnormal if the values were outside 97.5% confidence intervals for non-osteoarthritis knees. After virtual osteotomy, morphological abnormalities were split into two types. Type 1 was an under/over correction at the site of the osteotomy resulting in abnormal bone morphology. A Type 2 was defined as an error in the site of the correction, resulting in an uncorrected abnormal bone morphology. RESULTS The global rate of planned abnormalities after tibial virtual osteotomy was 50.7% (166/327) with abnormalities type 1 in 44% and type 2 in 6.7%. After femoral virtual osteotomy the global rate was 6.7% (22/327) with only abnormalities type 1. A lower preoperative HKA was significantly associated with a non-anatomical correction (R2 = 0.12, p < 0.001) for both femoral (R2= 0.06, p < 0.001) and tibial (R2= 0.07, p < 0.001) abnormalities. CONCLUSION Non-anatomical correction was found in more than half the cases analysed more frequently for preoperative global varus alignment. These results suggest that surgeons should considered anatomical angular values to avoid joint line obliquity. LEVEL OF EVIDENCE III; retrospective cohort study.
Anterior cruciate ligament reconstruction after graft failure may need associated bone correction... more Anterior cruciate ligament reconstruction after graft failure may need associated bone correction to ensure stability of the knee. This article presents a technique of posteromedial opening-wedge osteotomy using a custom cutting guide to correct increased tibial slope and metaphyseal varus deformity after recurrent graft failure. An autograft quadriceps tendon graft was selected for the revision anterior cruciate ligament graft. After exposure with an anteromedial incision a patient specific cutting guide was used to make the high tibial osteotomy. The final fixation of the posteromedial opening was achieved using a low-profile locking plate and a femoral head allograft bone wedge. The tibial tunnel was planned and included in the patient-specific cutting guide. The femoral tunnel was placed using an outside to in manner. Bioabsorbable screws were used as fixation devices.
Purpose Given the goal of achieving optimal correction and alignment after knee arthroplasty or h... more Purpose Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagit-tal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype. Methods A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype.
Purpose Defining a Minimal Clinically Important Difference (MCID) value for Patient-Reported Outc... more Purpose Defining a Minimal Clinically Important Difference (MCID) value for Patient-Reported Outcome Measures (PROMs) is crucial for determining the effectiveness of a procedure and calculating the sample size for trial planning. The purpose of this study was to determine the MCID of several PROMs (Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and the SF-12) in patients who underwent medial opening-wedge High-Tibial Osteotomy (owHTO) with Patient-Specific Cutting Guides (PSCGs), using anchor-based methods. Methods Patients undergoing isolated medial owHTO with PSCGs between January 2013 and January 2017 were enrolled in this single-center, prospective, observational study. Three outcome scores were collected pre-operatively and at the 2 years follow-up evaluation: KOOS, KSS and SF-12. The MCIDs were calculated using anchor-based method: at 2 years postoperatively: "Compared with before surgery, how would you rate operated joint now?" The responses were recorded using a five-point scale. Patients who answered "about the same" or "somewhat worse" were classified into the no change group, while those who answered "somewhat better" were classified into the minimal change group. A receiver operating characteristic (ROC) curve was used to define the cutoff point that best discriminated between the minimal change and no change groups for each PROMs Results 196 patients were included, 75 (somewhat better) and 24 patients (about the same and somewhat worse) were, respectively, assigned to the "no change" and "minimal change" groups. There was no significant difference between the two groups in terms of baseline characteristics and postoperative complications. At 24 months follow-up all the PROMs (KOOS, KSS and SF-12) were significantly better for the "minimal change" group compared to the "no change" group. MCID was 15.4 for KOOS pain, 15.1 for KOOS symptoms, 17 for KOOS ADL, 11.2 for KOOS sports/recreation, 16.5 for KOOS QQL, 3 for KSS symptoms, 5.6 for KSS activity, 7.2 for SF-12 physical component and 6.3 for PCS mental component. Conclusion This study determined the MCIDs of common used PROMs in patients undergoing owHTO. Level of evidence Prospective Cohort Study, Level II
Minimally invasive double-level osteotomy (DLP) surgery is performed in severe knee varus, when e... more Minimally invasive double-level osteotomy (DLP) surgery is performed in severe knee varus, when extraarticular deformity is identified in both the distal femur and proximal tibia. The main advantage is to maintain a horizontal joint line and avoid creating secondary anatomic deformities. This article considers the pearls and pitfalls in performing minimally invasive DLO surgery.
Double level osteotomy (femoral and tibial) (DLO) is a technically demanding procedure for which ... more Double level osteotomy (femoral and tibial) (DLO) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO) and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of 2 years. Methods: A single-center, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the Hip-Knee-Ankle Angle (ΔHKA), Medial Proximal Tibial Angle (ΔMPTA), Lateral Distal Femoral Angle (ΔLDFA) and Proximal Posterior Tibial Angle (ΔPPTA). Pre-and post-operative JLO was also evaluated. At 2 years follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables, the paired Student t test was used to estimate evolution of functional outcomes. Results: The mean ΔHKA was 1.3±0.5°, the mean ΔMPTA was 0.98±0.3°, the mean ΔLDFA was 0.94±0.2°; ΔPPTA was 0.45±0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4±0.2. At last follow-up it was recorded a significant improvement in all KOOS scores and 19 patients were enthusiastic, 2 satisfied and one moderately satisfied. Conclusion: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at 2 years follow-up
Operative Orthopadie Und Traumatologie, May 11, 2017
Frontalebenendeformitäten am distalen Femur in biplanarer Closed-wedge-Technik. Indikationen. Fem... more Frontalebenendeformitäten am distalen Femur in biplanarer Closed-wedge-Technik. Indikationen. Femorale metaphysäre Deformitäten in der Frontalebene. Kontraindikationen. Fortgeschrittene Knorpelschäden/totaler Meniskusverlust im kontralateralen Kompartiment, akute/chronische Entzündungen, ungenügende Weichteilverhältnisse, erhebliche Bewegungseinschränkung im Kniegelenk. Operationstechnik. Hautschnitt über Femurmetaphyse, begrenzte Freilegung des Knochens. Festlegung von primärer Osteotomie und aufsteigender biplanarer Osteotomie. Posterior zwei inkomplette Osteotomien des distalen Femurs zur
Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients ... more Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. Medial collateral ligament (MCL) release and posterior neurovascular structure protection during OW-HTO are steps that often induce stress and nervousness during surgery, especially for surgeons in the earlier stages of their learning curve. While is it well-known that the MCL should be released during OW-HTO, the standard retraction techniques pose challenges in visualization and instrument placement in the surgical field. We present our technique, which illustrates an alternative method to manage the MCL and safely protect the neurovascular structures using a second and more posterior surgical window during OW-HTO.
Revue de Chirurgie Orthopédique et Traumatologique, 2021
Resume Introduction Lorsque la deformation tibiale ou femorale n’est pas analysee avec precision,... more Resume Introduction Lorsque la deformation tibiale ou femorale n’est pas analysee avec precision, les osteotomies de correction peuvent aboutir a une interligne articulaire oblique. L’objectif de cette etude etait d’evaluer la deformation preoperatoire des patients planifies pour une osteotomie de correction et d’analyser les taux d’anomalies morphologiques du tibia et du femur obtenus apres le planning virtuel de correction realise a l’aide d’un logiciel de mesures 3D. Materiel et methode Les scanners de 327 patients programmes pour une osteotomie ont ete retrospectivement analyses. Chaque patient etait planifie a l’aide d’un logiciel et la correction virtuelle simulee etait validee par le chirurgien. Apres realisation de l’osteotomie virtuelle, les valeurs angulaires du tibia et du femur dans le plan coronal etaient considerees comme anormales si elles se trouvaient en dehors de l’intervalle de confiance a 97,5 % retrouvees pour des genoux non arthrosiques. Apres l’osteotomie virt...
Osteoarthritis is a very common cause of knee pain. It affects high percentages of patients above... more Osteoarthritis is a very common cause of knee pain. It affects high percentages of patients above 60 years of age [1] but is also seen in younger patients as a result of different etiologies including rheumatoid arthritis, a genetic predisposition, poor cartilage quality, or obesity.
Revue de Chirurgie Orthopédique et Traumatologique, 2021
Resume L’osteotomie femorale distale de valgisation voit ses indications s’elargir par une meille... more Resume L’osteotomie femorale distale de valgisation voit ses indications s’elargir par une meilleure comprehension des deformations segmentaires du membre inferieur. Historiquement, une deformation globale en varus etait corrigee dans le tibia et une deformation en valgus dans le femur. Cette approche consistant a realiser une correction « tout dans le tibia » pour un varus global peut neanmoins conduire a une morphologie postoperatoire anormale car non-anatomique avec creation d’un interligne oblique et potentiellement de contraintes de cisaillement cartilagineuses. Une technique originale d’osteotomie femorale de valgisation par fermeture laterale est decrite, celle-ci permet la correction d’un genu varum d’origine femorale ou mixte en cas d’osteotomie tibiale de valgisation associee. La technique detaillee permet de limiter le risque de fracture de charniere tout en ameliorant les suites postoperatoires.
Orthopaedics & Traumatology: Surgery & Research, 2021
The distal femoral valgisation osteotomy has a variety of indications due to enhanced understandi... more The distal femoral valgisation osteotomy has a variety of indications due to enhanced understanding of segmental deformities of the lower limb. Historically, an overall varus deformity was corrected at the tibia, and a valgus deformity at the femur. This approach of performing an "all in the tibia" correction for an overall varus can nevertheless lead to abnormal postoperative morphology because it is nonanatomical; creating joint line obliquity, and potentially shear stress on the cartilage. An original lateral femoral closing wedge osteotomy technique is described, allowing the correction of a genu varum of femoral or mixed origin, in the event of an associated tibial valgisation osteotomy. The detailed technique minimizes the risk of a hinge fracture while improving post-operative outcomes.
Knee osteoarthritis (OA) is the most common joint disorder worldwide. In particular, primary knee... more Knee osteoarthritis (OA) is the most common joint disorder worldwide. In particular, primary knee OA often presents with a varus malalignment. This increases the loads going through the medial compartment resulting in cartilage degeneration and symptomatic arthritis. High tibial osteotomy (HTO) is the workhorse surgical procedure for treating medial knee OA. When performed precisely in the hands of an experienced surgeon, HTO can delay or avoid knee arthroplasty. Of note, outcomes of knee arthroplasty are at best unpredictable in patients of younger age. Hence, there is a growing need for joint preservation procedures for younger patients presenting with knee OA, of which HTO is one. Through this article, the authors of whom all are joint preservation surgeons with a special interest in osteotomy hope to share from their experience as well as the available literature on the indications, perioperative planning, surgical technique, outcomes as well as pearls and pitfalls of HTO.
Double level osteotomy (femoral and tibial) (DLO) is a technically demanding procedure for which ... more Double level osteotomy (femoral and tibial) (DLO) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO) and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of 2 years. Methods: A single-center, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the Hip-Knee-Ankle Angle (ΔHKA), Medial Proximal Tibial Angle (ΔMPTA), Lateral Distal Femoral Angle (ΔLDFA) and Proximal Posterior Tibial Angle (ΔPPTA). Pre-and post-operative JLO was also evaluated. At 2 years follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables, the paired Student t test was used to estimate evolution of functional outcomes. Results: The mean ΔHKA was 1.3±0.5°, the mean ΔMPTA was 0.98±0.3°, the mean ΔLDFA was 0.94±0.2°; ΔPPTA was 0.45±0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4±0.2. At last follow-up it was recorded a significant improvement in all KOOS scores and 19 patients were enthusiastic, 2 satisfied and one moderately satisfied. Conclusion: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at 2 years follow-up
Orthopaedics & Traumatology: Surgery & Research, 2021
INTRODUCTION In cases where the femur or tibial deformity is not correctly analysed, the correcti... more INTRODUCTION In cases where the femur or tibial deformity is not correctly analysed, the corrective osteotomies may result in an oblique joint line. The aim of this study was to assess the preoperative deformity of patients due to undergo corrective osteotomy and the resulting abnormal tibial and femoral morphologies after the planned correction using 3D software. METHODS CT scans of 327 patients undergoing corrective osteotomy were retrospectively included. Each patient was planned using a software application and the simulated correction was validated by the surgeon. Following the virtual osteotomy, tibial and femoral coronal angular values were considered abnormal if the values were outside 97.5% confidence intervals for non-osteoarthritis knees. After virtual osteotomy, morphological abnormalities were split into two types. Type 1 was an under/over correction at the site of the osteotomy resulting in abnormal bone morphology. A Type 2 was defined as an error in the site of the correction, resulting in an uncorrected abnormal bone morphology. RESULTS The global rate of planned abnormalities after tibial virtual osteotomy was 50.7% (166/327) with abnormalities type 1 in 44% and type 2 in 6.7%. After femoral virtual osteotomy the global rate was 6.7% (22/327) with only abnormalities type 1. A lower preoperative HKA was significantly associated with a non-anatomical correction (R2 = 0.12, p < 0.001) for both femoral (R2= 0.06, p < 0.001) and tibial (R2= 0.07, p < 0.001) abnormalities. CONCLUSION Non-anatomical correction was found in more than half the cases analysed more frequently for preoperative global varus alignment. These results suggest that surgeons should considered anatomical angular values to avoid joint line obliquity. LEVEL OF EVIDENCE III; retrospective cohort study.
Anterior cruciate ligament reconstruction after graft failure may need associated bone correction... more Anterior cruciate ligament reconstruction after graft failure may need associated bone correction to ensure stability of the knee. This article presents a technique of posteromedial opening-wedge osteotomy using a custom cutting guide to correct increased tibial slope and metaphyseal varus deformity after recurrent graft failure. An autograft quadriceps tendon graft was selected for the revision anterior cruciate ligament graft. After exposure with an anteromedial incision a patient specific cutting guide was used to make the high tibial osteotomy. The final fixation of the posteromedial opening was achieved using a low-profile locking plate and a femoral head allograft bone wedge. The tibial tunnel was planned and included in the patient-specific cutting guide. The femoral tunnel was placed using an outside to in manner. Bioabsorbable screws were used as fixation devices.
Purpose Given the goal of achieving optimal correction and alignment after knee arthroplasty or h... more Purpose Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagit-tal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype. Methods A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype.
Purpose Defining a Minimal Clinically Important Difference (MCID) value for Patient-Reported Outc... more Purpose Defining a Minimal Clinically Important Difference (MCID) value for Patient-Reported Outcome Measures (PROMs) is crucial for determining the effectiveness of a procedure and calculating the sample size for trial planning. The purpose of this study was to determine the MCID of several PROMs (Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and the SF-12) in patients who underwent medial opening-wedge High-Tibial Osteotomy (owHTO) with Patient-Specific Cutting Guides (PSCGs), using anchor-based methods. Methods Patients undergoing isolated medial owHTO with PSCGs between January 2013 and January 2017 were enrolled in this single-center, prospective, observational study. Three outcome scores were collected pre-operatively and at the 2 years follow-up evaluation: KOOS, KSS and SF-12. The MCIDs were calculated using anchor-based method: at 2 years postoperatively: "Compared with before surgery, how would you rate operated joint now?" The responses were recorded using a five-point scale. Patients who answered "about the same" or "somewhat worse" were classified into the no change group, while those who answered "somewhat better" were classified into the minimal change group. A receiver operating characteristic (ROC) curve was used to define the cutoff point that best discriminated between the minimal change and no change groups for each PROMs Results 196 patients were included, 75 (somewhat better) and 24 patients (about the same and somewhat worse) were, respectively, assigned to the "no change" and "minimal change" groups. There was no significant difference between the two groups in terms of baseline characteristics and postoperative complications. At 24 months follow-up all the PROMs (KOOS, KSS and SF-12) were significantly better for the "minimal change" group compared to the "no change" group. MCID was 15.4 for KOOS pain, 15.1 for KOOS symptoms, 17 for KOOS ADL, 11.2 for KOOS sports/recreation, 16.5 for KOOS QQL, 3 for KSS symptoms, 5.6 for KSS activity, 7.2 for SF-12 physical component and 6.3 for PCS mental component. Conclusion This study determined the MCIDs of common used PROMs in patients undergoing owHTO. Level of evidence Prospective Cohort Study, Level II
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Papers by Kristian Kley