Sagittal Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 39-45 | Anshu Shekhar, Puneeth K, Sachin Tapasvi

DOI:10.13107/aja.2021.v06i02.033

Author: Anshu Shekhar [1], Puneeth K [2], Sachin Tapasvi [2]

[1] Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
[2] The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Address of Correspondence:

Dr. Anshu Shekhar,
Consultant, Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
E-mail: dr.anshushekhar@gmail.com

Abstract

The anatomy proximal tibia is such that the anterior part is higher than the posterior, both medially and laterally, which causes a natural posterior tibial slope (PTS). The ‘normal range’ of this slope is variable across geography, ethnicity and gender. The morphology of the slope has profound impact on knee biomechanics, especially with respect to the anterior and posterior cruciate ligaments. A high slope increases forces across the anterior cruciate ligament (ACL), while the posterior cruciate ligament (PCL) function is compromised when the slope is flat or reversed (sloping anteriorly). A flat or reversed slope also contributes to the ‘bony’ component of a genu recurvatum deformity, which can become symptomatic. A sagittal tibial osteotomy (STO) is one in which the PTS is altered without changing the coronal plane alignment. When the slope is reduced, it is known as an extension STO and when the slope is increased, it is known as a flexion STO. This review describes the biomechanics of the PTS; the planning, indications, technique and complications of a STO and discusses some case examples.

Keywords: Posterior tibial slope, Osteotomy, Sagittal plane deformity, Revision anterior cruciate ligament reconstruction, Genu recurvatum

References

1. Hashemi J, Chandrashekar N, Gill B, et al. The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Joint Surg Am. 2008;90(12):2724-2734. doi:10.2106/JBJS.G.01358

2. Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br. 1994;76(5):745-749.

3. Genin P, Weill G, Julliard R. La pente tibiale. Proposition pour une méthode de mesure [The tibial slope. Proposal for a measurement method]. J Radiol. 1993;74(1):27-33.

4. Pangaud C, Laumonerie P, Dagneaux L, LiArno S, Wellings P, Faizan A, Sharma A, Ollivier M. Measurement of the Posterior Tibial Slope Depends on Ethnicity, Sex, and Lower Limb Alignment: A Computed Tomography Analysis of 378 Healthy Participants. Orthop J Sports Med. 2020 Jan 24;8(1):2325967119895258.

5. Weinberg DS, Williamson DF, Gebhart JJ, Knapik DM, Voos JE. Differences in Medial and Lateral Posterior Tibial Slope: An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race. Am J Sports Med. 2017 Jan;45(1):106-113. doi: 10.1177/0363546516662449. Epub 2016 Oct 1. PMID: 27587744.

6. Aljuhani WS, Qasim SS, Alrasheed A, Altwalah J, Alsalman MJ. The effect of gender, age, and body mass index on the medial and lateral posterior tibial slopes: a magnetic resonance imaging study. Knee Surg Relat Res. 2021 Apr 8;33(1):12.

7. Zhang K, Han Q, Wang H, Yang K, Chen B, Zhang Y, Zhang S, Wang J, Chu H. Measurement of proximal tibial morphology in northeast Chinese population based on three-dimensional reconstruction computer tomography. Medicine (Baltimore). 2019 Nov;98(45):e17508.

8. Matsuda S, Miura H, Nagamine R, et al. Posterior tibial slope in the normal and varus knee. Am J Knee Surg. 1999;12(3):165-168.

9. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P. Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg. 2004;124(9):575-584. doi:10.1007/s00402-004-0728-8

10. Pandy MG, Shelburne KB. Dependence of cruciate-ligament loading on muscle forces and external load. J Biomech. 1997;30(10):1015-1024. doi:10.1016/s0021-9290(97)00070-5

11. Shelburne KB, Pandy MG. A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions. J Biomech. 1997;30(2):163-176. doi:10.1016/s0021-9290(96)00119-4

12. Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med. 2004;32(2):376-382. doi:10.1177/0363546503258880

13. Giffin JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD. Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med. 2007;35(9):1443-1449. doi:10.1177/0363546507304665

14. Bernhardson AS, Aman ZS, Dornan GJ, Kemler BR, Storaci HW, Brady AW, Nakama GY, LaPrade RF. Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases. Am J Sports Med. 2019 Feb;47(2):296-302.

15. McLean SG, Oh YK, Palmer ML, Lucey SM, Lucarelli DG, Ashton-Miller JA, Wojtys EM. The relationship between anterior tibial acceleration, tibial slope, and ACL strain during a simulated jump landing task. J Bone Joint Surg Am. 2011 Jul 20;93(14):1310-7.

16. Yamaguchi KT, Cheung EC, Markolf KL, Boguszewski DV, Mathew J, Lama CJ, McAllister DR, Petrigliano FA. Effects of Anterior Closing Wedge Tibial Osteotomy on Anterior Cruciate Ligament Force and Knee Kinematics. Am J Sports Med. 2018 Feb;46(2):370-377.

17. Imhoff FB, Mehl J, Comer BJ, Obopilwe E, Cote MP, Feucht MJ, Wylie JD, Imhoff AB, Arciero RA, Beitzel K. Slope-reducing tibial osteotomy decreases ACL-graft forces and anterior tibial translation under axial load. Knee Surg Sports Traumatol Arthrosc. 2019 Oct;27(10):3381-3389.

18. Bowen JR, Morley DC, McInerny V, MacEwen GD. Treatment of genu recurvatum by proximal tibial closing-wedge/anterior displacement osteotomy. Clin Orthop Relat Res. 1983;(179):194-199.

19. Moroni A, Pezzuto V, Pompili M, Zinghi G. Proximal osteotomy of the tibia for the treatment of genu recurvatum in adults. J Bone Joint Surg Am. 1992;74(4):577-586.

20. Utzschneider S, Goettinger M, Weber P, et al. Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 2011;19:1643-1648.

21. Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP. Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res. 2009 Aug;467(8):2066-72.

22. Luceri F, Basilico M, Batailler C, et al. Effects of sagittal tibial osteotomy on frontal alignment of the knee and patellar height. Int Orthop. 2020;44(11):2291-2298. doi:10.1007/s00264-020-04580-3

23. Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med. 2013 Dec;41(12):2800-4.

24. Salmon LJ, Heath E, Akrawi H, Roe JP, Linklater J, Pinczewski LA. 20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope. Am J Sports Med. 2018 Mar;46(3):531-543.

25. Lee CC, Youm YS, Cho SD, Jung SH, Bae MH, Park SJ, Kim HW. Does Posterior Tibial Slope Affect Graft Rupture Following Anterior Cruciate Ligament Reconstruction? Arthroscopy. 2018 Jul;34(7):2152-2155. doi: 10.1016/j.arthro.2018.01.058. Epub 2018 Mar 9. PMID: 29530354.

26. Ahmed I, Salmon L, Roe J, Pinczewski L. The long-term clinical and radiological outcomes in patients who suffer recurrent injuries to the anterior cruciate ligament after reconstruction. Bone Joint J. 2017 Mar;99-B(3):337-343. doi: 10.1302/0301-620X.99B3.37863. PMID: 28249973.

27. Friedmann, S., Agneskirchner, J. & Lobenhoffer, P. Extendierende und flektierende Tibiakopfosteotomien. Arthroskopie 21, 30–38 (2008).

How to Cite this article: Shekhar A, Puneeth K, Tapasvi S | Sagittal tibial osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 39-45.

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Patient Specific Instrumentation in Knee Osteotomies

Volume 6 | Issue 2 | July-December 2021 | Page 34-38 | Matthieu Ollivier, Christophe Jacquet, Grégoire Micicoi

DOI:10.13107/aja.2021.v06i02.032

Author: Matthieu Ollivier [1], Christophe Jacquet [2], Grégoire Micicoi [3]

[1] Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France.
[2] Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France.
[3] iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d’Azur, Nice, France

Address of Correspondence:

Dr. Matthieu Ollivier,
Institute of Movement and Locomotion Department of Orthopaedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France.
E-mail: matthieu.ollivier@ap-hm.fr

Abstract

Knee osteotomy is a successful operation which allow restoration of function, the preoperative planning and the achievement of the target correction during the surgery constitute critical steps which may affect the clinical results. With conventional techniques, the target correction may be difficult to obtain with substantial under- or overcorrection, then the preoperative planning should not only take into account the global alignment but also the segmental deformities with the proximal tibial deformity, the distal femoral deformity and the intra-articular deformity requiring an individualised approach to obtain the intended correction. The recent introduction of patient-specific cutting guides (PSCGs) based on preoperative CT-scan templating now offers the possibility of providing an instrumentation specific to each patient allowing to control exactly the correction in the different planes. The recent expansion in the use of PSCGs within the surgical community allows us to explore all its fields of application, from the simplest cases to the most complex cases. The accuracy of these guides allows in practice a great reliability for which the clinical impact must be known. However, we must keep in mind that the surgeon makes the final decision on target correction and this, whatever the level of accuracy of the tool used which involves that errors can occur in the event of poor preoperative analysis. The advantages and disadvantages of PSCGs require special consideration to justify their use.
Keywords: Knee osteotomy, Patient-specific cutting guide, Accuracy, Individualised approach, Correction

References

1. Arnal-Burró J, Pérez-Mañanes R, Gallo-Del-Valle E, Igualada-Blazquez C, Cuervas-Mons M, Vaquero-Martín J (2017) Three dimensional-printed patient-specific cutting guides for femoral varization osteotomy: Do it yourself. Knee 24:1359–1368
2. Bae DK, Song SJ, Yoon KH (2009) Closed-wedge high tibial osteotomy using computer-assisted surgery compared to the conventional technique. J Bone Joint Surg Br 91:1164–1171
3. Bardot L-P, Micicoi G, Favreau H, Zeman P, Khakha R, Ehlinger M, Ollivier M (2021) Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes. Knee Surg Sports Traumatol Arthrosc
4. Bastard C, Mirouse G, Potage D, Silbert H, Roubineau F, Hernigou P, Flouzat-Lachaniette C-H (2017) Return to sports and quality of life after high tibial osteotomy in patients under 60 years of age. Orthop Traumatol Surg Res 103:1189–1191
5. Bonutti P, Dethmers D, Stiehl JB (2008) Case report : femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res 466:1499–1502
6. Brouwer RW, Bierma-Zeinstra SMA, van Raaij TM, Verhaar J a. N (2006) Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg Br 88:1454–1459
7. Chaouche S, Jacquet C, Fabre-Aubrespy M, Sharma A, Argenson J-N, Parratte S, Ollivier M (2019) Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort. International Orthopaedics (SICOT) 43:2757–2765
8. Coon TM (2009) Integrating robotic technology into the operating room. Am J Orthop 38:7–9
9. Corona PS, Vicente M, Tetsworth K, Glatt V (2018) Preliminary results using patient-specific 3d printed models to improve preoperative planning for correction of post-traumatic tibial deformities with circular frames. Injury 49 Suppl 2:S51–S59
10. Ekhtiari S, Haldane CE, de Sa D, Simunovic N, Musahl V, Ayeni OR (2016) Return to Work and Sport Following High Tibial Osteotomy: A Systematic Review. J Bone Joint Surg Am 98:1568–1577
11. Han S-B, In Y, Oh KJ, Song KY, Yun ST, Jang K-M (2019) Complications Associated With Medial Opening-Wedge High Tibial Osteotomy Using a Locking Plate: A Multicenter Study. J Arthroplasty 34:439–445
12. Han S-B, Kim HJ, Lee D-H (2017) Effect of Computer Navigation on Accuracy and Reliability of Limb Alignment Correction following Open-Wedge High Tibial Osteotomy: A Meta-Analysis. BioMed Research International 2017:1–9
13. Hankemeier S, Hufner T, Wang G, Kendoff D, Zeichen J, Zheng G, Krettek C (2006) Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921
14. Hankemeier S, Hufner T, Wang G, Kendoff D, Zeichen J, Zheng G, Krettek C (2006) Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921
15. Iorio R, Pagnottelli M, Vadalà A, Giannetti S, Di Sette P, Papandrea P, Conteduca F, Ferretti A (2013) Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques. Knee Surg Sports Traumatol Arthrosc 21:113–119
16. Jacquet C, Chan-Yu-Kin J, Sharma A, Argenson J-N, Parratte S, Ollivier M (2019) “More accurate correction using “patient-specific” cutting guides in opening wedge distal femur varization osteotomies. International Orthopaedics (SICOT) 43:2285–2291
17. Jacquet C, Sharma A, Fabre M, Ehlinger M, Argenson J-N, Parratte S, Ollivier M (2019) Patient-specific high-tibial osteotomy’s ‘cutting-guides’ decrease operating time and the number of fluoroscopic images taken after a Brief Learning Curve. Knee Surg Sports Traumatol Arthrosc
18. Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS (2018) Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sports Traumatol Arthrosc
19. Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372
20. Munier M, Donnez M, Ollivier M, Flecher X, Chabrand P, Argenson J-N, Parratte S (2017) Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study. Orthop Traumatol Surg Res 103:245–250
21. Nelissen EM, van Langelaan EJ, Nelissen RGHH (2010) Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop 34:217–223
22. Nerhus TK, Ekeland A, Solberg G, Sivertsen EA, Madsen JE, Heir S (2017) Radiological outcomes in a randomized trial comparing opening wedge and closing wedge techniques of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:910–917
23. Pérez-Mañanes R, Burró JA, Manaute JR, Rodriguez FC, Martín JV (2016) 3D Surgical Printing Cutting Guides for Open-Wedge High Tibial Osteotomy: Do It Yourself. J Knee Surg 29:690–695
24. Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb® wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35:1151–1156
25. Saragaglia D, Chedal-Bornu B (2014) Computer-assisted osteotomy for valgus knees: medium-term results of 29 cases. Orthop Traumatol Surg Res 100:527–530
26. Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics 28:s1269-1274
27. Schröter S, Ihle C, Elson DW, Döbele S, Stöckle U, Ateschrang A (2016) Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 24:3410–3417
28. Schröter S, Ihle C, Elson DW, Döbele S, Stöckle U, Ateschrang A (2016) Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 24:3410–3417
29. Seo S-S, Kim O-G, Seo J-H, Kim D-H, Kim Y-G, Lee I-S (2016) Complications and Short-Term Outcomes of Medial Opening Wedge High Tibial Osteotomy Using a Locking Plate for Medial Osteoarthritis of the Knee. Knee Surg Relat Res 28:289–296
30. Sodhi N, Khlopas A, Piuzzi NS, Sultan AA, Marchand RC, Malkani AL, Mont MA (2018) The Learning Curve Associated with Robotic Total Knee Arthroplasty. J Knee Surg 31:17–21
31. Van den Bempt M, Van Genechten W, Claes T, Claes S (2016) How accurately does high tibial osteotomy correct the mechanical axis of an arthritic varus knee? A systematic review. The Knee 23:925–935
32. Victor J, Premanathan A (2013) Virtual 3D planning and patient specific surgical guides for osteotomies around the knee: a feasibility and proof-of-concept study. Bone Joint J 95-B:153–158

How to Cite this article: Ollivier M, Jacquet C, Micicoi G Patient Specific | Instrumentation in Knee Osteotomies | Asian Journal of Arthroscopy | July-December 2021; 6(2): 34-38.

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Double Level Osteotomy of the Knee for Varus Osteoarthritis

Volume 6 | Issue 2 | July-December 2021 | Page 27-33 | Sam Trowbridge, Hamid Razak, Dominic Davenport, Philip Pastides, Kristian Kley, Matthieu Ollivier, Raghbir S Khakha, Adrian J Wilson

DOI:10.13107/aja.2021.v06i02.031

Author: Sam Trowbridge [1], Hamid Razak [2, 3], Dominic Davenport [4], Philip Pastides [1], Kristian Kley [7], Matthieu Ollivier [5, 6], Raghbir S Khakha [1], Adrian J Wilson [7]

[1] Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
[2] Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore 544886.
[3] SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, 20 College Road, Academia Level 4, Singapore 1698.
[4] Consultant Trauma & Orthopaedic Surgeon, Princess Royal University Hospital, Bromley, London.
[5] Institute of movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France,
[6] Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.
[7] Harley Street Specialist Hospital, 18-22 Queen Anne Street, London W1G 8HU.

Address of Correspondence:

Dr. Raghbir S Khakha,
Consultant, Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
E-mail: raghbir.khakha@gmail.com

Abstract

High tibial osteotomy (HTO) has been a well accepted surgical procedure for knees with varus knee osteoarthritis. It is an excellent option for patients who are younger and have higher functional demands. However, correction of a severe varus knee by isolated (HTO) would require a significant opening which will invariably lead to joint line obliquity ( JLO) and increase the risk of complications such as hinge fractures. As such, double level osteotomy (DLO) consisting of a HTO and distal femoral osteotomy (DFO) has been purported as the preferred joint preserving procedure in patients with severe varus deformity. DLO is able to restore the mechanical alignment of the limb without causing JLO. In this narrative review, we explore the pathomechanics of varus osteoarthritis, surgical considerations for DLO planning, indications, outcomes and complications of DLO. We have also presented our preferred approach for DLO.

References

1. Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34(7):859-71.
2. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am. 1994;25(3):425-65.
3. Shelburne KB, Torry MR, Pandy MG. Muscle, ligament, and joint-contact forces at the knee during walking. Med Sci Sports Exerc. 2005;37(11):1948-56.
4. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585-608.
5. Marti CB, Gautier E, Wachtl SW, Jakob RP. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy. 2004;20(4):366-72.
6. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332-54.
7. Lee SS, Lee HI, Cho ST, Cho JH. Comparison of the outcomes between two different target points after open wedge high tibial osteotomy: The Fujisawa point versus the lateral tibial spine. Knee. 2020;27(3):915-22.
8. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res. 1989(246):250-9.
9. Khakha RS, Bin Abd Razak HR, Kley K, van Heerwaarden R, Wilson AJ. Role of high tibial osteotomy in medial compartment osteoarthritis of the knee: Indications, surgical technique and outcomes. Journal of Clinical Orthopaedics and Trauma. 2021;23:101618.
10. Elson DW, Petheram TG, Dawson MJ. High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2041-8.
11. Razak H, Micicoi G, Khakha RS, Ehlinger M, Faizan A, LiArno S, et al. Patients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees. Knee Surg Sports Traumatol Arthrosc. 2021.
12. Kim JS, Lim JK, Choi HG, Jeong HW, Park SB, Shim SJ, et al. Excessively Increased Joint-Line Obliquity After Medial Opening-Wedge High Tibial Osteotomy Is Associated With Inferior Radiologic and Clinical Outcomes: What Is Permissible Joint-Line Obliquity. Arthroscopy. 2021.
13. Nakayama H, Schröter S, Yamamoto C, Iseki T, Kanto R, Kurosaka K, et al. Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1873-8.
14. Benjamin A. Double osteotomy for the painful knee in rheumatoid arthritis and osteoarthritis. J Bone Joint Surg Br. 1969;51(4):694-9.
15. Babis GC, An KN, Chao EY, Rand JA, Sim FH. Double level osteotomy of the knee: a method to retain joint-line obliquity. Clinical results. J Bone Joint Surg Am. 2002;84(8):1380-8.
16. Schröter S, Nakayama H, Yoshiya S, Stöckle U, Ateschrang A, Gruhn J. Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg. 2019;139(4):519-27.
17. Saragaglia D, Mercier N, Colle PE. Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop. 2010;34(2):185-90.
18. Nakayama H, Iseki T, Kanto R, Kambara S, Kanto M, Yoshiya S, et al. Physiologic knee joint alignment and orientation can be restored by the minimally invasive double level osteotomy for osteoarthritic knees with severe varus deformity. Knee Surg Sports Traumatol Arthrosc. 2020;28(3):742-50.
19. Chernchujit B, Tharakulphan S, Prasetia R, Chantarapanich N, Jirawison C, Sitthiseripratip K. Preoperative planning of medial opening wedge high tibial osteotomy using 3D computer-aided design weight-bearing simulated guidance: Technique and preliminary result. J Orthop Surg (Hong Kong). 2019;27(1):2309499019831455.
20. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989(248):13-4.
21. Asif S, Choon DS. Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong). 2005;13(3):280-4.
22. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985(198):43-9.
23. Mitsou A, Vallianatos P, Piskopakis N, Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br. 1990;72(3):398-404.

How to Cite this article: Trowbridge S, Razak A, Davenport D, Pastides P, Kley K, Ollivier M, Khakha RS, Wilson AJ Double Level Osteotomy of the Knee | for Varus Osteoarthritis | Asian Journal Arthroscopy | July-December 2021; 6(2): 27-33.

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Opening Wedge High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 20-26 | Parag Sancheti, Sunny Gugale, Kailash Patil, Ashok Shaym

DOI:10.13107/aja.2021.v06i02.030

Author: Parag Sancheti [1], Sunny Gugale [1], Kailash Patil [1], Ashok Shaym [1, 2]

[1] Department of Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation & PG College, Pune, Maharashtra, India.
[2] Indian Orthopaedic Research Group, Thane, Maharashtra, India.

Address of Correspondence:

Dr. Parag Sancheti,
Dean, Professor & Chairman, Sancheti Institute for Orthopaedics & Rehabilitation & PG College, Pune, Maharashtra, India.
E-mail: sanchetipk@gmail.com

Abstract

In the era of Joint replacement surgery, Medial High Tibial Osteotomy is a time tested and successful surgical procedure for treatment of mild to moderate knee osteoarthritis. The success of this procedure lies in proper patient selection, an excellent surgical technique, a rigid internal fixation and early rehabilitation. There are a lots of research articles published in literature, many systematic reviews and meta-analysis on this specific topic. In this review article we discuss mainly the recent trends in the medial open wedge osteotomy for treatment of knee osteoarthritis.

Keywords: MOWHTO, Osteoarthritis, Osteotomy, Surgical treatment

References

1. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. NUMBER. 2016;4(3):9.
2. Murray R, Winkler PW, Shaikh HS, Musahl V. High Tibial Osteotomy for Varus Deformity of the Knee. JAAOS Glob Res Rev [Internet]. 2021 Jul [cited 2022 Jan 26];5(7). Available from: https://journals.lww.com/10.5435/JAAOSGlobal-D-21-00141
3. Choi HG, Kang YS, Kim JS, Lee HS, Lee YS. Meniscal and Cartilage Changes on Serial MRI After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med. 2021 Dec 1;9(12):232596712110479.
4. Lee DC, Byun SJ. High Tibial Osteotomy. Knee Surg Relat Res. 2012 Jun;24(2):61–9.
5. Ahmed El-Nahas WE-D. Comparison of Open Wedge High Tibial Osteotomy versus Unicondylar Knee Replacement for Medial Knee Osteoarthritis. Orthop Rheumatol Open Access J [Internet]. 2017 Feb 23 [cited 2022 Jan 26];5(1). Available from: https://juniperpublishers.com/oroaj/OROAJ.MS.ID.555651.php
6. Elyasi E, Cavalié G, Perrier A, Graff W, Payan Y. A Systematic Review on Selected Complications of Open-Wedge High Tibial Osteotomy from Clinical and Biomechanical Perspectives. Saarakkala S, editor. Appl Bionics Biomech. 2021 Oct 31;2021:1–14.
7. Duan D, Cao Y, Li R, Wang G, Zhang Y, Xiang K, et al. Opening Wedge High Tibial Osteotomy with Combined Use of Patient-Specific 3D-Printed Plates and Taylor Spatial Frame for the Treatment of Knee Osteoarthritis. Zou J, editor. Pain Res Manag. 2021 Dec 1;2021:1–6.
8. Brinkman J-M, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br. 2008 Dec;90(12):1548–57.
9. Elyasi E, Cavalié G, Perrier A, Graff W, Payan Y. A Systematic Review on Selected Complications of Open-Wedge High Tibial Osteotomy from Clinical and Biomechanical Perspectives. Saarakkala S, editor. Appl Bionics Biomech. 2021 Oct 31;2021:1–14.
10. Herbst M, Ahrend M-D, Grünwald L, Fischer C, Schröter S, Ihle C. Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results. Knee Surg Sports Traumatol Arthrosc [Internet]. 2021 Feb 11 [cited 2022 Jan 26]; Available from: http://link.springer.com/10.1007/s00167-021-06457-3
11. Chiba K, Yonekura A, Miyamoto T, Osaki M, Chiba G. Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results. Arch Orthop Trauma Surg. 2017 Mar;137(3):303–10.
12. Caton-Deschamps index (knee) | Radiology Reference Article | Radiopaedia.org [Internet]. [cited 2022 Jan 26]. Available from: https://radiopaedia.org/articles/caton-deschamps-index-knee
13. Atamaz F, Aydogdu, Hepguler S, Sur H. Evaluation of the knee with magnetic resonance imaging prior to high tibial osteotomy: is it useful? is it necessary in routine practice? Orthop Proc. 2006 Mar 1;88-B(SUPP_I):102–102.
14. Vaishya R, Bijukchhe AR, Agarwal AK, Vijay V. A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis. J Clin Orthop Trauma. 2018 Oct;9(4):300–6.
15. Yin Y, Li S, Zhang R, Guo J, Hou Z, Zhang Y. What is the relationship between the “Fujisawa point” and postoperative knee valgus angle? A theoretical, computer-based study. The Knee. 2020 Jan 1;27(1):183–91.
16. Peng H, Ou A, Huang X, Wang C, Wang L, Yu T, et al. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg. 2021 Jul;13(5):1465–73.
17. Chung JH, Choi CH, Kim S-H, Kim S-J, Lee S-K, Jung M. Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis. J Clin Med. 2021 Sep 21;10(18):4272.
18. Elson DW, Petheram TG, Dawson MJ. High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method. Knee Surg Sports Traumatol Arthrosc. 2015 Jul 1;23(7):2041–8.
19. Yoon S-D, Zhang G, Kim H-J, Lee B-J, Kyung H-S. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy. Knee Surg Relat Res. 2016 Dec;28(4):283–8.
20. Yoo M-J, Shin Y-E. Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results. Knee Surg Relat Res. 2016 Dec;28(4):270–6.
21. Heinz T, Reppenhagen S, Wagenbrenner M, Horas K, Ohlmeier M, Schäfer T, et al. Focal cartilage defects of the lateral compartment do influence the outcome after high tibial valgus osteotomy. SICOT-J. 2021;7:44.
22. Lee S-J, Kim J-H, Baek E, Ryu H-S, Han D, Choi W. Incidence and Factors Affecting the Occurrence of Lateral Hinge Fracture After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med. 2021 Oct 1;9(10):232596712110353.
23. Staubli AE, Jacob HAC. Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. Int Orthop. 2010 Feb;34(2):167–72.
24. Onodera J, Kondo E, Omizu N, Ueda D, Yagi T, Yasuda K. Beta-tricalcium phosphate shows superior absorption rate and osteoconductivity compared to hydroxyapatite in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2014 Nov 1;22(11):2763–70.
25. Gaasbeek RDA, Sonneveld H, van Heerwaarden RJ, Jacobs WCH, Wymenga AB. Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. The Knee. 2004 Dec 1;11(6):457–61.
26. Song SJ, Bae DK, Kim KI, Lee CH. Conversion Total Knee Arthroplasty after Failed High Tibial Osteotomy. Knee Surg Relat Res. 2016 Jun 30;28(2):89–98.
27. Han JH, Kim HJ, Song JG, Yang JH, Bhandare NN, Fernandez AR, et al. Is Bone Grafting Necessary in Opening Wedge High Tibial Osteotomy? A Meta-Analysis of Radiological Outcomes. Knee Surg Relat Res. 2015 Dec 30;27(4):207–20.
28. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P. The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2007 Aug;23(8):852–61.
29. Hartz C, Wischatta R, Klostermeier E, Paetzold M, Gerlach K, Pries F. Plate-related results of opening wedge high tibial osteotomy with a carbon fiber reinforced poly-ether-ether-ketone (CF-PEEK) plate fixation: a retrospective case series of 346 knees. J Orthop Surg. 2019 Dec 27;14(1):466.
30. Roberson TA, Momaya AM, Adams K, Long CD, Tokish JM, Wyland DJ. High Tibial Osteotomy Performed With All-PEEK Implants Demonstrates Similar Outcomes but Less Hardware Removal at Minimum 2-Year Follow-up Compared With Metal Plates. Orthop J Sports Med. 2018 Mar 12;6(3):2325967117749584.
31. Kyun-Ho S, Hyun-Jae R, Ki-Mo J, Seung-Beom H. Effect of concurrent repair of medial meniscal posterior root tears during high tibial osteotomy for medial osteoarthritis during short-term follow-up: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021 Dec;22(1):623.
32. Koshino T, Yoshida T, Ara Y, Saito I, Saito T. Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. The Knee. 2004 Dec;11(6):439–44.
33. Coventry MB. Upper Tibial Osteotomy. Clin Orthop Relat Res. 1984 Feb;182:46–52.
34. Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP. High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13-21 years. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2011 Jan;19(1):122–7.
35. Giuseffi SA, Replogle WH, Shelton WR. Opening-Wedge High Tibial Osteotomy: Review of 100 Consecutive Cases. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2015 Nov;31(11):2128–37.
36. Han JH, Kim HJ, Song JG, Yang JH, Nakamura R, Shah D, et al. Locking plate versus non-locking plate in open-wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017 Mar;25(3):808–16.
37. Lee S-H, Seo H-Y, Kim H-R, Song E-K, Seon J-K. Older age increases the risk of revision and perioperative complications after high tibial osteotomy for unicompartmental knee osteoarthritis. Sci Rep. 2021 Dec;11(1):24340.
38. Bonasia D, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial Opening Wedge High Tibial Osteotomy for Medial Compartment Overload/Arthritis in the Varus Knee. Am J Sports Med. 2014 Jan 21;42.
39. LOIA MC, VANNI S, ROSSO F, BONASIA DE, BRUZZONE M, DETTONI F, et al. High tibial osteotomy in varus knees: indications and limits. Joints. 2016 Aug 18;4(2):98–110.
40. Bode G, Heyden J, Pestka J, Schmal H, Salzmann G, Südkamp N, et al. Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2013 Nov 19;23.

How to Cite this article: Sancheti P, Gugale S, Patil K, Shaym A | Opening wedge high tibial osteotomy | Asian Journal Arthroscopy | July-December 2021; 6(2): 20-26.

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Lateral Closing-Wedge High Tibial Osteotomy in Unicompartmental Medial Knee Arthritis

Volume 6 | Issue 2 | July-December 2021 | Page 12-19 | Nicolaas C. Budhiparama, Dwikora N. Utomo, Kukuh D. Hernugrahanto

DOI:10.13107/aja.2021.v06i02.029

Author: Nicolaas C. Budhiparama [1, 2, 3], Dwikora N. Utomo [4], Kukuh D. Hernugrahanto [4, 5]

[1] Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Jakarta, Indonesia.
[2] Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
[3] Department of Vocational Studies, University Airlangga, Surabaya, Indonesia.
[4] Department of Orthopedic & Traumatology, Faculty of Medicine, University Airlangga, Indonesia.
[5] Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Address of Correspondence:
Dr. Nicolaas C. Budhiparama,
Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Jakarta, Indonesia.
E-mail: n.c.budhiparama@gmail.com

Abstract

The high tibial osteotomy (HTO) is one attainable management of varus knee osteoarthritis. Particularly aimed at the young and active patient population. This procedure can alleviate the symptoms and restore alignment, which may significantly defer the requirement for knee arthroplasty in the future time. Close-wedge high tibial osteotomy (CW-HTO) is an effective option with minimal complication rate. Choosing between an open-wedge HTO, close-wedge HTO, or unicompartmental knee arthroplasty (UKA) for medial compartmental knee arthritis should be tailored to patients’ preoperative conditions and surgeons’ preferences. There is no clear evidence that one surgical method is superior to the other.

Keywords: High tibial osteotomy, Varus knee osteoarthritis, Medial compartment

References

1. Haddad FS, Bentley G. Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty. 2000;15(5):597–603.
2. Yadav VP, Juyal A, Sharma S. Evaluation of lateral closed wedge high tibial osteotomy for medial compartment osteoarthritis. Bangladesh J Med Sci. 2015;14(4):389–92.
3. Hoell S, Suttmoeller J, Stoll V, Fuchs S, Gosheger G. The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients. Arch Orthop Trauma Surg. 2005;125(9):638–43.
4. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br. 1961;43(4):746–51.
5. Gariepy R. Genu varum treated by high tibial osteotomy. J Bone Jt Surg Br. 1964;46:783–4.
6. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. J Bone Jt Surg Am. 1965;47(5):984–90.
7. Smith JO, Wilson AJ, Thomas NP. Osteotomy around the knee: evolution, principles and results. Knee Surgery, Sport Traumatol Arthrosc. 2013;21(1):3–22.
8. Chul Lee MD D. High tibial osteotomy. Knee Surg Relat Res. 2012;24(2):149–61.
9. Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. JAAOS-Journal Am Acad Orthop Surg. 2011;19(10):590–9.
10. Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury. 2003;34:55–62.
11. Schröter S, Lobenhoffer P, Mueller J, Ihle C, Stöckle U, Albrecht D. Changes of patella position after closed and open wedge high tibial osteotomy: review of the literature. Orthopade. 2012;41(3):186–8.
12. El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S. Patellar height and posterior tibial slope after open-and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med. 2010;38(2):323–9.
13. Tunggal JAW, Higgins GA, Waddell JP. Complications of closing wedge high tibial osteotomy. Int Orthop. 2010;34(2):255–61.
14. Atrey A, Morison Z, Tosounidis T, Tunggal J, Waddell JP. Complications of closing wedge high tibial osteotomies for unicompartmental osteoarthritis of the knee. Bone Joint Res. 2012;1(9):205–9.
15. Berruto M, Maione A, Tradati D, Ferrua P, Uboldi FM, Usellini E. Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2020;28(12):3955–61. Available from: https://doi.org/10.1007/s00167-020-05890-0
16. Marcheggiani Muccioli GM, Fratini S, Cammisa E, Vaccari V, Grassi A, Bragonzoni L, et al. Lateral Closing Wedge High Tibial Osteotomy for Medial Compartment Arthrosis or Overload. Clin Sports Med. 2019;38(3):375–86.
17. Hohmann E, Bryant A, Imhoff AB. The effect of closed wedge high tibial osteotomy on tibial slope: A radiographic study. Knee Surgery, Sport Traumatol Arthrosc. 2006;14(5):454–9.
18. Duerr RA, Harangody S, Magnussen RA, Kaeding CC, Flanigan DC. Technique for Medial Closing-Wedge Proximal Tibia Osteotomy in the Valgus Knee. Arthrosc Tech. 2020;9(7):e925–33.
19. Takeuchi R, Ishikawa H, Miyasaka Y, Sasaki Y, Kuniya T, Tsukahara S. A novel closed-wedge high tibial osteotomy procedure to treat osteoarthritis of the knee: hybrid technique and rehabilitation measures. Arthrosc Tech. 2014;3(4):e431–7.
20. Mattei L, Lea S, Nicolaci G, Ferrero G, Marmotti A, Castoldi F. Closing wedge tibial osteotomy: is it an actual procedure nowadays? planning. 2017;3:6.
21. Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closingwedge high tibial osteotomy: Determinants of survival and functional outcome. Bone Jt J. 2014;96B(11):1491–7.
22. Cheng X, Liu F, Xiong F, Huang Y, Paulus AC. Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: A systematic review and meta-analysis. J Orthop Surg Res. 2019;14(1):1–15.
23. Habib MK, Khan ZA. Radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy. Sicot-J. 2019;5.
24. Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, et al. Closing-wedge high tibial osteotomy: Survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord. 2011;12:12–6.
25. Ramanoudjame M, Vandenbussche E, Baring T, Solignac N, Augereau B, Gregory T. Fibular nonunion after closed-wedge high tibial osteotomy. Orthop Traumatol Surg Res. 2012;98(8):863–7.
26. Kim J-H, Kim H-J, Lee D-H. Survival of opening versus closing wedge high tibial osteotomy: a meta-analysis. Sci Rep. 2017;7(1):1–7.
27. Deng Y-J, Yuan Y, Ren Y-M, Li Q, Wang D, Yang Y, et al. Differences between open-wedge versus closed-wedge high tibial osteotomy on clinical and radiological outcomes and adverse events. Int J Clin Exp Med. 2018;11(5):4371–88.
28. Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J. 2010;30:131.
29. Santoso MB, Wu L. Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review. J Orthop Surg Res. 2017;12(1):1–10.
30. Adravanti P, Budhiparama NC, Berend KR, Thienpont E. ACL-deficient knee and unicompartmental OA: state of the art. J ISAKOS. June, 2017
31. Thienpont E, Budhiparama NC. Current expert opinions about unicompartmental knee arthroplasty: Proceedings for the Partial Knee Meeting. January, 2017.

How to Cite this article: Budhiparama NC, Utomo DN, Hernugrahanto KD | Lateral Closing-Wedge High Tibial Osteotomy in Unicompartmental Medial Knee Arthritis | Asian Journal of Arthroscopy | July- December 2021; 6(2): 12-19.

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Planning for a Successful High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 08-11 | Hamid Razak, Kristian Kley
DOI:10.13107/aja.2021.v06i02.028

Author: Hamid Razak [1, 2], Kristian Kley [3, 4]

[1] SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme 20 College Road, Academia Level 4, Singapore 169865.
[2] Department of Orthopaedic Surgery, Sengkang General Hospital 110 Sengkang East Way, Singapore 544886.
[3] London Osteotomy Centre, Harley Street Specialist Hospital, 18-22 Queen Anne Street, London.
[4] Orthoprofis Hannover, Luisenstraße 10-11, 30159, Hannover, Germany.

Address of Correspondence:
Dr. Hamid Razak,
Department of Orthopaedic Surgery, Sengkang General Hospital 110 Sengkang East Way, Singapore 544886.
E-mail: hamidrazak@gmail.com

Abstract

High tibial osteotomy (HTO) has been the workhorse joint preserving surgery for medial knee osteoarthritis (KOA) with varus deformity. Its importance as a surgical option has been amplified in recent years due to the greater incidence of KOA in young active patients. HTO procedures produce the best outcomes and the highest predictability when executed according to the pre-ordained surgical plan. Planning for an HTO is a mandatory and critical step. Failure to plan adequately leads to poor outcomes following HTO. Methods of planning can be broadly classified into traditional pen-and-paper planning as well as digital planning with software. Both are acceptable methods with their own merits but their utilization may be influenced by surgeon preferences, accessibility, case load and experience.
keywords: Varus knee osteoarthritis, Knee preservation, High tibial osteotomy, Preoperative planning, Surgical planning

References

1. Smith JO, Wilson AJ, Thomas NP. Osteotomy around the knee: evolution, principles and results. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):3-22.2. Niinimäki TT, Eskelinen A, Ohtonen P, Junnila M, Leppilahti J. Incidence of osteotomies around the knee for the treatment of knee osteoarthritis: a 22-year population-based study. Int Orthop. 2012;36(7):1399-402.
3. Bayliss LE, Culliford D, Monk AP, Glyn-Jones S, Prieto-Alhambra D, Judge A, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424-30.
4. El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG. Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics. 2011;34(10):e622-8.
5. Razak H, Micicoi G, Khakha RS, Ehlinger M, Faizan A, LiArno S, et al. Patients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees. Knee Surg Sports Traumatol Arthrosc. 2021.
6. Engel GM, Lippert FG, 3rd. Valgus tibial osteotomy: avoiding the pitfalls. Clin Orthop Relat Res. 1981(160):137-43.
7. Kettelkamp DB, Wenger DR, Chao EY, Thompson C. Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force. J Bone Joint Surg Am. 1976;58(7):952-60.
8. Tjörnstrand B, Selvik G, Egund N, Lindstrand A. Roentgen stereophotogrammetry in high tibial osteotomy for gonarthrosis. Arch Orthop Trauma Surg. 1981;99(2):73-81.
9. Majeed H. Litigations in trauma and orthopaedic surgery: analysis and outcomes of medicolegal claims during the last 10 years in the United Kingdom National Health Service. EFORT Open Rev. 2021;6(3):152-9.
10. Al Ghunimat A, Hind J, Abouelela A, Sidhu GAS, Lacon A, Ashwood N. Communication With Patients Before an Operation: Their Preferences on Method of Communication. Cureus. 2020;12(11):e11431-e.
11. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res. 1989(246):250-9.
12. Fick R. Handbuch der Anatomie und Mechanik der Gelenke: T. Spezielle Gelenk-und Muskelmechanik: G. Fischer; 1911.
13. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585-608.
14. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res. 1992(274):248-64.
15. Lee SS, Lee HI, Cho ST, Cho JH. Comparison of the outcomes between two different target points after open wedge high tibial osteotomy: The Fujisawa point versus the lateral tibial spine. Knee. 2020;27(3):915-22.
16. Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy. 2012;28(1):85-94.
17. Jacobi M, Wahl P, Jakob RP. Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):200-3.
18. Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW. A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):90-5.
19. Nakamura R, Komatsu N, Fujita K, Kuroda K, Takahashi M, Omi R, et al. Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. Bone Joint J. 2017;99-b(10):1313-8.
20. Sivertsen EA, Vik J, Meland ASV, Nerhus TK. The Dugdale planning method for high tibial osteotomies underestimates the correction angle compared to the Miniaci method. Knee Surg Sports Traumatol Arthrosc. 2021.
21. Elson DW, Petheram TG, Dawson MJ. High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2041-8.
22. Yoon SD, Zhang G, Kim HJ, Lee BJ, Kyung HS. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy. Knee Surg Relat Res. 2016;28(4):283-8.

How to Cite this article: Razak H, Kley K | Indications for High Tibial Osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 08-11.

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July-December 2021

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Indications for High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 3-7 | Clement Joseph, Yugal Varandani

DOI: 10.13107/aja.2021.v06i02.027

Author: Clement Joseph [1], Yugal Varandani [1]

[1] Department of Arthroscopy & Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, Tamil Nadu, India.

Address of Correspondence:
Dr. Clement Joseph,
Senior Consultant & Head, Arthroscopy & Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, Tamil Nadu, India.
E-mail: clementorth@yahoo.co.in

Abstract

There is a resurgence of interest in HTO to treat young to middle aged patients with varus alignment and isolated medial joint osteoarthritis. With improvements in implant design and preoperative planning methods, good outcomes are reported in multiple studies. But the most important factor for a successful outcome is patient selection. The ideal patient would be a middle-aged patient with isolated medial joint arthritis with good range of movements, non-smoker and with reasonable functional status of knee. The indications of HTO are evolving to include patients in higher age groups, with minimal to moderate patellofemoral symptoms and varying amounts of flexion deformities. It is also increasingly being performed as a joint protective surgery following meniscus repairs and cartilage repair procedures and to correct abnormal joint alignment following neglected ligamentous injuries.

References

1. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br. 1961 Nov;43-B:746-51. doi: 10.1302/0301-620X.43B4.746. https://doi.org/10.1302/0301-620x.43b4.746
2. Coventry, M B. “Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report” J Bone Joint Surg Am. 1965; 47:984-990. PMID: 14318636
3. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332-354. PMID: 3818700.
4. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res. 1999;(367):18-27. PMID: 10546594.
5. Capella M, Gennari E, Dolfin M, Saccia F. Indications and results of high tibial osteotomy. Ann Joint 2017:2;33. doi: 10.21037/aoj.2017.06.06 https://aoj.amegroups.com/article/view/3720/4378
6. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. Arch Bone Jt Surg. 2016;4(3):204-212. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4969364/
7. Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J. 2014;96-B (11):1491-1497. doi:10.1302/0301-620X.96B11.33617 https://doi.org/10.1302/0301-620x.96b11.33617
8. Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):149-152. doi:10.1007/s00167-005-0638-5 https://doi.org/10.1007/s00167-005-0638-5
9. Bonasia DE, Dettoni F, Sito G, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med. 2014;42(3):690-698. doi:10.1177/0363546513516577 https://doi.org/10.1177/0363546513516577
10. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br. 2008;90(5):592-596. doi:10.1302/0301-620X.90B5.20386 https://doi.org/10.1302/0301-620x.90b5.20386
11. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91-96. doi:10.1097/01.blo.0000229362.12244.f6 https://doi.org/10.1097/01.blo.0000229362.12244.f6
12. Herbst M, Ahrend MD, Grünwald L, Fischer C, Schröter S, Ihle C. Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results [published online ahead of print, 2021 Feb 11]. Knee Surg Sports Traumatol Arthrosc. 2021;10.1007/s00167-021-06457-3. doi:10.1007/s00167-021-06457-3 https://doi.org/10.1007/s00167-021-06457-3
13. Noyes, Frank & Barber-Westin, Sue. (2010). Primary, Double, and Triple Varus Knee Syndromes. In book: Noyes’ Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes (pp.821-895). 10.1016/B978-1-4160-5474-0.00031-X
14. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):170-180. doi:10.1007/s00167-012-2087-2 https://doi.org/10.1007/s00167-012-2087-2
15. Schuster P, Geßlein M, Schlumberger M, et al. Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment. Am J Sports Med. 2018;46(6):1362-1370. doi:10.1177/0363546518758016 https://doi.org/10.1177/0363546518758016
16. Hohloch L, Kim S, Eberbach H, et al. Improved clinical outcome after medial open-wedge osteotomy despite cartilage lesions in the lateral compartment. PLoS One. 2019;14(10):e0224080. Published 2019 Oct 24. doi:10.1371/journal.pone.0224080 https://doi.org/10.1371/journal.pone.0224080
17. Bin SI, Kim HJ, Ahn HS, Rim DS, Lee DH. Changes in Patellar Height After Opening Wedge and Closing Wedge High Tibial Osteotomy: A Meta-analysis. Arthroscopy. 2016;32(11):2393-2400. doi:10.1016/j.arthro.2016.06.012 https://doi.org/10.1016/j.arthro.2016.06.012
18. Kloos, F., Becher, C., Fleischer, B. et al. High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. Knee Surg Sports Traumatol Arthrosc 27, 2334–2344 (2019). https://doi.org/10.1007/s00167-018-5194-x
19. Javidan P, Adamson GJ, Miller JR, et al. The effect of medial opening wedge proximal tibial osteotomy on patellofemoral contact. Am J Sports Med. 2013;41(1):80-86. doi:10.1177/0363546512462810 https://doi.org/10.1177/0363546512462810
20. Krause M, Drenck TC, Korthaus A, Preiss A, Frosch KH, Akoto R. Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1859-1866. doi:10.1007/s00167-017-4548-0 https://doi.org/10.1007/s00167-017-4548-0
21. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med. 2000;28(3):282-296. doi:10.1177/03635465000280030201 https://doi.org/10.1177/03635465000280030201
22. Arthur A, LaPrade RF, Agel J. Proximal tibial opening wedge osteotomy as the initial treatment for chronic posterolateral corner deficiency in the varus knee: a prospective clinical study. Am J Sports Med. 2007;35(11):1844-1850. doi:10.1177/0363546507304717 https://doi.org/10.1177/0363546507304717
23. Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J. 2010;30:131-140. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2958284/
24. Kanamiya T, Naito M, Hara M, Yoshimura I. The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations. Arthroscopy. 2002;18(7):725-729. doi:10.1053/jars.2002.35258 https://doi.org/10.1053/jars.2002.35258
25. Thambiah MD, Tan MKL, Hui JHP. Role of High Tibial Osteotomy in Cartilage Regeneration – Is Correction of Malalignment Mandatory for Success?. Indian J Orthop. 2017;51(5):588-599. doi:10.4103/ortho.IJOrtho_260_17 https://doi.org/10.4103/ortho.ijortho_260_17
26. Nha KW, Lee YS, Hwang DH, et al. Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus [published correction appears in Arthroscopy. 2019 Feb;35(2):691] [published correction appears in Arthroscopy. 2020 Mar;36(3):923]. Arthroscopy. 2013;29(2):226-231. doi:10.1016/j.arthro.2012.08.027 https://doi.org/10.1016/j.arthro.2012.08.027
27. Lee DW, Lee SH, Kim JG. Outcomes of Medial Meniscal Posterior Root Repair During Proximal Tibial Osteotomy: Is Root Repair Beneficial?. Arthroscopy. 2020;36(9):2466-2475. doi:10.1016/j.arthro.2020.04.038 https://doi.org/10.1016/j.arthro.2020.04.038

How to Cite this article: Joseph C, Varandani Y | Indications for High Tibial Osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 03-07

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Short Term Clinical Outcomes of Fixed Length Loop Devices and Adjustable Length Loop Devices for Femoral Fixation of Hamstring Graft for Arthroscopic Anterior Cruciate Ligament Reconstruction: A Non-Randomized Comparative Trial

Volume 6 | Issue 2 | July-December 2021 | Page 58-62 | Samir C. Dwidmuthe, Kaustubh Patil, Vikram Sapre, Sushil Mankar

DOI: 10.13107/aja.2021.v06i02.036

Author: Samir C. Dwidmuthe [1], Kaustubh Patil [2], Vikram Sapre [2], Sushil Mankar [2]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
[2] Department Of Orthopaedics, NKPSIMS & RC, Nagpur, Maharashtra, India.

Address of Correspondence:
Dr. Samir C. Dwidmuthe
Associate professor, Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
E-mail: samirdwidmuthe@aiimsnagpur.edu.in

Abstract

Background: In anterior cruciate ligament (ACL) reconstruction, cortical suspension devices are used widely. The two most commonly used cortical suspension devices for ACL reconstruction are fixed fixed-length loop devices (FLDs) and adjustable length loop devices ALDs.
Aim: This study is aimed to compare the clinical outcomes between ALDs and FLDs in the femoral fixation component of ACL reconstruction using a hamstring graft. Methods: It was a non-randomized trial which that was conducted at department of orthopaedics tertiary care teaching hospital. The total sample size of the study was calculated as 34, in which 17 patients were placed in FLDs and the rest of 17 patients were placed in ALDs. Functional outcomes were measured by Lysholm score at preoperatively and then postoperatively at one month, two months, and six months. Knee laxity was tested were assessed by the Lachman test and Pivot shift test at preoperatively and postoperatively at 6 months.
Results: The mean Lysholm score increased from at preoperatively was 51.53±6.39 and postoperative score at last, at last, follow up was to 97.94±1.95 in FLD group and from 50.24.±12.36 to 98.29±1.86 in ALD group at 6-month follow-up. No significant difference was found in between the groups for Lysholm score at preoperatively and postoperative follow follow-ups(p>0.05). Lachman and Pivot shift test also showed no significant difference in between the groups (p>0.05).
Conclusion: The clinical effectiveness of FLDs and ALDs were found to be similar in ACL reconstruction.
Keywords: Anterior cruciate ligament reconstruction, Fixed length loop devices, Adjustable length loop devices, Lysholm score, Lachman test, Pivot shift test

References

1. Grassi A, Roberti di Sarsina T, Di Paolo S, Signorelli C, Bonanzinga T, Raggi F, Mosca M, Zaffagnini S. Increased Rotatory Laxity after Anterolateral Ligament Lesion in Anterior Cruciate Ligament- (ACL-) Deficient Knees: A Cadaveric Study with Noninvasive Inertial Sensors. Bini F, editor. Biomed Res Int 2021;1–7.
2. Kiapour AM, Murray MM. Basic science of anterior cruciate ligament injury and repair. Bone Jt Res 2014 ;3(2):20–31.
3. Eggerding V, Reijman M, Meuffels DE, Es E van, Arkel E van, Brand I van den, Linge J van, Zijl J, Bierma-Zeinstra SM, Koopmanschap M. ACL reconstruction for all is not cost-effective after acute ACL rupture. Br J Sports Med 2021;1–5.
4. Canale ST (S. T, Azar FM, Beaty JH, Campbell WC (Willis C. Campbell’s operative orthopaedics. THIRTEEN. Elsevier Inc.; 2017. p. 2123–2237.
5. Houck DA, Kraeutler MJ, McCarty EC, Bravman JT. Fixed- Versus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Studies 2018;6(10).
6. Zeng C, Lei G, Gao S, Luo W. Methods and devices for graft fixation in anterior cruciate ligament reconstruction. Cochrane Database Syst Rev 2013;(9).
7. Hapa O, Barber FA. ACL fixation devices. Sports Med Arthrosc 2009 ;17(4):217–23.
8. Barrow AE, Pilia M, Guda T, Kadrmas WR, Burns TC. Femoral Suspension Devices for Anterior Cruciate Ligament Reconstruction: Do Adjustable Loops Lengthen? 2013;42(2):343–9.
9. Eguchi A, Ochi M, Adachi N, Deie M, Nakamae A, Usman MA. Mechanical properties of suspensory fixation devices for anterior cruciate ligament reconstruction: Comparison of the fixed-length loop device versus the adjustable-length loop device. Knee 2014;21(3):743–8.
10. Johnson JS, Smith SD, LaPrade CM, Turnbull TL, LaPrade RF, Wijdicks CA. A Biomechanical Comparison of Femoral Cortical Suspension Devices for Soft Tissue Anterior Cruciate Ligament Reconstruction Under High Loads 2014;43(1):154–60.
11. Ahn JH, Ko TS, Lee YS, Jeong HJ, Park JK. Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- and Adjustable-Length Loop Cortical Fixation. Clin Orthop Surg 2018;10(2):157–66.
12. Lee, Dae-Hee & Son, Dong-Wook & Seo, Yi-Rak & Lee, In-Gyu. (2020). Comparison of femoral tunnel widening after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral cross-pin fixation: a systematic review and meta-analysis. Knee Surgery & Related Research. 32. 10.1186/s43019-020-0028-9.
13. Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR. Age, Graft Size, and Tegner Activity Level as Predictors of Failure in Anterior Cruciate Ligament Reconstruction With Hamstring Autograft 2013;41(8):1808–12.
14. Watson J. suspension device vs . adjustable-loop fixation designs : Review of mechanical data 2014;04(04):1–9.
15. BC N, JS D, AA A, DW A, A B. Biomechanical Evaluation of an Adjustable Loop Suspensory Anterior Cruciate Ligament Reconstruction Fixation Device: The Value of Retensioning and Knot Tying. Arthroscopy 2016 ;32(10):2050–9.
16. Singh S, Shaunak S, Shaw SCK, Anderson JL, Mandalia V. Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Indian Journal of Orthopaedics 2020;54: 426–43.
17. Firat A, Catma F, Tunc B, Hacihafizoglu C, Altay M, Bozkurt M, Kapicioglu MİS. The attic of the femoral tunnel in anterior cruciate ligament reconstruction: a comparison of outcomes of two suspensory femoral fixation systems. Knee Surgery, Sport Traumatology Arthroscopy 2013 ;22(5):1097–105.
18. Sheth H, Salunke AA, Barve R, Nirkhe R. Arthroscopic ACL reconstruction using fixed suspensory device versus adjustable suspensory device for femoral side graft fixation: What are the outcomes? J Clin Orthop Trauma 2019;10(1):138–42.
19. Ahn HW, Seon JK, Song EK, Park CJ, Lim HA. Comparison of Clinical and Radiologic Outcomes and Second-Look Arthroscopic Findings After Anterior Cruciate Ligament Reconstruction Using Fixed and Adjustable Loop Cortical Suspension Devices. Arthrosc J Arthrosc Relat Surg 2019 ;35(6):1736–42.
20. Lanzetti RM, Monaco E, De Carli A, Grasso A, Ciompi A, Sigillo R, Argento G, Ferretti A. Can an adjustable-loop length suspensory fixation device reduce femoral tunnel enlargement in anterior cruciate ligament reconstruction? A prospective computer tomography study. Knee 2016 ;23(5):837–41.
21. Ahn JH, Ko TS, Lee YS, Jeong HJ, Park JK. Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- and Adjustable-Length Loop Cortical Fixation. Clin Orthop Surg 2018;10(2):157–66.
22. Sharma, Parmar RS. Early outcome analysis of arthroscopic anterior cruciate ligament reconstruction using fixed closed loop and adjustable loop techniques: A prospective case series. J Orthop Allied Sci 2018 ;6(2):74.
23. Choi N-H, Yang B-S, Victoroff BN. Clinical and Radiological Outcomes After Hamstring Anterior Cruciate Ligament Reconstructions: Comparison Between Fixed-Loop and Adjustable-Loop Cortical Suspension Devices.Am J Sports Med 2016;45(4):826–31.
24. Wise BT, Patel NN, Wier G, Labib SA. Outcomes of acl reconstruction with fixed versus variable loop button fixation. Orthopedics 2017 ;40(2):e275–80.
25. Pokharel B, Bhalodia M, Raut A. Comparative study on fixed versus adjustable-length loop device for femoral fixation of graft in anterior cruciate ligament reconstruction. Int. J. Orthop.Sci 2018 ;4(1):889–92.

How to Cite this article: Dwidmuthe S C, Patil K, Sapre V, Mankar S | Short Term Clinical Outcomes of Fixed Length Loop Devices and Adjustable Length Loop Devices for Femoral Fixation of Hamstring Graft for Arthroscopic Anterior Cruciate Ligament Reconstruction: A Non-Randomized Comparative Trial | Asian Journal of Arthroscopy | July-December 2021; 6(2): 58-62.

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