Journal articles on the topic 'Mechanical medial proximal tibial angle'
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Yasukawa, Shinji, Koji Tanegashima, Mamiko Seki, Kenji Teshima, Kazushi Asano, Tomohiro Nakayama, Kei Hayashi, and Kazuya Edamura. "Evaluation of bone deformities of the femur, tibia, and patella in Toy Poodles with medial patellar luxation using computed tomography." Veterinary and Comparative Orthopaedics and Traumatology 29, no. 01 (January 2016): 29–38. http://dx.doi.org/10.3415/vcot-15-05-0089.
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SummaryObjectives: To evaluate morphological parameters of the femur, tibia, and patella in Toy Poodles with medial patellar luxation (MPL) using three-dimensional (3D) computed tomography (CT) and to compare these parameters between radiography and CT.Methods: Thirty-five hindlimbs of Toy Poodles were divided into normal and grade 2 and 4 MPL groups. The anatomical and mechanical lateral proximal femoral angle, anatomical and mechanical lateral distal femoral angle (aLDFA, mLDFA), femoral varus angle (FVA), inclination of the femoral head angle, procurvation angle, anteversion angle (AA), frontal angle of the femoral neck, mechanical medial proximal or distal tibial angle, mechanical cranial proximal or distal tibial angle, tibial plateau angle, tibial torsion angle (TTA), Z angle, relative tibial tuberosity width, ratio of the medial distance of tibial tuberosity to the proximal tibial width (MDTT/PTW), patella size, and the patellar ligament length: patellar length (L:P) ratio were evaluated on radiography and 3D CT.Results: The aLDFA, mLDFA, FVA, and TTA were significantly larger and the AA, MDTT/ PTW, and patella were significantly smaller in the grade 4 MPL group. There were significant differences in many parameters between imaging tools, and CT was considered less susceptible to potential artefacts and rotational deformities.Clinical significance: Toy Poodles with grade 4 MPL had significant femoral varus deformity, medial displacement of the tibial tuberosity, internal torsion of the proximal tibia, and hypoplasia of the patella.
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Palumbo Piccionello, Angela, Alberto Salvaggio, Antonella Volta, Fabiola Emiliozzi, Riccardo Botto, Fabrizio Dini, and Massimo Petazzoni. "Good Inter- and Intra-Observer Reliability for Assessment of Radiographic Femoral and Tibial Frontal and Sagittal Planes Joints Angles in Normal Cats." Veterinary and Comparative Orthopaedics and Traumatology 33, no. 05 (May 14, 2020): 308–15. http://dx.doi.org/10.1055/s-0040-1709694.
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Abstract Objective The aim of this study was to evaluate the inter- and intra-observer reliability of plain digital radiographs for assessing normal feline femoral and tibial joint reference angles in the sagittal and frontal planes. Study Design This was a cadaveric radiographic anatomical study. that involved 20 short-haired domestic adult cats. Materials and Methods Sagittal and frontal plane tibial and femoral joint angles of 40 limbs were measured twice by three observers with different levels of experience. Inter- and intraobserver reliability was determined by the intra-class correlation coefficient (ICC). An ICC > 0.75 was considered high correlation, 0.74 > ICC > 0.60 good correlation, 0.59 > ICC > 0.4 fair correlation and an ICC < 0.40 poor correlation. Results Mean ± standard deviation angles were anatomic lateral proximal femoral angle (aLPFA) 110.6 ± 3.6; anatomic lateral distal femoral angle (aLDFA) 91.9 ± 2.1; mechanical lateral proximal femoral angle; mLPFA (mLPFA) 107.3 ± 3.6; mechanical lateral distal femoral angle (mLDFA) 95.5 ± 1.7; femoral neck anteversion (FNA) 121.9 ± 4.1; anatomical caudal proximal femoral angle (aCPFA) 156.1 ± 3.9; anatomical caudal distal femoral angle (aCDFA) 101.4 ± 1.4; mechanical medial proximal tibial angle (mMPTA) 93.5 ± 1.2; mechanical medial distal tibial angle (mMDTA) 100.5 ± 2.3; mechanical cranial proximal tibial angle (mCrPTA) 113.1 ± 3.2; tibial plateau angle (TPA) 23.1 ± 3.2; mechanical cranial proximal tibial angle (mCrDTA) 86.7 ± 3.1.The intra-observer ICC indicated high correlation for 70% or more of the measurements. The inter-observer agreement among observers was high. These results show that the radiographic method for measuring femoral and tibial joint angles was good or high, except for FNA and mCrDTA. Conclusions This study provides some radiographic anatomical and mechanical joint angles of the femurs and tibias of normal domestic short-haired cats. We found good reliability for both intra- and interobserver measurements.
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Lusetti, Filippo, Andrea Bonardi, Chadi Eid, Anna De Bellesini, and Filippo Maria Martini. "Pelvic limb alignment measured by computed tomography in purebred English Bulldogs with medial patellar luxation." Veterinary and Comparative Orthopaedics and Traumatology 30, no. 03 (2017): 200–208. http://dx.doi.org/10.3415/vcot-16-07-0116.
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SummaryObjectives: The aim of the study was to describe the differences in pelvic limb alignment between healthy purebred English Bulldogs and those with medial patellar luxation through the measurement of femoral and tibial angles on computed tomography images in multiplanar reconstruction modality (MPRCT).Methods: Twenty-one purebred English Bulldogs were included and divided into two groups: one including healthy dogs (15 limbs) and the other including those with medial patellar luxation (24 limbs). Three different observers used MPR-CT to measure the following angles: anatomical lateral proximal femoral angle (aLPFA), anatomical lateral distal femoral angle (aLDFA), mechanical lateral proximal femoral angle (mLPFA), mechanical lateral distal femoral angle (mLDFA), angle of inclination of the femoral neck (AI), angle of anteversion (AA), mechanical medial proximal tibial angle (mMPTA), mechanical medial distal tibial angle (mMDTA), mechanical caudal distal tibial angle (mCdDTA), mechanical caudal proximal tibial angle (mCdPTA), and the tibial torsion angle (TTA). A Mann-Whitney U test was used to compare each variable in both groups.Results: The values for aLDFA and mLDFA in the medial patellar luxation population were significantly increased compared to healthy subjects (p <0.05). No significant differences were observed for the other variables.Clinical significance: In our population, an increased distal femoral varus was associated with medial patellar luxation. Our results could be useful to determine whether or not angular deformity of the femur is present and help determine the degree of correction necessary to restore alignment.ORCID iD:FMM: http://orcid.org/0000-0001-9615-2540
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Hette, K., R. S. Volpi, O. C. M. Pereira-Junior, M. J. Mamprim, V. Colombi da Silva, and S. C. Rahal. "Radiographic measurement of tibial joint angles in sheep." Veterinary and Comparative Orthopaedics and Traumatology 22, no. 03 (2009): 204–9. http://dx.doi.org/10.3415/vcot-08-07-0065.
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SummaryThe aim of this study was to establish normal reference values of anatomic and mechanical joint angles of the tibia in sheep at different age groups. Eighteen clinically healthy Santa Ines sheep were used. The animals were divided into three equal groups according to age: Group I – from six- to eight-months-old, Group II – 2-years-old, Group III – from three- to five-years-old. Anatomic medial proximal and lateral distal tibial angles, mechanical proximal and distal tibial angles, and anatomic caudal proximal and anatomic cranial distal tibial angles were measured from tibiae radiographs (n = 36). In the craniocaudal view, the mean values of the anatomic medial proximal, anatomic lateral distal, mechanical medial proximal, and mechanical lateral distal tibial joint angles were 89.6°, 86.6°, 91.4°, and 85.19° respectively. In mediolateral view, the mean values of the anatomic caudal proximal and anatomic cranial distal tibial angles were 64.55° and 105.69°, respectively. The joint orientation angles of the tibia in sheep showed similar values regardless of animal age for both anatomic and mechanical axes.
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Davies, John, and Albert Lynch. "Percutaneous Tibial Fracture Reduction Using Computed Tomography Imaging, Computer Modelling and 3D Printed Alignment Constructs: A Cadaveric Study." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 02 (February 13, 2019): 139–48. http://dx.doi.org/10.1055/s-0039-1677751.
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Objective The main aim of this study was to evaluate a percutaneous method of bone alignment using a diaphyseal tibial fracture model. Materials and Methods Mid-shaft diaphyseal fractures were created in 12 large-breed canine tibiae. Interaction pins were inserted into the proximal and distal bone segments. Computed tomography scans of the fractured tibiae and pins were imported into three-dimensional (3D) modelling software and the fractures were virtually reduced. A multi-component 3D printed alignment jig was created that encompassed the pins in their aligned configuration. Orthogonal radiographs were taken after alignment jig application. Intact and post-alignment tibial lengths and joint angles were compared. Rotational alignment was subjectively evaluated. Results Post-alignment tibial lengths differed on the mediolateral and craniocaudal radiographs by an average of 1.55 and 1.43% respectively. Post-alignment mechanical medial proximal tibial angle, mechanical medial distal tibial angle and mechanical caudal proximal tibial angle had an average difference of 1.67°, 1.92° and 2.17° respectively. Differences in tibial length and joint angles were not significant (p > 0.05). Clinical Significance While in vivo evaluation is necessary, this technique to align diaphyseal fractures percutaneously using computer modelling and 3D printing is technically feasible and may facilitate the clinical use of minimally invasive osteosynthesis techniques.
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Cabassu, Julien. "Minimally Invasive Plate Osteosynthesis Using Fracture Reduction Under the Plate without Intraoperative Fluoroscopy to Stabilize Diaphyseal Fractures of the Tibia and Femur in Dogs and Cats." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 06 (July 29, 2019): 475–82. http://dx.doi.org/10.1055/s-0039-1693413.
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Objective The aim of this study was to prospectively evaluate postoperative alignment when using fracture reduction under the plate (FRUP) during a minimally invasive plate osteosynthesis in tibial and femoral fractures, without intraoperative imaging, and report immediate postoperative complications. Materials and Methods After precise plate contouring and preoperative planning, FRUP was obtained with one cortical screw per fragment. Fractures were stabilized with a plate or plate rod. Tibial/femoral lengths, tibial plateau angles, mechanical medial proximal and distal tibial angles, anatomical lateral distal femoral angles, femoral curvatum and neck anteversion were evaluated on postoperative radiographs and contralateral bone. Tibial torsion was evaluated visually. Paired t-test were used to compare data. Immediate postoperative complications were recorded. Results Twenty-one tibial and 20 femoral fractures were stabilized (14 plate rod cases). Mean postoperative operated tibial length was 1.4% shorter (p = 0.001). Mean postoperative operated femoral length was 2% shorter (p = 0.04). Mean operated tibial plateau angle was 1.1° lower (p = 0.02). No difference in tibial torsion was noticed. No significant difference in mechanical medial proximal tibial angle, mechanical medial distal tibial angle, anatomical lateral distal femoral angle and femoral neck anteversion was observed. Mean operated femoral curvatum angle was 5.6° less (p = 0.01). Five cases (3 plate rod cases) required an immediate revision. Clinical Significance Minimally invasive plate osteosynthesis with FRUP leads to acceptable postoperative alignment. Correct pin placement should be evaluated.
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Chaja, Warda, Ihsane Mansir, Ibtissam Zouita, Dounia Basraoui, and Hicham Jalal. "Blount Disease: A Case Report and Review of the Literature." Scholars Journal of Medical Case Reports 9, no. 10 (October 30, 2021): 1026–28. http://dx.doi.org/10.36347/sjmcr.2021.v09i10.027.
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Introduction: Blount disease is an asymmetrical disorder of proximal tibial growth that produces a three-dimensional deformity. Tibia vara is the main component of the deformity. There is general agreement that two clinical forms should be distinguished based on age, infantile and adolescent, with 10 years as the cut-off. Case: We present a case of 11 year old girl admitted to our radiology department with chronic bilateral gonalgia and genu varum evoluting for a year. The clinical examination reveals bilateral varus deformity of the proximal tibia, a palpable prominence or “beaking” of the proximal medial tibial epiphysis and metaphysic. The diagnosis of blount disease has been confirmed on standard radiography. Conclusion: Blount's disease remains a rare disease whose etiology is still unknown, seems to involve hereditary and environmental factors explaining its very particular distribution. Radiological investigations are helpful to the diagnosis by showing medial varus malalignment of the tibial metaphysis. Many angles have been described. A mongthem, the mostuseful are the mechanical tibio-femoral angle, metaphyseal-diaphyseal angle (MDA) of Levine and Drennan, and bony tibial slope.
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Chaja, Warda, Ihsane Mansir, Ibtissam Zouita, Dounia Basraoui, and Hicham Jalal. "Blount Disease: A Case Report and Review of the Literature." Scholars Journal of Medical Case Reports 9, no. 10 (October 30, 2021): 1026–28. http://dx.doi.org/10.36347/sjmcr.2021.v09i10.027.
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Introduction: Blount disease is an asymmetrical disorder of proximal tibial growth that produces a three-dimensional deformity. Tibia vara is the main component of the deformity. There is general agreement that two clinical forms should be distinguished based on age, infantile and adolescent, with 10 years as the cut-off. Case: We present a case of 11 year old girl admitted to our radiology department with chronic bilateral gonalgia and genu varum evoluting for a year. The clinical examination reveals bilateral varus deformity of the proximal tibia, a palpable prominence or “beaking” of the proximal medial tibial epiphysis and metaphysic. The diagnosis of blount disease has been confirmed on standard radiography. Conclusion: Blount's disease remains a rare disease whose etiology is still unknown, seems to involve hereditary and environmental factors explaining its very particular distribution. Radiological investigations are helpful to the diagnosis by showing medial varus malalignment of the tibial metaphysis. Many angles have been described. A mongthem, the mostuseful are the mechanical tibio-femoral angle, metaphyseal-diaphyseal angle (MDA) of Levine and Drennan, and bony tibial slope.
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Kawasaki, Makoto, Ryuji Nagamine, Weijia Chen, Yuan Ma, Akinori Sakai, and Toru Suguro. "Proximal tibia vara involves the medial shift of the tibial articular surface." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949902090259. http://dx.doi.org/10.1177/2309499020902592.
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Purpose: According to the concept of the constitutional varus, the tibial articular surface (TAS) has varus inclination. On the other hand, it has been reported that proximal tibia vara involved medial shift of the TAS. However, it has not been assessed whether varus inclination of the TAS has a correlation with the medial shift. We investigated whether varus inclination of the TAS has a correlation with the medial shift. If there is a correlation between two parameters, the influence of the medial shift of the TAS on the value of the hip–knee–ankle (HKA) angle and the femorotibial angle should be considered. Methods: A total of 112 patients who underwent total knee arthroplasty had anteroposterior view tibia digital radiograph on which five parameters were analyzed. Varus angle of the TAS, the distance between the mechanical axis and the anatomical axis on the articular surface, and the width of the articular surface were measured. Results: The more the proximal tibia had varus deformity, the more the TAS shift medially would be. Therefore, the mechanical axis does not match the anatomical axis. Because the HKA angle was assessed based on the concept that the mechanical and anatomical axes match on the tibia, this angle may not express the true alignment of the lower extremity in knees with proximal tibia vara. Conclusion: In varus knees, the proximal tibia has a medial shift of the TAS that may influence the value of the HKA angle.
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Palmer, Jonathan S., Luke D. Jones, A. Paul Monk, Michael Nevitt, John Lynch, David J. Beard, M. K. Javaid, and Andrew J. Price. "Varus alignment of the proximal tibia is associated with structural progression in early to moderate varus osteoarthritis of the knee." Knee Surgery, Sports Traumatology, Arthroscopy 28, no. 10 (January 21, 2020): 3279–86. http://dx.doi.org/10.1007/s00167-019-05840-5.
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Abstract Purpose Lower limb malalignment is a strong predictor of progression in knee osteoarthritis. The purpose of this study is to identify the individual alignment variables that predict progression in early to moderate osteoarthritis of the knee. Method A longitudinal cohort study using data from the Osteoarthritis Initiative. In total, 955 individuals (1329 knees) with early to moderate osteoarthritis (Kellgren-Lawrence grade 1, 2 or 3) were identified. All subjects had full-limb radiographs analysed using the Osteotomy module within Medicad® Classic (Hectec GMBH) to give a series of individual alignment variables relevant to the coronal alignment of the lower limb. Logistic regression models, with generalised estimating equations were used to identify which of these individual alignment variables predict symptom worsening (WOMAC score > 9 points) and or structural progression (joint space narrowing progression in the medial compartment > 0.7mm) over 24 months. Results Individual alignment variable were associated with both valgus and varus alignment (mechanical Lateral Distal Femoral Angle, Medial Proximal Tibial Angle and mechanical Lateral Distal Tibial Angle). Only the Medial Proximal Tibial Angle was significantly associated with structural progression and none of the variables was associated with symptom progression. The odds of joint space narrowing progression in the medial compartment occurring at 24 months increased by 21% for every one degree decrease (more varus) in Medial Proximal Tibial Angle (p < 0.001) Conclusions Our results suggest that the risk of structural progression in the medial compartment is associated with greater varus alignment of the proximal tibia. Level of evidence Level III, retrospective cohort study.
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Beale, Brian, Caleb Hudson, and Kathryn Flesher. "Technique and Outcome of a Modified Tibial Plateau Levelling Osteotomy for Treatment of Concurrent Medial Patellar Luxation and Cranial Cruciate Ligament Rupture in 76 Stifles." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 01 (January 2019): 026–32. http://dx.doi.org/10.1055/s-0038-1676296.
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Objectives The main aim of this article is to describe the technique and outcome of a modified tibial plateau levelling osteotomy (TPLO) that simultaneously levels the tibial plateau and realigns the quadriceps mechanism through medial translation of the proximal tibial segment in dogs less than 15 kg. Materials and Methods A retrospective medical records search identified dogs with concurrent cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL). A study group (76 stifles) treated with a modified TPLO was compared with a non-tibial translation group (45 stifles) corrected with traditional surgical technique. Signalment, arthroscopic findings, adjunctive surgical procedures, osteotomy healing time and complications were recorded. Tibial plateau angle, proximal tibial segment medialization, width of the tibial osteotomy, mechanical medial proximal tibial angle and mechanical medial distal tibial angle were measured and recorded on preoperative and postoperative radiographs. Results Overall complication rate was 18.4% in the treatment group and 28.9% in the non-tibial translation group. Reluxation occurred in 6.6% of cases in the study group and in 8.8% of cases in the non-tibial translation group. There was no statistical difference in healing time between groups. Clinical Significance A modified TPLO can be used to treat patients with concurrent MPL and CCLR with good clinical outcome. Complication rates are comparable to traditional repairs for MPL. No major differences were appreciated between study and a non-tibial translation groups for variables compared.
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Banks, Charlotte, Richard Meeson, Elvin Kulendra, Darren Carwardine, Benjamin Mielke, Matthew Pead, Helen Phillips, and Andrew Phillips. "Establishment of Normal Mechanical Tibial Joint Angles in Dachshunds." Veterinary and Comparative Orthopaedics and Traumatology 34, no. 04 (January 31, 2021): 234–40. http://dx.doi.org/10.1055/s-0040-1722336.
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Abstract Objective The aim of this study was to establish breed-standard mechanical tibial joint reference angles in the frontal plane in Dachshunds. Study Design Craniocaudal (n = 38) and mediolateral (n = 32) radiographs of normal tibiae from Dachshunds were retrospectively reviewed. The mechanical medial proximal, mechanical medial distal, mechanical caudal proximal and mechanical cranial distal tibial angles were measured on three occasions by two separate observers using previously established methodology. Interclass correlation coefficient was used to assess the reliability of radiographic measurements. Results The mean and standard deviation for mechanical medial proximal, mechanical medial distal, mechanical caudal proximal and mechanical cranial distal were 93.1 degrees ± 4.2, 97.5 degrees ± 3.9, 75.3 degrees ± 3.7 and 85.0 degrees ± 5.3 respectively. Intra-observer reliability was good to excellent for all measures, while inter-observer reliability was moderate to excellent in the frontal plane and poor to good in the sagittal plane. Dachshund-specific joint reference angles were similar to a range of previously reported non-chondrodystrophic breeds in the frontal plane but differed to most in the sagittal plane. Conclusion Dachshund tibial joint reference angles are reported which can be used in surgical planning for correction of bilateral pes varus.
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Akdeniz, Olcay, Cemal Dinçer, and Mehmet Hasan Tatari. "Does Open Wedge Proximal Tibial Osteotomy Really Affect Tibial Slope and Patellar Height?" Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0016. http://dx.doi.org/10.1177/2325967114s00164.
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Objectives: Open wedge proximal tibial osteotomy has gained popularity over recent years. This technique has several advantages over lateral closed wedge osteotomy, like lack of any need for fibular osteotomy and freedom from peroneal nerve complications, easier and more precise correction, no limb shortening and easier access for an eventual total knee arthroplasty. However it was been shown that open wedge osteotomy may reduce patellar height and increase sagittal tibial slope which can cause patellofemoral problems. The aim of the study was to evaluate the alterations in the angle of posterior slope of the tibia and the degree of patellar height following medial opening wedge proximal tibial osteotomy in our patients. Methods: 26 females and 7 males, with a mean age of 48, who underwent medial opening wedge proximal tibial osteotomy were included in the study. In all cases, the preoperative measured varus angle was overcorrected to between 5-8° valgus. The posterior slope of the tibia was determined by the proximal tibial anatomical axis and patellar height was measured retrospectively by the Caton index on the pre- and postoperative radiograms at the end of the second month. Results: Preoperatively, on the standing orthoroentgenograms, the mean mechanical axis deviation was 12,36° (8-20) and the mean posterior tibial slope in the sagittal view was 16,24° (10-23). The mean postoperative tibial slope was 17,85° (6-25). Using paired samples test, this increase was statistically significant (p=0.049). Preoperative mean Caton index was 1,35 (1,01-1,92) and the postoperative average was 1,73 (1,11-2,76). There was also a statistical significant increase between the pre-and postoperative values (p<0.001) with paired samples test. There was a positive correlation between preoperative mechanical axis deviation and postoperative slope angle (p=0,014) but there was no correlation between preoperative mechanical axis deviation and postoperative patellar height. Conclusion: In conclusion, tibial slope and patellar height are strongly affected by open wedge high tibial osteotomy and this might have an adverse effect on an eventual knee arthroplasty.
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Nicetto, T., A. Vezzoni, A. Piras, R. Palmer, and M. Petazzoni. "Treatment of pes varus using locking plate fixation in seven Dachshund dogs." Veterinary and Comparative Orthopaedics and Traumatology 25, no. 03 (2012): 231–38. http://dx.doi.org/10.3415/vcot-11-03-0035.
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SummaryObjectives: To describe the surgical treatment of pes varus in Dachshund dogs by medial opening wedge osteotomy of the distal tibia stabilized with a locking plate system and to retrospectively report the clinical and radiographic outcomes.Materials and methods: Lameness in nine limbs of seven Dachshund dogs with pes varus deformity was treated with corrective osteotomy at or near the centre of rotation of angulation as defined by the intersection of the proximal and distal mechanical axes determined on caudo-cranial radiographs. Outcomes evaluated included comparison of preand postoperative radiographic measurements of frontal angulation and lameness assessment.Results: Lameness resolved in eight limbs and improved in one limb. All osteotomies healed and no implant complications were detected. Mean preoperative radiographic measurements were: mechanical medial proximal tibial angle (mMPTA) = 91.1° (range 87.6°-95°), mechanical medial distal tibial angle (mMDTA) = 62.1° (range 51.9°-69.6°). Mean postoperative measurements were: mMPTA 92.4° (range 78°-97.5°), mMDTA 81.8° (range 76°-87°). Measurable undercorrection was common, though seldom visually or functionally evident.Clinical significance: Pes varus deformity in Dachshunds can be treated by medial opening wedge osteotomy of the distal tibia stabilized with a locking plate system. Care to preserve the lateral cortex of the osteotomy may help avoid under-correction.
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Ucpunar, H., S. K. Tas, Y. Camurcu, H. Sofu, M. Mert, and A. I. Bayhan. "The effects of residual hip deformity on coronal alignment of the lower extremity in patients with unilateral slipped capital femoral epiphysis." Journal of Children's Orthopaedics 12, no. 6 (December 2018): 599–605. http://dx.doi.org/10.1302/1863-2548.12.180137.
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Purpose The aim of our explorative study was to compare the differences in the coronal alignments of the hip, knee and ankle on the slip side and non-slip sides in patients with slipped capital femoral epiphysis (SCFE). Methods The study group consisted of 28 patients. On the full-length standing radiographs, measurements of articulo-trochanteric distance (ATD), neck-shaft angle (NSA), femoral offset, hip-knee-ankle axis, femur-tibial angle, mechanical axis deviation ratio (MAD-r), anatomical medial proximal femoral angle (aMPFA), mechanical lateral proximal femoral angle (mLPFA), anatomical lateral distal femoral angle (aLDFA), mechanical lateral distal femoral angle (mLDFA), knee joint line congruency angle, mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), ankle joint line orientation angle (AJOA), and leg length discrepancy (LLD) were performed. The data from the slip side were compared with those from the non-slip side. Results At skeletal maturity, there were significant differences between the slip side and non-slip side in ATD (p <0.001), NSA (p <0.001), MAD-r (p <0.001), aMPFA (p <0.001), aLDFA (p = 0.03), mLDFA (p = 0.04), mLDTA (p = 0.02), AJOA (p <0.001) and LLD (p<0.001). Conclusion Residual deformity in the proximal femur after epiphyseal slip and premature epiphysiodesis could cause changes in the coronal alignment of the lower extremity. We can add lower extremity alignment examination to follow-up protocol to rule out secondary problems in patients with SCFE. Level of Evidence Level III, retrospective comparative study
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ICHINOHE, Tomu, Nobuo KANNO, Hiroki OCHI, Yukihiro FUJITA, Yasuji HARADA, Yoshinori NEZU, Takuya YOGO, Shinya YAMAGUCHI, Masahiro TAGAWA, and Yasushi HARA. "The Effect of Plate Types on Tibial Plateau Angle (TPA) and Mechanical Medial Proximal Tibial Angle (mMPTA) after Tibial Plateau Leveling Osteotomy." Japanese Journal of Veterinary Anesthesia & Surgery 43, no. 3+4 (2012): 47–54. http://dx.doi.org/10.2327/jvas.43.47.
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Maderbacher, Günther, Jan Matussek, Felix Greimel, Joachim Grifka, Jens Schaumburger, Clemens Baier, and Armin Keshmiri. "Lower Limb Malrotation Is Regularly Present in Long-Leg Radiographs Resulting in Significant Measurement Errors." Journal of Knee Surgery 34, no. 01 (July 29, 2019): 108–14. http://dx.doi.org/10.1055/s-0039-1693668.
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AbstractWeight-bearing long-leg radiographs are commonly used in orthopaedic surgery. Measured parameters, however, change when radiographs are conducted in different rotational positions of the leg. It was hypothesized that rotational errors are regularly present in long-leg radiographs resulting in wrong measurements. In 100 consecutive long-leg radiographs conducted according to the method of Paley, rotation was assessed by fibular overlap. Angular parameters in radiographs (mechanical lateral proximal femoral angle (mLPFA), mechanical lateral distal femoral angle (mLDFA), angle between the anatomical and mechanical femoral axis (AMA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), and the mechanical femoral and tibial axis (mFA–mTA) were measured and deviations related to malrotation calculated. An average internal rotation of 8 degrees was found in lower limbs showing a range between 29 degrees of internal and 22 degrees of external rotation. As a result, mean differences before and after rotational correction for measured parameters (mLPFA, mLDFA, AMA, mMPTA, mLDTA, mFA–mTA) ranged between 0.4 and 1.7 degrees (−2.1; 5.6 95% confidence interval [CI]). In conclusion, malrotation of lower limbs is regularly present in long-leg radiographs. As all measured parameters are influenced by malrotation, correct lower limb rotation needs to be verified.
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Vezzoni, Luca, Sara Bazzo, Silvia Boiocchi, and Aldo Vezzoni. "Use of a Modified Tibial Plateau Levelling Osteotomy with Double Cut and Medial Crescentic Closing Wedge Osteotomy to Treat Dogs with Cranial Cruciate Ligament Rupture and Tibial Valgus Deformity." Veterinary and Comparative Orthopaedics and Traumatology 33, no. 01 (November 22, 2019): 059–65. http://dx.doi.org/10.1055/s-0039-1700565.
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Abstract Objective The aim of this study was to report efficacy of a modified tibial plateau levelling osteotomy (TPLO) with double cut and medial crescentic closing wedge osteotomy (TPLO/MCCWO) to treat dogs with cranial cruciate ligament rupture and concurrent tibial valgus. Study Design This study was a cases series. Materials and Methods Medical records of dogs that had TPLO with medial crescentic closing wedge osteotomy were reviewed. Data collected included signalment, body weight, pre- and postoperative tibial valgus angle, tibial plateau angle (TPA), surgical planning, corrective osteotomy technique, method of fixation, complications, and length of time to radiographic healing. Results Fifty-two surgical procedures performed in 45 dogs (7 bilateral) were included in the study. Mean age at surgery was 54 months, and body weight ranged from 5 to 63 kg (mean: 36.5 kg). Mean pre- and postoperative mechanical medial proximal tibial angle were 101° (98°–107°) and 92.80° (88°–97°) respectively. The mean pre- and postoperative TPA were 27.80° (16–35°) and 6.50° (3–11°) respectively. Intraoperative complications occurred in two stifles: in one stifle over-rotation of the proximal tibial segment resulted in a TPA of –8°, with immediate revision to a 5° TPA; in the second stifle a fissure of the lateral tibial cortex developed during insertion of a screw and required adjunctive fixation. No postoperative complications were recorded and all osteotomies healed uneventfully. Conclusions Tibial plateau levelling osteotomy/medial crescentic closing wedge osteotomy is an effective treatment for dogs with cranial cruciate ligament rupture and tibial valgus allowing accurate correction of the tibial deformity with a low complication rate.
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Tsibidakis, Haridimos, Artemisia Panou, Antonios Angoules, Vassilios I. Sakellariou, Nicola Marcello Portinaro, Julian Krumov, and Anastasios D. Kanellopoulos. "The Role of Taylor Spatial Frame in the Treatment of Blount Disease." Folia Medica 60, no. 2 (June 1, 2018): 208–15. http://dx.doi.org/10.1515/folmed-2017-0082.
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Abstract Background: Alteration of the posteromedial part of the proximal tibia is the main characteristic of Blount’s disease and if left untreated, leg alignment and normal development of the lower limbs may be compromised. Aim: To report treatment outcomes in children with Blount’s disease using the Taylor Spatial Frame (TSF). Materials and methods: From January 2007 to December 2014, 16 young children (24 tibia) with a mean age of 7.5 years (range of 3-14 yrs) and severe Blount’s disease were treated using TSF. Preoperative long standing radiographs were performed and anatomic medial proximal tibial angle (MPTA), diaphyseal-metaphyseal tibial angle (Drennan), femoro-tibial angle and leg length discrepancy (LLD) were measured. Results: Post-operative improvement of all measurements was observed. MPTA increased from a mean of 71.8° (58° - 79°) to 92.5° (90° - 95°), the Drennan decreased from 16.6° (14° - 18°) to 3.6° (0° - 6°), the F-T angle changed from 15.4° (10° - 25°) of varus to 5.9° (2° - 10°) of valgus and the LLD decreased from 208 mm (150-320) to 69 mm (0- +120). Mean follow-up was 45.6 months. According to Paley’s criteria pin track infection was present in 6 tibiae, while in 5 patients software changes were necessary. Recurrence was observed in 3 patients (triplets). Complete restoration of the mechanical axis was obtained at the end of the treatment. Conclusions: In the last decades, different surgical treatments have been proposed for Blount’s disease (tension band plate, staples, osteotomies using external or internal fixation). External fixation using the TSF allows gradual safe correction of multiplanar deformities and is a well-tolerated technique by patients with Blount’s disease.
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Karuppal, Raju, Rahul Mohan, Anwar Marthya, Gopakumar TS, and Sandhya S. "Case Report: ‘Z’ osteotomy - a novel technique of treatment in Blount’s disease." F1000Research 4 (November 12, 2015): 1250. http://dx.doi.org/10.12688/f1000research.6770.1.
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Blount’s disease is a progressive form of genu varum due to asymmetrical inhibition of the postero medial portion of the proximal tibial epiphysis. The surgical treatments involved in correction of Blount’s disease are often technically demanding, complicated procedures. These procedures can lead to prolonged recovery times and poor patient compliance. In such a context we are suggesting “fibulectomy with Z osteotomy” of the proximal tibia, a relatively simple and highly effective technique. This technique is based on correcting the mechanical axis of the lower limb thereby restoring growth from the medial physis of proximal tibia. We have used a new surgical technique, which includes fibulectomy followed by a Z-shaped osteotomy. We have used this simple technique in a 5 year-old boy with unilateral Blount’s disease. The femoro-tibial angle was corrected from 18.2° of varus to 4.2° of valgus. The angular correction obtained after operation was 22°. There were no postoperative complications. This technique has the advantages of correcting both angular and rotational deformities simultaneously. The purpose of this case study is to introduce a new surgical technique in the treatment of Blount’s disease.
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Kaya, Hüseyin, Elcil Kayabiçer, Ali Engin Daştan, and Emin Taşkıran. "Is it possible to avoid posterior tibial slope increase in open-wedge high tibial osteotomy?" Orthopaedic Journal of Sports Medicine 5, no. 2_suppl2 (February 1, 2017): 2325967117S0005. http://dx.doi.org/10.1177/2325967117s00052.
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Aim: Posterior tibial slope has shown to be increased with open-wedge high tibial osteotomy (OWHTO) which may lead to an increase in loading of the anterior cruciate ligament and causing patellofemoral problems in return. In this case series, patients with an OWHTO performed posteromedial to the medial collateral ligament (MCL), keeping it intact was investigated. The aim of this study was to evaluate the influence of this technique on the posterior tibial slope. Methods: Thirty knees (15 right, 15 left) of 28 patients (22 women, 6 men) with a mean age of 53.57±5.9 years who had an OWHTO between January 2014 and February 2016 were included in this study. Surgical technique: A proximal tibial osteotomy is performed posteromedial to MCL keeping it intact. Following the osteotomy, distraction is also performed from the posteromedial aspect of tibia. Fixation is achieved utilizing TomoFix plate. Radiological evaluation: Preoperative and postoperative mechanical axes (MA) were measured on standard weight bearing long axis x-rays. Preoperative and postoperative posterior tibial slope angles were measured on lateral x-rays using three different Methods: the angles between medial tibial plateau and (1) posterior tibial cortex, (2) tibial proximal anatomical axis, and (3) posterior fibular cortex were measured. The correlations of three different measurement methods were analyzed. Patients were grouped according to preoperative MA deviations and postoperative MA changes (either <10º or >=10º). The posterior tibial slope changes were compared between groups. Statistical analyses: All statistical analyses were performed utilizing SPSS 18.0. Results: Mean preoperative and postoperative MA deviations were 9.81°±4.94° and -2.72°± 2.69° respectively. The mean correction angle of MA of lower extremity was 12.62°±4.58°. The three methods used to measure the posterior tibial slope angles were found to be highly correlated with each other ((1) and (2) r=0.961; (1) and (3) 0.906; (2) and (3) 0.934; p values <0.0001). Preoperative mean posterior tibial slope angles were 9.50º±4.47°, 11.51º± 4.50°, and 10.80º±4.58°; postoperative angles were 6.10º±4.23°, 8.78º±4.57° and 8.11º±4.55°, respectively. Posterior tibial slope angle was significantly decreased postoperatively with respect to all three methods (p <0.0001). The changes in the posterior tibial slope was not statistically significant between the groups with preoperative <10º and >=10º deformities (p values 0.861, 0.723, 0.727, respectively). Conclusions: Posterior tibial slope was found to be decreased with this posteromedial OWHTO technique. This technique offered the advantage of preserving the posterior tibial slopes postoperatively even in highly deformed knees which necessitated higher degrees of corrections in the mechanical axes.
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Fürmetz, Julian, Jan Sass, Jalil Jalali, Nikolaus Degen, Wolfgang Böcker, and Peter Thaller. "3D-ANALYSIS OF LOWER LIMB ANATOMY: NORMAL VALUES FOR JOINT ANGLES AND ALIGNMENT." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl4 (May 1, 2020): 2325967120S0029. http://dx.doi.org/10.1177/2325967120s00295.
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Aims and Objectives: The analysis of lower limb anatomy is mandatory in deformity surgery and total knee replacement. Standard values for joint angles and alignment are only available for 2D images using long standing and lateral radiographs. In contrast, 3D bone models realistically represent the anatomy and are independent of position and projection. Using a self-developed, standardised and validated protocol for 3D analysis of lower limb geometry, standard values for specific joint angles and axes can be obtained in a young cohort for the first time. Materials and Methods: After power and sample size analysis, 60 thin-slice CTs of the entire leg were analysed (30 patients, 13 f, 17 m; age = 33.8 [18-50 years]). After segmentation all 24 relevant bony landmarks were set using our standardised analysis method. Results of joint angles and mechanical axis deviation are calculated automatically. Mean values are stated with standard deviations to describe a possible reference range. Results: The mean neck-shaft angle (NSA) was 133±10° and the mean medial proximal femoral angle (MPFA) 85±9°. Around the knee joint, the mean mechanical lateral distal femoral angle (mLDFA) was 87±4° and the medial proximal tibial angle (MPTA) 88±5°. Medial and lateral slope averaged 12±7° and 9±8°. The deviation of the frontal mechanical leg axis from the knee joint center (MAD frontal) was 7±15mm and the mechanical femoro-tibial angle (HKA) 175±6°. Women showed a smaller mLDFA than men (86.4° vs. 87.8°, p<0.05) and a larger joint line convergence angle (JLCA 2.5° vs. 1.4°, p<0.01) representing a more valgiform anatomy. Conclusion: The standardised 3D analysis enabled reference ranges for the relevant joint angles and axes to be defined on the 3D bone model for the first time. The results redefine reference ranges for 3D measurements similar to existing 2D measurements on long standing radiographs. The systematic analysis of the complex 3D anatomy results in a multitude of new questions and possibilities in preoperative planning.
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LAMBERT, RUTH J., and KIRK L. WENDELBURG. "Determination of the Mechanical Medial Proximal Tibial Angle Using a Tangential Radiographic Technique." Veterinary Surgery 39, no. 2 (February 2010): 181–86. http://dx.doi.org/10.1111/j.1532-950x.2009.00625.x.
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L, Guenego. "Comparison of the Tibial Anatomical-Mechanical Axis Angle and Patellar Positions between Labrador Retrievers and Golden Retrievers with and without Cranial Cruciate Ligament Rupture." Open Access Journal of Veterinary Science & Research 5, no. 2 (2020): 1–9. http://dx.doi.org/10.23880/oajvsr-16000199.
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This study investigated proximodistal and craniocaudal patellar positions and assessed these positions with the tibial anatomical-mechanical axis angle (AMA-angle), tibial plateau angle (TPA), relative tibial tuberosity width (rTTW), and Z-angle in Labrador Retrievers (LR) and Golden Retrievers (GR) with and without cranial cruciate ligament rupture (CCLR). Mediolateral radiographs were obtained from 2 groups. The affected group had a normal contralateral stifle measured at the time of unilateral surgically confirmed CCLR, which developed a subsequent contralateral CCLR (SC-CCLR; 40 dogs), and the control group (60 dogs aged >11 years) had normal stifles. In the SC-CCLR group, 95% of the tibial anatomical axes (AAs) were cranial (CR) to the patella, with a median (range) AMA-angle of 2.92° (1.65°-4.92°), while in the control group, 93% of the stifles had AAs caudal (CA) to or in the middle (M) of the patella, with a median (range) AMA-angle of 1.03° (0°-3.52°). The craniocaudal position of the patella was correlated statistically with the AMA-angles (median (range), 0.86° (0-1.61°), 1.87° (1.22-2.7°), and 2.97° (1.72-4.92°) in the CA, M, and CR positions, respectively, but not with other tibial measurements (p<0.0001). The patellar height did not differ between the groups (p<0.0001). The highly significant difference found in the AMA-angle and the craniocaudal patellar position between LR and GR with or without CCL injury suggest that craniocaudal angulation of the proximal tibia could influence the development of canine CCLR.
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Liu, Kuei-Yu, Kuan-Wen Wu, Chia-Che Lee, Sheng-Chieh Lin, Ken N. Kuo, and Ting-Ming Wang. "Tibial Lengthening along Submuscular Plate with Simultaneous Acute Tibial Deformity Correction by High-Energy Osteotomy: A Comparative Study." Journal of Clinical Medicine 11, no. 18 (September 18, 2022): 5478. http://dx.doi.org/10.3390/jcm11185478.
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Submuscular plating and osteotomy using power saw have shown the benefits in certain situations of limb lengthening. However, no previous studies combining both procedures have been conducted for acute tibial deformity correction and limb lengthening. Nineteen cases were enrolled in this study. Ten patients received tibial lengthening with acute knee angular deformity correction using high-energy osteotomy (Group 1), and nine patients received tibial lengthening only with osteotomy using multiple drills and osteotome (Group 2). Radiographic parameters retrieved before and after the operation included leg-length discrepancy, tibial length, length gained, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD). There were significant differences between groups in terms of external fixator index (EFI) (p = 0.013) and healing index (HI) (p = 0.014), but no significance in the length gained (p = 0.356). The latest postoperative mLDFA (p = 0.315), MPTA (p = 0.497), and MAD (p = 0.211) of Group 1 were not distinguishable from Group 2. The functional outcomes were excellent, and there were no permanent complications. Despite showing a longer healing time, this alternative lengthening procedure which combines fixator-assisted plate lengthening in the tibia with simultaneous surgical intervention of acute tibial deformity correction using an oscillating saw is appropriate for patients with leg-length discrepancy and angular deformity of the tibia.
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Toliopoulos, Panagiota, Marc-Andre LeBlanc, Jonathan Hutt, Martin Lavigne, Francois Desmeules, and Pascal-Andre Vendittoli. "Anatomic Versus Mechanically Aligned Total Knee Arthroplasty for Unicompartmental Knee Arthroplasty Revision." Open Orthopaedics Journal 10, no. 1 (July 28, 2016): 357–63. http://dx.doi.org/10.2174/1874325001610010357.
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Objectives:The purpose of this study was to compare the intra-operative benefits and the clinical outcomes from kinematic or mechanical alignment for total knee arthroplasty (TKA) in patients undergoing revision of failed unicompartmental kneel arthroplasty (UKA) to TKA.Methods:Ten revisions were performed with a kinematic alignment technique and 11 with a mechanical alignment. Measurements of the hip-knee-ankle angle (HKA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) were performed using long-leg radiographs. The need for augments, stems, and constrained inserts was compared between groups. Clinical outcomes were compared using the WOMAC score along with maximum distance walked as well as knee range of motion obtained prior to discharge. All data was obtained by a retrospective review of patient files.Results:The kinematic group required less augments, stems, and constrained inserts than the mechanical group and thinner polyethylene bearings. There were significant differences in the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) between the two groups (p<0.05). The mean WOMAC score obtained at discharge was better in the kinematic group as was mean knee flexion. At last follow up of 34 months for the kinematic group and 58 months for the mechanical group, no orthopedic complications or reoperations were recorded.Conclusion:Although this study has a small patient cohort, our results suggest that kinematic alignment for TKA after UKA revision is an attractive method. Further studies are warranted.
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Saw, Aik, Zi Hao Phang, Mohammed Khalid Alrasheed, Roshan Gunalan, Mohammed Ziyad Albaker, and Rukmanikanthan Shanmugam. "Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults." Journal of Orthopaedic Surgery 27, no. 3 (September 1, 2019): 230949901987398. http://dx.doi.org/10.1177/2309499019873987.
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Purpose: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy. Methods: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA). Results: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection. Conclusions: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.
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Livet, Véronique, Mathieu Taroni, François-Xavier Ferrand, Claude Carozzo, Eric Viguier, and Thibaut Cachon. "Modified Triple Tibial Osteotomy for Combined Cranial Cruciate Ligament Rupture, Tibial Deformities, or Patellar Luxation." Journal of the American Animal Hospital Association 55, no. 6 (November 1, 2019): 291–300. http://dx.doi.org/10.5326/jaaha-ms-6823.
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ABSTRACT Proximal tibial deformities or patellar luxation may occur concurrently with cranial cruciate ligament rupture. The objective of this study was to describe the management of those conditions with a modified triple tibial osteotomy (TTO) in nine dogs. Medical records of dogs who underwent a modified TTO were reviewed. The mean pre- and postoperative patellar tendon angles were 104.2° and 92.9°, respectively. The mean pre- and postoperative mechanical medial proximal tibial angles were 99.5° and 91.5°, respectively. Medial patellar luxation was present in five dogs (55.6%) and treated in all five dogs with a tibial crest transposition. Tibial torsion was grossly resolved in two dogs (22.2%). Perioperative distal tibial crest fracture was treated by pins and a figure-of-eight tension-band wire in five dogs (55.6%). One major (surgical site infection) and three minor postoperative complications were observed. At the last follow-up, seven dogs (77.8%) had no lameness, one dog (11.1%) had mild lameness, and one dog (11.1%) had moderate lameness. Radiographic evaluation showed good (2/9; 22.2%) to excellent (7/9; 77.8%) bone healing. The visual analog scale evaluation revealed good-to-excellent owner satisfaction. Cranial cruciate ligament rupture, tibial deformities, and medial patellar luxation are difficult to treat together. A modified TTO may be used to treat these conditions.
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Roh, Yh. "Effect of Jig on the Precision of Tibial Plateau Leveling Osteotomy in Toy-Breed Dogs." Pakistan Veterinary Journal 40, no. 04 (December 1, 2020): 484–88. http://dx.doi.org/10.29261/pakvetj/2020.070.
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Because of plate development, it is now possible to perform tibial plateau leveling osteotomy (TPLO) in small-breed dogs with cranial cruciate ligament rupture. Compared with conventional treatment, faster walking and better function are reported post-TPLO. However, TPLO can be more difficult in toy-breed dogs than large-breed dogs. Because of the smaller bones, it is difficult to manipulate the bone fragments during surgery, and small movements of bones can cause major differences in limb alignment. In TPLO, a jig is conventionally recommended to increase the accuracy of alignment; however, installation of the jig can be difficult in small-breed dogs, and it may cause problems such as iatrogenic fracture. The present study thus aimed to evaluate the accuracy of TPLO without a jig in toy-breed dogs. Paired stifles (n=22) obtained from 11 toy-breed dogs cadavers (body weight range, 2.0-7.4 kg) were randomly assigned to a jig or non-jig group. Radiographic images were obtained preoperative and postoperative TPLO. Tibias were dissected from the hindlimb and measured for evaluation of accuracy. The following postoperative parameters were compared: tibial plateau angle, mechanical medial proximal tibial angle, osteotomy location, tibia crest thickness, gap between segments, and orientation line angles. There were no significant differences between the two groups, demonstrating that jig usage does not affect precision of TPLO in toy-breed dogs. Therefore, it is better not to use a jig in toy-breed dogs with relatively small bones, considering the risk of iatrogenic injury, cost and operation time
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Brown, Matthew L., Julie C. McCauley, Guilherme C. Gracitelli, and William D. Bugbee. "Osteochondritis Dissecans Lesion Location Is Highly Concordant With Mechanical Axis Deviation." American Journal of Sports Medicine 48, no. 4 (March 2020): 871–75. http://dx.doi.org/10.1177/0363546520905567.
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Background: The cause of osteochondritis dissecans (OCD) is unknown. Purpose: To determine if mechanical axis deviation correlates with OCD lesion location in the knee, if degree of mechanical axis deviation correlates with size of OCD lesion, and if the deformity was primarily in the distal femur or proximal tibia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We identified 61 knees that underwent osteochondral allograft (OCA) transplantation for femoral condyle OCD lesions and used preoperative lower extremity alignment radiographs to measure lower extremity mechanical axis, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and hip-knee-ankle angle. Lesion location and area were retrieved from operative records. Results: The location of the OCD lesion was the medial femoral condyle (MFC) for 37 knees and lateral femoral condyle (LFC) for 24 knees. Among knees with MFC lesions, alignment was varus in 25 (68%). Conversely, knees with LFC lesions had valgus alignment in 16 (67%). The mLFDA was significantly more valgus in the LFC group. mMPTA was not different between MFC and LFC groups. There was no significant correlation between degree of mechanical axis deviation and lesion size. Conclusion: In this cohort, two-thirds of patients with symptomatic OCD lesions had associated mechanical axis deviation. Lesion location correlated with mechanical axis deviation (LFC lesions were associated with a deformity in the distal femur). Degree of deformity was not correlated with lesion size. Mechanical axis deviation may play a role in OCD pathogenesis. These data do not allow analysis of the role of mechanical axis deviation in causation or prognosis of OCD lesions, but surgeons treating OCD should be aware of this common association.
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Danino, B., R. Rödl, J. E. Herzenberg, L. Shabtai, F. Grill, U. Narayanan, E. Segev, and S. Wientroub. "Growth modulation in idiopathic angular knee deformities: is it predictable?" Journal of Children's Orthopaedics 13, no. 3 (June 2019): 318–23. http://dx.doi.org/10.1302/1863-2548.13.190033.
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Purpose To evaluate the temporal and spatial sequence of events following temporal hemiepiphysiodesis in idiopathic knee varus/valgus. Methods This is a retrospective multicentre study on 372 physes in 206 patients. The average rate of correction (ROC) was calculated; univariate and multivariate analysis were performed. Results In all, 92% of the femoral physes were followed for more than one year/reached skeletal maturity. Of those, 93% were corrected to a mechanical lateral distal femoral angle (mLDFA) of 85° to 89°; 2% did not, while 5% were over-corrected. A total of 92% of the tibial physes were followed for more than one year/reached skeletal maturity. Of those, 92% were corrected to a mechanical medial proximal tibial angle (mMPTA) of 85° to 89°; 2% did not, while 6% were over-corrected. Factors significantly influencing success and ROC were age, direction and magnitude of deformity. Femoral ROC was significantly faster than tibial ROC: 0.85° versus 0.78°/month, respectively (p = 0.05). Femoral valgus ROC was significantly faster than varus ROC: 0.90° versus 0.77°/month, respectively (p = 0.04). A constant was derived to calculate the amount of correction. Significant correlation was found between calculated and actual mLDFA in valgus deformity during the first year (r = 0.58 to 0.87, p < 0.01). Calculated mLDFA of varus deformity did not correlate with actual mLDFA. Significant correlation was found when calculating mMPTA correction in all deformities. Conclusions Femur corrects faster than tibia; valgus femoral deformities are corrected faster than varus. Valgus correction in the distal femur/proximal tibia as well as varus correction in the tibia in idiopathic patients is highly predictable. The constant derived is the first tool which enables predicting and monitoring amount of correction in hemiepiphysiodesis when correcting angular deformities around the knee. Level of Evidence IV
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Bhimani, Rohan, Soheil Ashkani-Esfahani, Bart Lubberts, Daniel Guss, Gino Kerkhoffs, Christopher W. DiGiovanni, and Gregory R. Waryasz. "Defining Reference Values for the Anatomical Axis of Syndesmosis and Landmark for the Clamp Placement to Minimize Malreduction." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0011. http://dx.doi.org/10.1177/2473011421s00116.
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Category: Ankle; Sports; Trauma Introduction/Purpose: Malreduction of the fibula within the incisura is often caused by an eccentric clamp or screw placement and short fibular length. Weightbearing computed tomography (WBCT) has proven to be a reliable method to diagnose syndesmotic instability and can be used as a template to determine the syndesmotic axis and optimal position to place the clamp. We aimed to determine the anatomic axis of the syndesmosis, or the trans-syndesmotic angle (TSA) in healthy individuals on WBCT, and to see if side-to-side and gender based variations exist. We also aimed to determine the clamp's medial tine placement along the trans-syndesmotic axis. Methods: The study group was made up of patient population without ankle injury who underwent bilateral foot and ankle WBCT imaging (n = 100; 200 ankles). Measurements on bilateral WBCT images included: 1) TSA at 1cm, 2cm, and 3cm proximal to tibial plafond, respectively; 2) Medial tine of the clamp positioning at 1cm and 2 cm along the syndesmotic axis. The medial tine clamp position was described in terms of the percentage of anterior to posterior tibial diameter from the anterior cortical boundary. In addition, the aforementioned TSA measurements were compared to historically defined 30 degrees of syndesmotic axis. Paired t-test was used to compare side to side and gender based differences. A p-value < 0.05 was considered statistically significant. Results: In the uninjured healthy population, the mean trans-syndesmotic angles were 17.60, 21.60, and 24.10 at 1cm, 2cm, and 3cm proximal to the tibial plafond respectively. The clamp's medial tine should be positioned 24.7% and 21.3% of the AP tibial cortical distance, posterior to the anterior tibial cortex at 1cm and 2 cm proximal to the tibial plafond. There was no significant side to side or gender based differences for any of the measurements. Additionally, all three weightbearing TSA measurements were significantly larger than the historically defined syndesmotic angle of 30 degrees (p<0.001). Conclusion: Preoperative WBCT imaging provides a reliable template to determine TSA and to plan optimal clamp tine positioning along the syndesmotic axis. Our study has established normal ranges for cross-sectional syndesmotic axis measurements during weight-bearing and established that no differences exist between laterality and gender in patients without syndesmotic injury.
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Khairy, Umaima R., Sadiq J. Hamandi, and Ahmed S. Abid Ali. "Proposed Geometrical Tool for Cases of Laterally Adapted Tibial Tubercle during Total Knee Replacement." Advances in Orthopedics 2021 (August 7, 2021): 1–7. http://dx.doi.org/10.1155/2021/5244034.
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The alignment of tibial component in total knee replacement operation must be achieved in three planes to ensure optimum results. In coronal plane, the alignment depends on three anatomical landmarks. These landmarks are tibial tuberosity, leg shin, and midtalar point. In eastern community, people get used to sit cross-legged which causes additional tension in the quadriceps muscle which is attached distally to the tibial tuberosity. This tension causes adaptation of the tuberosity laterally. Tuberosity adaptation causes the three anatomical landmarks being not collinear. In this work, eight cases of lateral adapted tubercle were diagnosed of this condition before the surgery and their X-ray images after the surgery were checked regarding tibial alignment. Tibial alignment has been checked by measuring the medial proximal tibial angle (MPTA) which is the angle between the mechanical tibial axis and the tibial component plateau. MPTAs for the eight cases were (86.9°–93.6°). Three cases had MPTA less than 90° indicating varus alignment and five of them had MPTA more than 90° indicating valgus alignment. A geometrical tool was designed using the DesignSpark Mechanical software as a proposed solution to solve the adaptation problem. The tool can give a method for fixing the tibial component precisely without any varus\valgus malalignment.
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Qiao, Yi, Junjie Xu, Xiuyuan Zhang, Zipeng Ye, Chenliang Wu, Caiqi Xu, Song Zhao, and Jinzhong Zhao. "Correlation of Tibial Torsion With Lower Limb Alignment and Femoral Anteversion in Patients With Patellar Instability." Orthopaedic Journal of Sports Medicine 10, no. 12 (December 1, 2022): 232596712211414. http://dx.doi.org/10.1177/23259671221141484.
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Background: Alignment and rotation of the lower extremities have been suggested to be predisposing pathologic factors for patellar instability. Purpose: To elucidate the relationship between the lower limb alignment and lower extremity rotation in patients with patellar instability. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 83 patients with patellar instability. Computed tomography scans and standing full-leg radiographs were used to measure the tibial tuberosity–trochlear groove (TT-TG) distance, mechanical femorotibial angle (mFTA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), femoral torsion, and tibial torsion of the different segments. The relationships between femoral torsion, tibial torsion of the different segments, and the mFTA, mLDFA, and mMPTA were evaluated. The levels of tibial torsion and femoral torsion in patients with varus, normal, or valgus alignment were compared with 1-way analysis of variance and chi-square test. Results: The total tibial torsion was significantly associated with total femoral anteversion ( r = 0.329; P = .002) and mFTA ( r = –0.304; P = .005). There were no significant correlations between mFTA and TT-TG distance or femoral anteversion. Compared with patients with valgus malalignment, patients with varus malalignment tended to have higher tibial torsion. Conclusion: Tibial torsion was associated with leg axis alignment and femoral anteversion in patients with patellar instability. Patients with patellar instability, especially those with concurrent leg axis deformities, should undergo further radiological imaging so that tibial torsion can be assessed and a diagnosis of torsion deformity made early in the treatment pathway and the proper surgical plan formulated.
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Wang, Peizhao, Xiao Wang, Xiaotao Shi, and Honglue Tan. "Evaluation of Accuracy of Preoperative Planning of the Femurofibular Angle in Open-Wedge High Tibial Osteotomy for Mild Medial Knee Osteoarthritis." BioMed Research International 2021 (February 18, 2021): 1–8. http://dx.doi.org/10.1155/2021/8813300.
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Objective. The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. Methods. Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. Results. The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02 % to a postoperative value of 56.19 ± 0.10 % from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08 % at the final follow-up ( P < 0.01 ). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values ( P > 0.05 ). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63 ° to a postoperative week-one valgus of 2.37 ± 0.28 ° , and it had a valgus of 2.48 ± 0.39 ° at the final follow-up ( P < 0.01 ). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26 ° ( P > 0.05 ). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53 ° and 90.33 ± 1.52 ° , respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72 ° and the intraoperative setting value of 90.25 ± 1.67 ° ( P > 0.05 ). All corrected values were within the acceptable range of preoperative planning. Conclusion. Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.
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Eberbach, Helge, Julian Mehl, Matthias J. Feucht, Gerrit Bode, Norbert P. Südkamp, and Philipp Niemeyer. "Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity." American Journal of Sports Medicine 45, no. 4 (December 21, 2016): 909–14. http://dx.doi.org/10.1177/0363546516676266.
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Background: Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. Purpose: The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary–based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. Results: Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a straight-leg axis and an anatomic postoperative joint line with a tolerance of ±4°, the ideal site of a corrective osteotomy was tibial in 55.2% of cases and femoral in 19.5% of cases. A double-level osteotomy would be necessary in 25.2% of cases. With a tolerance of ±2°, the ideal osteotomy site was the proximal tibia in 41.0% of cases and the distal femur in 13.6% of cases; a double-level osteotomy would be necessary in 45.5% of cases. Conclusion: In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.
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Vilensky, Viktor A., Andrey A. Pozdeev, Timur F. Zubairov, and Ekaterina A. Zakharyan. "Treatment of pediatric patients with lower leg deformities associated with physeal arrest: analysis of 28 cases." Pediatric Traumatology, Orthopaedics and Reconstructive Surgery 5, no. 4 (December 28, 2017): 38–47. http://dx.doi.org/10.17816/ptors5438-47.
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Aim. To retrospectively analyze the results of two treatment methods for lower leg deformities associated with partial growth arrest.
Materials and methods. Group I comprised 15 children who underwent osteotomy, acute overcorrection, and external fixation by Ilizarov with subsequent lengthening of the segment. Group II comprised 13 patients who underwent epiphysiodesis of the healthy part of the growth plate by drilling, osteotomy with external fixation by use of an Ortho-SUV Frame, and subsequent gradual deformity correction and lengthening.
Results. In group I, overcorrection of varus deformities by mechanical axis deviation (MAD) was 18.28 ± 5.25 mm, overcorrection by mechanical medial proximal tibial angle (mMPTA) was 14.86 ± 4.45°, and overcorrection by mechanical lateral distal tibial angle (mLDTA) was 12.85 ± 3.02°. Overcorrection of valgus deformities according to MAD was 15.12 ± 8.28 mm, overcorrection by mMPTA was 10.38 ± 2.77°, and overcorrection by mLDTA was 7.5 ± 3.9°. Recurrence of the deformity was observed in 11 (73%) cases (range, 5–16 months).
In group II, the accuracy of correction (AC) in varus deformities for MAD was 98% and 94% for mMPTA and mLDTA. For valgus deformities, AC for MAD was 90% and 96% for mMPTA and mLDTA. The AC for anatomical proximal posterior tibial angle and anatomical anterior distal tibial angle was 96% for procurvation deformities and that for recurvation deformities was 92%. Deformity recurrence was observed in only one case within 6 months after frame removal. In 2 cases, repeat limb length discrepancy correction surgeries were performed.
Conclusion. Use of epiphysiodesis of the healthy portion of the growth plate in combination with osteotomy, computer-assisted external fixation with subsequent gradual deformity correction, and lengthening in patients with deformities associated with partial physeal arrest significantly decreased the number of deformity recurrences.
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Park, Jun-Gu, Seung-Beom Han, and Ki-Mo Jang. "Association of Preoperative Tibial Varus Deformity With Joint Line Orientation and Clinical Outcome After Open-Wedge High Tibial Osteotomy for Medial Compartment Osteoarthritis: A Propensity Score–Matched Analysis." American Journal of Sports Medicine 49, no. 13 (October 8, 2021): 3551–60. http://dx.doi.org/10.1177/03635465211044146.
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Background: The correction of lower limb deformity should be performed at the site of deformity to maintain knee joint orientation. However, the effectiveness of open-wedge high tibial osteotomy (OWHTO) for treatment of medial osteoarthritis in varus malalignment without definite tibial varus deformity has not been confirmed. Purpose/Hypothesis: This study aimed to compare the clinical and radiologic outcomes after OWHTO in patients without tibial varus deformity versus patients with tibial varus deformity after matching for confounding factors. We hypothesized that these outcomes would be inferior in patients without tibial varus deformity. Study Design: Cohort study; Level of evidence, 3. Methods: The outcomes of 133 OWHTO operations for medial osteoarthritis in 107 patients were retrospectively reviewed after follow-up for >2 years. The patients were divided into group 1 (tibia with varus deformity, preoperative medial proximal tibial angle [MPTA] <85°) and group 2 (tibia without varus deformity, preoperative MPTA ≥85°). The confounding factors, including patient characteristics, preoperative limb alignment, degree of osteoarthritis, and correction angle, were matched using propensity score matching. The radiologic parameters, including MPTA and joint line obliquity, were evaluated preoperatively, between 6 and 12 months postoperatively, and at the last follow-up. The radiologic outcomes were assessed using the medial joint space width and mechanical hip-knee-ankle angle. The clinical outcomes were evaluated by the Hospital for Special Surgery knee score, Knee Society Score (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The clinical and radiologic outcomes were compared between the groups. The proportions of patients achieving improvement in the clinical outcome beyond the minimal clinically important difference (MCID) or minimally important change were compared between the groups. Results: After propensity score matching, 32 patients were selected for each group. The mechanical hip-knee-ankle angle was corrected without significant difference from a mean ± SD varus angle of 8.0°± 3.3° to valgus angle of −3.2°± 2.5° in group 1 and from varus 8.0°± 3.6° to valgus −3.9°± 1.7° in group 2. The preoperative joint line obliquity was greater in group 2 as compared with group 1 (2.2°± 2.2° vs −0.4°± 1.8°, P < .001). With a similar 10° correction angle, the postoperative MPTA and joint line obliquity were 96.6°± 2.5° and 5.3°± 2.3°, respectively, in group 2, which were greater than 94.0°± 2.6° and 3.5°± 1.8°, respectively, in group 1 (both P < .001). The changes in joint space width and mechanical hip-knee-ankle angle were not significantly different between the groups over the follow-up period. At the last follow-up, the postoperative KSS objective score and WOMAC pain score in terms of symptom improvement were not significantly different between groups ( P = .092 and .068). However, the postoperative KSS and WOMAC functional scores were significantly worse in group 2 than in group 1 (77.3 ± 14.1 vs 84.4 ± 11.6, P = .044; 10.3 ± 9.2 vs 5.6 ± 7.2, P = .001). In group 1, 96.9% and 100% of patients showed improvements of >10 points in the KSS functional score and 15 points in the WOMAC functional score based on MCID or minimally important change. Meanwhile, 65.6% and 81.3% of patients in group 2, which were significantly lower than those of group 1, were improved beyond the MCID or minimally important change ( P = .001 and .024, respectively). Conclusion: In varus malalignment, the knee joint line was more oblique in patients without tibial varus deformity after OWHTO pre- and postoperatively. The clinical outcomes in terms of functional scores were inferior in patients without tibial varus deformity. However, the radiologic outcomes and symptomatic improvement after OWHTO were comparable regardless of the preoperative tibial varus deformity on midterm follow-up.
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Kim, Kang-Il, Min-Chul Seo, Sang-Jun Song, Dae-Kyung Bae, Duk-Hyun Kim, and Sang Hak Lee. "Change of Chondral Lesions and Predictive Factors After Medial Open-Wedge High Tibial Osteotomy With a Locked Plate System." American Journal of Sports Medicine 45, no. 7 (March 14, 2017): 1615–21. http://dx.doi.org/10.1177/0363546517694864.
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Background: Although cartilage regeneration after medial open-wedge high tibial osteotomy (HTO) has been described, there is a paucity of reports regarding which factors influence cartilage regeneration. Purpose: To document whether cartilage regeneration occurs in the previously degenerated medial compartment of arthritic knees after medial open-wedge HTO without concomitant cartilage procedures and to assess which predictive factors influence regeneration after HTO. Study Design: Case series; Level of evidence, 4 Methods: From February 2008 to January 2014, 104 consecutive knees were enrolled retrospectively that received medial open-wedge HTO with a medial locked plate system without any additional cartilage regeneration procedures and were followed by second-look arthroscopy for plate removal 2 years after surgery. The mean ± SD age at the time of index HTO was 56.3 ± 5.4 years. Cartilage status was graded at the time of initial HTO and second-look arthroscopy according to the International Cartilage Repair Society grading system, and regenerated articular cartilage was classified by the macroscopic staging system of Koshino et al at the time of second-look arthroscopy. Variables evaluated for possible association with regeneration of articular cartilage included age, sex, body mass index (BMI), American Knee Society score, mechanical tibiofemoral angle, medial proximal tibial angle, amount of correction angle, and degree of arthritis. Results: Per the International Cartilage Repair Society grading system, the lesions in the medial femoral condyle and the medial tibial plateau were improved in 54 knees (51.9%) and 36 knees (34.6%), respectively, at the time of second-look arthroscopy. According to the macroscopic grading system, partial and total regeneration of articular cartilage in the medial femoral condyle and the medial tibial plateau was observed in 75 knees (72%) and 57 knees (55%), respectively. Based on univariable logistic regression tests, regeneration of articular cartilage was associated with a smaller mean preoperative varus mechanical tibiofemoral angle (odds ratio [OR], 0.7; P = .023) and lower BMI (OR, 0.8; P = .026) for the medial femoral condyle and younger age (OR, 0.9; P = .048) and a larger mean correction angle (OR, 1.1; P = .023) for the medial tibial plateau. The mean preoperative knee and function scores were significantly improved at the last follow-up, but no correlation was found between the clinical outcomes and cartilage regeneration. Multiple logistic regression analysis for regeneration of articular cartilage showed lower BMI (OR, 0.7; P = .015) to be a significant predictor for the medial femoral condyle. Conclusion: Regeneration of degenerated articular cartilage in the medial compartment can be expected while correcting a varus deformity in arthritic knees after medial open-wedge HTO with a locked plate system without any additional cartilage regeneration procedures. Moreover, we suggest that medial open-wedge HTO in the medial arthritic knee with varus malalignment should be highly successful in terms of cartilage regeneration, especially for lower BMI patients.
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Rosso, Federica, Roberto Rossi, Antonino Cantivalli, Carola Pilone, and Davide Edoardo Bonasia. "Joint Line Obliquity Does Not Affect the Outcomes of Opening Wedge High Tibial Osteotomy at an Average 10-Year Follow-up." American Journal of Sports Medicine 50, no. 2 (December 2, 2021): 461–70. http://dx.doi.org/10.1177/03635465211059811.
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Background: A significant number of high tibial osteotomies (HTOs) result in an overcorrected tibia and subsequent excessive lateral joint line obliquity (JLO). The correlation between excessive JLO and poor outcomes is controversial. Purpose: To evaluate the prognostic factors (including a pathological postoperative JLO) related with the outcomes of opening wedge HTO at 10 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing HTO between 2004 and 2017 for medial osteoarthritis and with a postoperative hip-knee-ankle angle between 176° and 185° were included. Clinical evaluation included Knee Society Score (KSS; knee score and function score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale for pain. Several mechanical and anatomic angles were measured pre- and postoperatively on long-leg weightbearing radiographs. Abnormal JLO was defined as a Mikulicz–joint line angle (MJL) ≥94° or a mechanical medial proximal tibial angle (mMPTA) ≥95°. Regression analysis was performed to evaluate the association between independent variables and each outcome. A Kaplan-Meier cumulative survival analysis was performed. Results: A total of 92 knees in 76 patients were included. The mean age of the patients was 53.5 years (SD, 9.7 years), and the mean follow-up was 129.4 months (SD, 44.4 months). Increased JLO was associated with a significant preoperative varus deformity (small preoperative hip-knee-ankle angle), increased mechanical lateral distal femoral angle, increased joint line congruency angle, and increased knee-ankle joint angle. Male sex was associated with better WOMAC scores ( P = .0277), and increased body mass index (BMI) was associated with inferior WOMAC scores ( P = .0024). A good preoperative range of motion was associated with better knee score ( P = .0399) and function score ( P = .0366) on the KSS. An increased BMI was associated with inferior KSS function scores ( P = .0317). MJL ≥94° and mMPTA ≥95° were not associated with inferior WOMAC or KSS outcomes. With indication to total knee arthroplasty as an endpoint, Kaplan-Meier analysis showed a survival rate of 98.7% at 5 years, 95.5% at 10 years, and 92.7% at 12 years. Conclusion: Increased lateral JLO (MJL ≥94° or mMPTA ≥95°) was not correlated with the clinical outcomes of opening wedge HTO at 10 years of follow-up.
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Olsen, Anastasia, Luca Vezzoni, Antonio Ferretti, Ross Palmer, Aldo Vezzoni, and Felix Duerr. "Hemiepiphysiodesis for the correction of proximal tibial valgus in growing dogs." Veterinary and Comparative Orthopaedics and Traumatology 29, no. 04 (July 2016): 330–37. http://dx.doi.org/10.3415/vcot-15-12-0204.
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SummaryObjectives: To describe the use of hemiepiphysiodesis for the treatment of proximal tibial deformities in immature dogs and evaluate the effect on the mechanical medial proximal tibial angle (mMPTA).Methods: Skeletally immature dogs with proximal tibial deformities from three institutions treated with hemiepiphysiodesis between March 2006 and January 2015 were included. All dogs were required to have an mMPTA outside the previously published reference range (93.3 ± 1.78°) preoperatively. Dogs were required to have radiographs or computed tomography performed preoperatively and at least eight weeks postoperatively.Results: A total of 19 dogs (n = 31 limbs) fulfilled the inclusion criteria. The mean mMPTA was 102.5° ± 5.3° preoperatively and 92.4° ± 7.2° at the final re-evaluation. The mean difference in mMPTA was -10 ± 5.1° (range, -1 to -19°; p <0.001). Overcorrection was observed in 16 limbs and mMPTA remained above the reference range in nine limbs. Rebound growth was observed in eight limbs where implant removal was performed.Clinical significance: Hemiepiphysiodesis for the treatment of proximal tibial valgus is a technique that allows for reduction in mMPTA and should be considered as an early treatment for immature animals that are presented with proximal tibial deformities. Serial radiographs to monitor for overcorrection should be performed. Implant removal should be considered if overcorrection occurs, taking into consideration that rebound growth may be observed.A Supplementary Table for this paper is available online at: http://dx.doi.org/10.3415/VCOT-15-12-0204
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Chun, Dong-Il, Jahyung Kim, Sung Hun Won, Jaeho Cho, Jeongku Ha, Minkyu Kil, and Young Yi. "Changes in Coronal Alignment of the Knee Joint after Supramalleolar Osteotomy." BioMed Research International 2021 (February 19, 2021): 1–8. http://dx.doi.org/10.1155/2021/6664279.
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Background. Assessing knee joint orientation changes after SMO may help clinical advancement in managing patients with ipsilateral ankle and knee joint arthritis. However, knee joint changes after supramalleolar osteotomy (SMO) have not been reported. We investigated changes in coronal alignment of the knee joint after SMO. Methods. In this multicentre study, from January 2014 to December 2018, 47 ankles with varus osteoarthritis treated with SMO were retrospectively identified. Ankle joint changes were assessed using the tibiotalar angle, talar tilt angle, and lateral distal tibial angle (LDTA); knee joint changes using the medial proximal tibial angle (MPTA), medial and lateral joint space widths (mJSW and lJSW, respectively), and medial and lateral joint line convergence angles (JLCA); and lower limb alignment changes using mechanical axis deviation angle (MADA) and the hip-knee-ankle (HKA) angle measured on full-length anteroposterior radiographs of the lower extremity. Correlation analysis and binary logistic regression analysis were performed. Results. Postoperatively, LDTA ( p < 0.001 ) and tibiotalar angle ( p < 0.001 ) significantly changed, indicating meaningful improvement in the ankle joint varus deformity. Regarding the knee joint changes, JLCA significantly changed into valgus direction ( p = 0.044 ). As for lower limb alignment changes, MADA significantly decreased ( p < 0.001 ), whereas the HKA angle significantly increased ( p < 0.001 ). In univariate and multivariate logistic regression analyses, changes in the MADA ( p < 0.001 ) and the HKA angle ( p < 0.001 ) were significantly correlated with the correction angle. Conclusions. SMO remarkably improves ankle joint varus deformity, followed by significant lower limb alignment changes. Despite meaningful changes in JLCA, the relationship between the amount of osteotomy near the ankle joint and improvement in knee joint radiographic parameters was not significant. Radiographic parameters of the knee joint would less likely be changed following SMO.
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Sakti, Triharto Banjaran, Natan Kevin Partogu Siagian, Wongso Kesuma, and Andreas Marojahan Haratua Siagian. "Simultaneous Gradual Correction of Bilateral Late Onset Tibia Vara using High Tibial Osteotomy with a Mono-Axis Dynamic External Fixator: A Case Report." Hip and Knee Journal 3, no. 1 (February 25, 2022): 40–43. http://dx.doi.org/10.46355/hipknee.v3i1.115.
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Tibia vara is a disease characterized by an abrupt angulation of the tibia into varus in the proximal end. This condition is caused by developmental growth defect of the proximal tibia physis. Tibia Vara can be classified into groups according to the age of the patient and the mainstay treatment is either acute or gradual surgical correction.A 21 year-old man with chief complaint bowing of the legs with leg pain since 3 years ago. Physical examination showed bilateral genu varum. The anteroposterior long leg standing X-Ray found that the deformity was of osseous origin at the proximal part of the tibia in varus position. Medial osteotomy of the proximal tibia was performed and a dynamic external fixator was installed. Gradual correction was performed at a rate of 1 mm per day. After 3 months, radiological evaluation showed good union and target angle of correction with acceptable mechanical axis was achieved. Patient had no complaint of pain or instability post-surgery.Gradual correction using external fixator provides a more flexible angle correction with lower risk of neurovascular compromises; but with its own disadvantage such as loss of correction after removal of the external device. In this case, gradual correction of late onset tibia vara using dynamic external fixator provides satisfactory outcome and enable a more fine-tuned angle correction. It also potentially eliminate the need for a second surgery to remove the external device; thus reducing the length of hospitalization.
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Meade, Matthew, Eugene Borst, Joseph Nguyen, S. Rozbruch, and Austin Fragomen. "Does the Surgical Correction of Tibial Torsion with Genu Varum Produce Outcomes Similar to Those in Varus Correction Alone?" Journal of Knee Surgery 31, no. 04 (June 24, 2017): 359–69. http://dx.doi.org/10.1055/s-0037-1603797.
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AbstractThe aim of this article is to study the relationship between tibia vara and external tibial torsion in adults. The following questions were asked: (1) what is the incidence of rotational deformity in patients with genu varum and (2) do patients who undergo correction of tibial torsion with genu varum have similar outcomes to those who undergo simple tibia vara correction? In this study, 69 patients (138 limbs) underwent bilateral proximal tibial osteotomy for the correction of genu varum. Patients with simple coronal plane deformity (varus alone) were treated with either a monolateral external fixator or a hexapod frame. Those with concomitant external tibial torsion were treated with circular external fixation. The primary outcome was the ability to achieve the desired correction of alignment in the coronal, sagittal, and axial planes. Secondary outcomes included a postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) and a routine patient satisfaction questionnaire. The incidence of tibial torsion among the entire group of patients with bilateral tibia vara was 46% and overwhelmingly external in direction. The two groups had some significant differences in demographics with torsion patients tending to be younger and thinner. The final mechanical axis deviation and medial proximal tibial angle values for both groups did not differ significantly (p = 0.956). The postcorrection thigh–foot axis was not significantly different between the two groups (p = 0.666). Time to union was not significant (p > 0.999). KOOS was not different between the two groups in symptoms, pain, activities of daily living, and return to sport. There was a difference in the quality of life score between the two groups (p = 0.044). There was no difference between the two groups regarding the patient questionnaire. Based on the finding of this analysis, the incidence of rotational malalignment with genu varum is close to 50%. The recognition of this close association with external tibial torsion deformity may allow for further insights into the role of rotation in varus deformity-related knee pathology and treatment. Patients can expect nearly identical outcomes from this surgery.
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Harrer, Jörg, Max Schenke, Christoph Lutter, Jörg Dickschas, Matthias Feucht, and Thomas Tischer. "Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration." Video Journal of Sports Medicine 1, no. 6 (November 2021): 263502542110466. http://dx.doi.org/10.1177/26350254211046632.
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Background: Lower extremity alignment-correcting procedures for unicompartmental osteoarthritis are experiencing a rapid rise. Medial open-wedge high tibial osteotomy (MOW-HTO) thereby represents the most common technique among osteotomies but is limited in cases of severe malalignment. Some cases make a double-level osteotomy necessary. Indications: If planning of malalignment correction using a MOW-HTO results in a mechanical medial proximal tibial angle (mMPTA) of more than 93° (causing an oblique joint line), double-level osteotomy is indicated to avoid nonphysiological knee kinematics. Technique Description: After clinical examination and detailed analysis of malalignment (full-weight-bearing long-leg radiograph: hip-knee-angle [HKA], mMPTA, mechanical lateral distal femoral angle [mLDFA], joint line convergence angle [JLCA]), as well as individualized planning of the correction, the surgical procedure starts with an arthroscopy to evaluate the cartilage conditions and eventually treat intraarticular pathologies. Then, the femoral supracondylar correction is performed (closed wedge, biplanar osteotomy [ to increase bony healing]) according to the presurgical planning by resecting the osteotomy wedge with the measured length. K-wires are placed to check the correction. An angle-stable plate is used for osteosynthesis. The wedge taken out will be used as bone stock for the MOW-HTO afterward. The biplanar open-wedge tibial osteotomy is then performed subsequently using a medial tibial approach and an angle-stable plate. Opening of the osteotomy is then performed and double checked with intraoperative fluoroscopy using an alignment rod. Postoperative partial weight bearing for 6 weeks is recommended. Results: In recent literature, only few publications report on results of double-level osteotomies. Babis et al reports that it is a valuable procedure for patients with large varus deformity. Nakayama et al noted a significant improvement in patient-registered clinical outcomes in early postoperative evaluation of 20 patients. Schröter et al reports on 37 knees and findings include good clinical results, despite progressive osteoarthritis. Discussion/Conclusion: In cases of severe malalignment, adequate axis correction may require a double-level osteotomy. Exact preoperative planning is essential. Results reported in recent publications are promising. By splitting 1 large correction into 2 smaller ones, complications like hinge fracture and delayed bone healing are lowered.
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Winanto, Iman Dwi, and Yoyos Dias Ismiarto. "Mechanical Lateral Distal Femoral Angle (MLDFA), Medial Proximal Tibia Angle (MPTA), and Mechanical Axis Deviation (MAD) Value in Young Adults in North Sumatera." Cermin Dunia Kedokteran 49, no. 4 (April 1, 2022): 184. http://dx.doi.org/10.55175/cdk.v49i4.1817.
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<p>Introduction. Reference value to determine the angle of lower extremity is only based on clinical measurement and radiological assessment, which is limited to tibiofemoral angle (TFA). Although this examination can estimate the lower extremity angle, it is not satisfactory for a comprehensive analysis. Material and Method. A descriptive study in RSUP Haji Adam Malik Hospital in August - September 2019 to measure mechanical lateral distal femoral angle (MLDFA), medial proximal tibia angle (MPTA), and mechanical axis deviation (MAD). Results. Thirty nine subjects were included in this study. The mean age was 26.77±4,65 years old (range: 22 to 39 years); 69,2% were male (n = 27) and 30,8% were female (n = 12). The average mechanical lateral distal femoral angle (MLDFA) was 87,93o ±2,16o . The average medial proximal tibia angle (MPTA) was 86,28o ±2,26o . The average mechanical axis deviation (MAD) was 1.56±1,48 mm. Our results of MLDFA and MPTA measurement, but not in MAD, are consistent with study conducted by Farr, et al. Conclusion. Our MLDFA, MPTA, but not MAD measurement results are similar to studies involving Caucasian population.</p><p>Pendahuluan. Nilai acuan sudut pada ekstremitas bawah hanya berdasarkan pemeriksaan klinis dan radiologis, yang terbatas pada sudut tibiofemoral. Pemeriksaan sudut tibiofemoral (STF) tunggal tidak cukup untuk analisis komprehensif ekstremitas bawah. Bahan dan Cara. Penelitian deskriptif di RSUP Haji Adam Malik pada bulan Agustus – September 2019 untuk mengukur sudut mekanik lateral distal femur (SMLDF), sudut medial proksimal tibia (SMPT), dan deviasi aksis mekanik (DAM). Hasil. Sejumlah 39 subjek diteliti. Usia rata-rata 26,77 ± 4,65 tahun (22 - 39 tahun); 69,2% pria (n = 27) dan 30,8% wanita (n = 12). Nilai rata-rata sudut mekanik lateral distal femur (SMLDF) adalah 87,93º ± 2,16º. Nilai rata-rata sudut medial proksimal tibia (SMPT) adalah 86,28º ± 2,26º. Nilai rata–rata deviasi aksis mekanik (DAM) adalah 1.56 ± 1,48 mm. Pada penelitian ini, hasil pengukuran SMLDF dan SMPT sesuai hasil penelitian Farr, et al, tetapi hasil pengukuran DAM tidak sesuai. Simpulan. Nilai SMLDF dan SMPT pada penelitian ini tidak berbeda dengan penelitian pada populasi Kaukasia</p><p> </p>
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Phetkaew, Thitaporn, Marissak Kalpravidh, Rampaipat Penchome, and Chalika Wangdee. "A Comparison of Angular Values of the Pelvic Limb with Normal and Medial Patellar Luxation Stifles in Chihuahua Dogs Using Radiography and Computed Tomography." Veterinary and Comparative Orthopaedics and Traumatology 31, no. 02 (February 2018): 114–23. http://dx.doi.org/10.3415/vcot-17-05-0067.
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Objective This article aimed to determine and compare the angular values of the pelvic limb in normal and medial patellar luxation (MPL) stifles in Chihuahuas using radiography and computed tomographic (CT) scan, to identify the relationship between pelvic limb angles and severity of MPL. In addition, radiographic and CT images were compared to determine the more suitable method of limb deformity assessment. Methods Sixty hindlimbs of Chihuahuas were divided into normal and grade 1, 2, 3 and 4 MPL groups. The pelvic limb angles in frontal and sagittal planes were evaluated on radiography and CT scan. Femoral and tibial torsion angles (FTA and TTA) were evaluated only by CT scan. All angles were compared among normal and MPL stifles and between radiography and CT scan. Results Based on the CT scan, the mechanical lateral distal femoral angle (mLDFA), anatomical caudal proximal femoral angle (aCdPFA), and TTA were related to the severity of MPL. The mLDFA and TTA were significantly increased (p < 0.05) in grade 4 MPL, while the aCdPFA was significantly decreased in grade 2, 3 and 4 MPL groups. There were significant differences of many angles between radiography and CT scan. Clinical Significance The angles related to MPL in Chihuahuas are aLDFA, mLDFA, aCdPFA and TTA. Radiography had some limitations for evaluating pelvic limb angles. The caudocranial radiograph is recommended for the assessment of the distal femoral angles, while the craniocaudal radiograph is for the tibial angles.
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Alcântara, B. M., B. W. Minto, G. G. Franco, D. V. F. Lucena, and L. G. G. G. Dias. "Bridge plating for simple tibial fractures treated by minimally invasive plate osteosynthesis." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 73, no. 3 (May 2021): 589–97. http://dx.doi.org/10.1590/1678-4162-12261.
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ABSTRACT This study aimed to evaluate the effectiveness of bridge plating of simple tibial fractures in dogs by minimally invasive plate osteosynthesis (MIPO). Medical and radiographic records of twenty-nine dogs with simple tibial fractures that underwent bridge fixation by MIPO were retrospectively evaluated. The clinical outcome was classified considering the presence of lameness at the end of the treatment. The tibial mechanical joint angles were measured and compared with the values described in the literature. Additionally, fragment apposition and implant disposition were evaluated. Based on the modified Radiographic Union Scale for Tibial fractures, the moment of clinical union was determined. Clinically, at the end of treatment, only one patient presented lameness at a trot. While there was no significant difference between the bone alignment in the frontal plane values and the values described in the literature (P>0.05), the caudal proximal tibial angle was significantly higher (P=0.001). The median fragment apposition was considered acceptable. The average bridge plate ratio, plate working length, and plate screw density were 0.8, 0.57, and 0.48, respectively. The median time to clinical union was 30 days. Bridge plating in simple tibial fractures resulted in fast healing and low complication rates.
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Song, Suk Kyoon, Cheol Hwan Ryu, and Won-Kee Choi. "Advantages of the experience of navigation when starting manual total knee arthroplasty." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949902090339. http://dx.doi.org/10.1177/2309499020903395.
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Purpose: To evaluate how the accuracy of coronal-plane bone cutting and operative time may be affected by the experience of navigated total knee replacement (TKR) in starters of manual TKR. Methods: We analyzed 30 cases of navigated TKR performed in the early years (group 1), 30 consecutive cases of navigated TKR performed after experiencing more than 100 cases of navigated TKR (group 2), and the initial 30 consecutive cases of manual TKR (group 3). Postoperative mechanical hip-knee-ankle (mHKA) angle, mechanical medial proximal tibial angle (mMPTA), and mechanical lateral distal femoral angle (mLDFA) were measured. Bone cutting was aimed at mHKA angle of 0°, mMPTA of 90°, and mLDFA of 90°. We have set the tolerance of absolute value of errors in mHKA angle, mMPTA and mLDFA as 0 ± 3°. Comparative analysis of tourniquet times have been performed. Results: Postoperative absolute error values of mHKA angle, mMPTA, and mLDFA were 2.78 ± 3.53°, 1.06 ± 1.91°, and 1.44 ± 1.90° in group 1; 1.18 ± 1.32°, 1.20 ± 1.49°, and 0.98 ± 1.09° in group 2; and 2.11 ± 2.49°, 1.35 ± 0.62°, and 1.92 ± 2.85° in group 3. Tourniquet times were 67.50 ± 21.50 min in group 1, while group 2 and group 3 showed tourniquet times of 51.87 ± 12.00 and 52.00 ± 15.00 min, respectively. Conclusion: In starters of manual TKR, previous experience of performing navigated TKR may help the error values during femoral and tibial bone cutting to fall within the values similar to the median error value of navigated TKR. It may also help to reduce the operative time of manual TKR similar to the operative time of and experienced surgeon with over 100 cases of navigated TKR.
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Schmale, G. A., A. F. Bayomy, A. O. O’Brien, and V. Bompadre. "The reliability of full-length lower limb radiographic alignment measurements in skeletally immature youth." Journal of Children's Orthopaedics 13, no. 1 (February 2019): 67–72. http://dx.doi.org/10.1302/1863-2548.13.180087.
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Purpose Reliable radiographic measurement techniques are important for investigating limb alignments prior to and following paediatric anterior cruciate ligament (ACL) reconstruction. We investigated the inter- and intraobserver reliability of alignment measurements from lower extremity anteroposterior and lateral radiographs of adolescents having undergone transphyseal ACL reconstruction Methods A total of 15 of 90 patients who had undergone transphyseal ACL reconstruction were randomly selected for alignment measurements of radiographs of operative and nonoperative limbs. Radiographs were de-identified, randomized to three varying sequences and made available in electronic format to three blinded investigators: a junior orthopaedic resident, a senior orthopaedic resident and a paediatric orthopaedic attending. Coronal measurements comprised the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and mechanical axis deviation (MAD), measured from standing teleoroentgenograms of the lower extremities. Tibial slope was measured on lateral knee radiographs of operative limbs. The intra-class correlation coefficient (ICC) was calculated for each of the three coronal measures and for tibial slope. Results Intraobserver reliability was excellent across all measures (ICC > 0.75) except for tibial slope in one investigator’s measurements (good or ICC = 0.68 for the operative limbs) and mLDFA in another investigator’s measurements (fair or ICC = 0.49 for the operative limbs, and poor ICC = 0.27 for the nonoperative limbs). Interobserver reliability was excellent across all investigators for all measurements for operative and nonoperative limbs. Conclusions Radiographic measurements of lower extremity alignment may be reliably measured on teleoroentgenograms in a subset of youth who underwent transphyseal ACL reconstruction. Level of Evidence III