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Mechanical axis deviation (MAD) is the perpendicular distance between the mechanical axis of the lower extremity and the center of the knee joint.
Source publication
Osteotomies are the established surgical procedure for the deformity of the lower limb induced by osteoarthritis (OA) of the knee and ankle. Closed-wedge (CW) and open-wedge (OW) high tibial osteotomy (HTO) are extra-articular surgery, which aim to shift the mechanical axis from medial to slightly lateral and reduce the overload in the medial compa...
Similar publications
Unintended rotation of the distal tibia occurs during medial open-wedge high tibial osteotomy (MOWHTO). Computed tomography (CT) is the standard method of measuring lower limb alignment; however, the new low-dose EOS system allows three-dimensional limb modeling with automated measurements of lower limb alignment. This study investigated the differ...
Purpose
This study evaluated the tibial torsional angle changes of 72 knees before and after open-wedge high tibial osteotomy (OWHTO) and compared the results according to the osteotomy level.
Materials and methods
Seventy patients (72 knees) with Kellgren–Lawrence grade 3 underwent OWHTO. Demographic data, operation procedures, and measurement of...
p class="abstract">Blount’s disease is more common in Afro-Caribbean, obese, female child. Early walking have been associated with the disease process. Adult patients with Blount’s disease who received no treatment previously, are rarely reported across the other parts of the world and hence less discussed. The treatment of neglected cases of Bloun...
Background
Optimal alignment after opening-wedge high tibial osteotomy (OWHTO) is crucial for obtaining good clinical results. A hip-to-calcaneus radiograph (HCR) appears to reflect the true mechanical axis. However, no study has been reported using the HCR in patients who underwent OWHTO. We aimed to analyze the radiographic factors affecting the...
Objective
To compare the clinical outcomes of performing a closed tibial high osteotomy with an open osteotomy and the changes in posterior tibia slope and patellar height.
Methods
Methods were collected from three hundred and forty patients (440 knees) with high tibial osteotomy performed from January 2019 to January 2020. Forty patients (50 knee...
Citations
... Based on the present results, the advantages of TCVO appear to be: 1) correction of varus malalignment of the lower extremity; 2) reconstruction of medial articular deformation of the tibial plateau; and 3) reduction of joint incongruity and laxity. The following advantageous points have also been indicated: 4) early weight-bearing because the osteotomy line does not reach the lateral tibial condyle; 5) low risk of hinge fracture; and 6) reduction of subluxated lateral joints during the operation compared to HTO [27,53,54]. TCVO is thought to represent an effective surgical procedure for patients with advanced varus knee OA, inclined medial tibial plateau, widened lateral femorotibial joint, and high joint instability. ...
Background
This study aimed to compare radiological features and short-term clinical outcomes between open-wedge high tibial osteotomy (OWHTO) and tibial condylar valgus osteotomy (TCVO), to provide information facilitating decision-making regarding those two procedures.
Methods
Twenty-seven cases involving 30 knees that had undergone OWHTO (HTO group) and eighteen cases involving 19 knees that had undergone TCVO (TCVO group) for medial compartment knee osteoarthritis (OA) were retrospectively evaluated. Patient characteristics, severity of knee OA, lower limb alignment, joint congruity and instability were measured from standing full-length leg and knee radiographs obtained before and 1 year after surgery. Range of motion in the knee joint was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) was obtained to evaluate clinical results preoperatively and 1 year postoperatively.
Results
Mean age was significantly higher in the TCVO group than in the HTO group. Radiological features in the TCVO group included greater frequencies of advanced knee OA, varus lower limb malalignment, higher joint line convergence angle, and varus-valgus joint instability compared to the HTO group before surgery. However, alignment of the lower limb and joint instability improved to comparable levels after surgery in both groups. Maximum flexion angles were significantly lower in the TCVO group than in the HTO group both pre- and postoperatively. Mean values in all KOOS subscales recovered similarly after surgery in both groups, although postoperative scores on three subscales (Symptom, Pain, and ADL) were lower in the TCVO group (Symptom: HTO, 79.0; TCVO, 67.5; Pain: HTO, 80.5; TCVO, 71.1; ADL: HTO, 86.9; TCVO, 78.0).
Conclusions
Both osteotomy procedures improved short-term clinical outcomes postoperatively. TCVO appears preferable in cases of advanced knee OA with incongruity and high varus-valgus joint instability. An appropriate choice of osteotomy procedure is important to obtain favorable clinical outcomes.
... Based on the present results, the advantages of TCVO appear to be: 1) correction of varus malalignment of the lower extremity; 2) reconstruction of medial articular deformation of the tibial plateau; and 3) reduction of joint laxity. The following advantageous points have also been indicated: 4) early weight-bearing because the osteotomy line does not reach the lateral tibial condyle; 5) low risk of hinge fracture; and 6) reduction of subluxated lateral joints during the operation compared to HTO [26,53,54]. TCVO is thought to represent an effective surgical procedure for patients with advanced varus knee OA, inclined medial tibial plateau, widened lateral femorotibial joint, and high joint instability. ...
Background: The purpose of this study was to compare radiological features and short-term clinical outcomes between open-wedge high tibial osteotomy (OWHTO) and tibial condylar valgus osteotomy (TCVO), in order to define the indication criteria for TCVO.
Methods: Twenty-seven cases involving 30 knees that had undergone HTO and eighteen cases involving 19 knees that had undergone TCVO for medial compartment knee osteoarthritis (OA) were retrospectively evaluated. Patient characteristics, severity of knee OA, lower limb alignment, and joint instability were measured in standing full-length leg and knee radiographs obtained before and 1 year after surgery. Range of motion in the knee joint was measured and the Knee Injury and Osteoarthritis Outcome Score (KOOS) was obtained to evaluate clinical results preoperatively and at 1 year postoperatively.
Results: Mean age was significantly higher in the TCVO group than in the HTO group. Radiological features in the TCVO group included greater frequencies of advanced knee OA, varus lower limb malalignment, and varus-valgus joint instability compared to the HTO group before surgery. However, alignment of the lower limb and joint instability improved to comparable levels after surgery in both groups. Maximum flexion angles were significantly lower in the TCVO group than in the HTO group both pre- and postoperatively. Mean values in all the KOOS subscales recovered similarly after surgery in both groups, although scores on three subscales (Symptom, Pain, and ADL) were lower in the TCVO group.
Conclusions: TCVO appears preferable in cases of advanced knee OA and high varus-valgus joint instability. An appropriate choice of surgical procedure is important to obtain favorable clinical outcomes.
... The range of motion of the knee is examined preoperatively to exclude patients with obvious flexion contracture. The stability of the knee is examined to exclude patients with obvious laxity of the medial stability structures [7,8]. ...
High tibial osteotomy (HTO) is a common orthopedic procedure [1–3], which includes medial open wedge osteotomy, lateral closed wedge osteotomy, arch osteotomy, and oblique osteotomy, of which the former two techniques are the most used [4]. However, both techniques are disadvantageous to correcting a severe deformity because, in that case, enormous bone grafting is required in medial open wedge osteotomy, there is a high possibility of nonunion and correction loss, and enormous tibial height loss is inevitable in lateral close wedge osteotomy. Posterior proximal-to-anterior distal oblique proximal tibial osteotomy (PTO) has been reported but seldom used in large series. The main disadvantage is that the osteotomy site of the posterior tibial cortex is too close to the joint line and a high risk of the posterior neurovascular structure injury [5]. Polyzois et al. reported a slightly anterior proximal-to-posterior distal (AP-PD) oblique HTO, which we consider suitable for minor deformity correction [6]. Thus, we would like to introduce an AP-PD oblique PTO technique to address the need for a great deformity correction and decrease the risk of posterior neurovascular injury. The main indication of this technique is medial compartment osteoarthritis with varus knee caused mainly by tibial deformity (Table 59.1).
... Tibial condylar valgus osteotomy (TCVO), a novel L-shaped osteotomy performed from the medial side of the proximal tibia to the intercondylar eminence, can adjust the congruity of the joint surface and improve intra-articular stability (5,6). TCVO has been reported to be an efficient technique for treating intra-articular deformity caused by degenerative arthritis (7,8), trauma (9), and growth disorders, such as Blount disease (5). ...
Background:
Preoperative deformity and hinge position are associated with the magnitude of the gap opening during corrective osteotomy. A larger opening gap angle is associated with a higher risk of complications. This cross-sectional study sought to identify a suitable hinge position that results in the smallest opening angle during tibial condylar valgus osteotomy (TCVO).
Methods:
The data of 66 arthritic knees treated by TCVO were included, comprising 16 knees with the hinge points selected medial to the center (group M), 21 knees with the hinge points selected at the center (group C), and 29 knees with the hinge points selected lateral to the center of the intercondylar eminence (group L). The opening gap angles and the correction amounts of the medial proximal tibial angle (ΔMPTA) were compared among the 3 groups to identify the preliminary relationship between the hinge positions and the opening gap angle. A simplified geometric model with the hinge positions selected at the medial beak, the center, and the lateral beak of the intercondylar eminence was constructed to simulate the realignment process. Several anatomical points were allocated as Cartesian coordinates. The opening gap angle with different hinge positions was mathematically formulated with MATLAB (MathWorks, Natick, MA, USA).
Results:
The average ΔMPTAs were 9.4±2.9°, 9.4±3.5°, and 9.3±3.0° in groups L, C, and M, respectively. The opening angle of the osteotomy gap was the largest in group M and the smallest in group L (29.7±11.1° and 16.9±5.3°; P<0.01). The comparison of the opening angle per the ΔMPTA revealed a similar pattern. The simulated realignment process indicated that the hinge point at the lateral beak of the intercondylar eminence led to the smallest opening angle. The opening angle during TCVO was mathematically derived in terms of the ΔMPTA, the position of the intersection of the pre- and postoperative joint lines, and the position of the hinge point.
Conclusions:
The hinge point at the lateral beak of the intercondylar eminence results in the smallest opening angle and may be suitable for TCVO.
... З цієї точки зору важливішими є меніски, які заповнюють суглобову щілину у різні фази руху [15]. Однак функція гіалінового хряща й менісків, як і зв'язок з сухожилко-м'язовим апаратом, є недостатньою при наявності або виникненні внутрішньосуглобової деформації кістки [16]. Постійна дія сили гравітації, ваги вищерозташованої частини тіла в поєднанні з щоденними навантаженнями призводять до розвитку та прогресування дегенеративних змін в усіх елементах суглоба з порушенням його стабіль-ності та функціональних можливостей. ...
Introduction. The feasibility of X-ray examination in the diagnosis of gonarthrosis in the knee joint has been increasingly questioned in recent years due to the impossibility of visualizing soft tissue elements; instead, magnetic resonance imaging as a priority method of radiation diagnostics is considered as more appropriate. The goal of this study is to investigate the structural and functional state of the knee joints of patients with monogonarthrosis by comparing the findings obtained by standard X-ray and magnetic resonance imaging. Material and methods. Materials included clinical and radiological examination protocols of 125 patients (54 (43.2%) men and 71 (57.8%) women), aged from 18 - 79 years with monogonarthrosis. Research methods included the clinical assessment of orthopaedic status; X-ray diagnostics: X-ray examination of knee joints with the evaluation of qualitative and quantitative parameters of bone elements; magnetic resonance imaging with a study of the frequency of changes in soft tissues; biochemical investigation of blood serum with determining the C-reactive protein content, which was used as a serological marker of inflammation, and synovial fluid to assess the content of rheumatoid factor; obtained findings were processed statistically. Results and discussion. According to the results of the comprehensive examination, group A with primary monogonarthrosis (118; 94.4%) and group B with gray-positive unspecified rheumatoid monoarthritis (7; 5.6%) were identified. Group A was divided into 2 subgroups: seronegative A1 (71; 56.8%) with normal CRP content and seropositive A2 (47; 37.6%) with CRP > 5 mg/l. Qualitative and quantitative X-ray signs of knee joints in the patients with monogonarthrosis grade 1-2 according to the Kellgren-Lawrence classification revealed asymmetry of the width of the condyles of the femur (81.6%) and tibia (86.4%), asymmetry of the joint space (89.6%) and discordance of joint surfaces (88.8%). MRI scans of the affected knee joint demonstrated a high frequency of synovitis (98.4%), hypertrophy of Hoff fat bodies (92.0%), degenerative lesions of the medial (22.4%) and both (65.6%) menisci, chondromalacia of the patella ( 68.8%), osteophytes (64%), and incomplete rupture of the anterior cruciate ligament (64.8%). In subgroups A1 and A2, the X-ray anatomical structure of the knee joints was almost identical without statistical difference in any of the studied parameters. Conclusion. Standard radiography of the knee joint in patients with monogonarthrosis enables to assess the anatomobiomechanical characteristics of the bone elements of the knee joint. According to the MRI results, it is possible to assess the state of the soft tissue components in the knee joint. These imaging techniques complement each other and, to some extent, help to predict the further course of the disease.
... The center of rotation of angulation (CORA) indicates the point of angular deformity. Importantly, intra-articular deformities are often presented by joint incongruency [4,5]. The CORA point should be determined before any osteotomy for proper surgery planning, because it determines the distance of the deformity from the joint [6]. ...
Total knee replacement (TKA) is a frequent modality performed in patients with osteoarthritis. Specific circumstances can make it much more difficult to execute successfully, and additional procedures such as osteotomy may be required. The aim of this study was to perform a meta-analysis and systematic review of osteotomies combined with TKA.
Methods:
In June 2022, a search PubMed, Embase, Cochrane, and Clinicaltrials was undertaken, adhering to PRISMA guidelines. The search included the terms "osteotomy" and "total knee arthroplasty".
Results:
Two subgroups (tibial tubercle osteotomy and medial femoral condyle osteotomy) were included in the meta-analysis. Further subgroups were described as a narrative review. The primary outcome showed no significant difference in favor to TTO. Secondary outcomes showed improved results in all presented subgroups compared to preoperative status.
Conclusion:
This study showed a significant deficit of randomized control trials treated with osteotomies, in addition to TKA, and a lack of evidence-based surgical guidelines for the treatment of patients with OA in special conditions: posttraumatic deformities, stiff knee, severe varus, and valgus axis or patella disorders.
... Those situations, such as the medial tibia plateau depression (the so-called "pagoda deformity") or an OA-related joint narrowing, could not be corrected by an extra-articular surgical procedure (3). Furthermore, performing HTO in intra-articular deformities fail to restore femorotibial joint congruence resulting in joint instability and teeter effect (6). To manage intra-articular deformities, in 1992, Chiba et al. described a new surgical technique for advanced medial knee OA with lateral joint subluxation called tibial condylar valgus osteotomy (TCVO) (7). ...
... Therefore, TCVO should not be considered a subtype of HTO. Teramoto, the greatest disciple of Chiba, followed this philosophy and reported good clinical results in many cases (6,24). Teramoto's osteotomy could be called a "classic TVCO". ...
The increasing incidence and distribution of primary and post-traumatic knee osteoarthritis (OA) in the young, active population has renewed interest in joint-preserving procedures. High tibial osteotomy (HTO) represents the most common treatment for medial knee OA associated with varus tibial deformity. However, deformities may also be related to intra-articular defects that an extra-articular procedure could not correct. The tibial condylar valgus osteotomy (TCVO) represents an intra-articular surgical technique for treating advanced medial knee OA with lateral joint subluxation. Currently, only a few papers with small samples and limited follow-up report the use of TCVO for the treatment of intra-articular deformities. Indications and operative techniques are various and not standardized. After an extensive search of PubMed, Scopus and Cochrane library, the main purpose of this paper is to summarize and discuss the indications, surgical techniques, and outcomes of intra-articular osteotomies while also reporting the preoperative planning and surgical procedure performed at our institution. These characteristics allow earlier weightbearing and faster complete recovery. TCVO is an effective procedure to correct lower limbs’ intra-articular defects from degenerative conditions developmental and post-traumatic deformities. This surgical technique, working at the intra-articular level, leads to some benefits related to restoring joint congruence and stability by realigning the axis of the lower limb and reducing the lateral joint subluxation. Moreover, the improved valgisation and lateralization of the mechanical axis and the limitation of the osteotomy to the medial condyle led to a better load distribution to the not osteotomy-involved compartment.
... The present study is meaningful in that the study assesses the post-operative results radiologically and shows that intra-articular osteotomy such as DTOO changed the configuration of the ankle joint. DTOO is expected to increase the contact area of the ankle joint by changing the joint's configuration and dispersing the load pressure across the ankle joint [28]. Ankle stability would consequently be enhanced when dynamic stress is imposed on the ankle such as during walking, thus leading to alleviation of ankle joint pain. ...
Introduction
Traumatic osteoarthritis of the ankle joint caused after malleolar fractures of the ankle and tibial plafond fractures are frequently observed in comparatively young and highly active patients. Since the ankle movement in these patients is in general, comparatively favorable, orthopedists may sometimes have difficulty in deciding on a treatment policy. In our department, when treating traumatic osteoarthritis patients having a movable range within their ankle joints, we proactively applied distal tibial oblique osteotomy (DTOO) developed by Dr. Teramoto in 1994 or intra-articular osteotomy developed based on DTOO concepts such as distal tibial intra-articular osteotomy (DTIO) and distal fibular oblique osteotomy (DFOO).The objectives of the current study are to radiologically assess the ankle joint after intra-articular osteotomy for traumatic ankle osteoarthritis and evaluate the change in configuration of the ankle joint. This study summarizes the clinical results of intra-articular osteotomy obtained through the above-mentioned study.
Patients and methods
The subjects of this study were 20 patients diagnosed with traumatic osteoarthritis who were surgically treated for a total of 20 ankles. All patients underwent treatment with intra-articular osteotomy and were evaluated retrospectively for the following parameters: surgical procedure, fixation devices, clinical results based on the Japanese Society for Surgery of the Foot ankle/hindfoot scale (hereafter, JSSF scale) and post-operative adverse events. They were also assessed radiologically with pre- and post-operative anterior-posterior (AP) and lateral weight-bearing ankle radiographs.
Results
The 20 patients consisted of 12 males and 8 females. The median age at surgery was 49 years old (range 14 - 87 years old) and the average follow-up period was 42 months (range 19 to 121 months). DTOO was applied to 10 cases, DFOO to 2 cases, DTOO and DFOO to 2 cases, medial-distal tibial intra-articular osteotomy (M-DTIO) and DFOO to 1 case, lateral-distal tibial intra-articular osteotomy (L-DTIO) and DFOO to 3 cases, M-DTIO followed by DTOO and DFOO to 1 case, and DTOO followed by low tibial osteotomy (LTO) to 1 case. Fixation devices utilized included circular external fixator for 15 cases, locking compression plate (LCP) to 3 cases, LCP and Kirschner-wire (K-wire) to 1 case, and screw and K-wire to 1 case. Radiological assessment revealed significant changes in the following parameters after surgery: tibial ankle surface angle (TAS, P= 0.0203), tibiotalar surface angle (TTS, P= 0.0021), medial malleolar angle (MMA, P= 0.0217), empirical axis (EA, P= 0.0019), fibular angle (FA, P= 0.0002), talar tilt angle (TTA, P= 0.0374), and tibial lateral surface angle (TLS, P= 0.0279). The JSSF scale also improved significantly after surgery (pre-operative JSSF scale: 51.1±11.0, post-operative JSSF scale: 89.2±8.2), p=0.0001.
Conclusion
Intra-articular osteotomy may change the radiological configuration of the ankle in a weight-bearing state. The present study showed very good short-term clinical results. Intra-articular osteotomy can prove a viable surgical option applicable for treatment of patients with traumatic ankle osteoarthritis having a reasonable range of motion within their ankle joints.
