SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Ankle pain and orientation after high tibial osteotomy as a treatment of medial compartment knee osteoarthritis
No full textBackground: Ankle pain frequently occurs in patients with medial compartment knee osteoarthritis (OA), particularly in those with varus deformity. In these patients, an atypical alignment of the ankle joint line relative to the ground is often observed in the coronal plane. The purpose of this study was to evaluate changes in ankle pain and ankle joint orientation after high tibial osteotomy as a treatment of medial compartment knee OA. Methods: This prospective work was conducted on 100 patients, aged 40–55 years old, with symptomatic medial compartment knee OA associated with ankle pain, with a good range of motion and intact lateral compartment. All patients treated with high tibial osteotomy fixed by plate. Ankle pain was measured by visual analogue score (VAS) preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. The following parameters were assessed preoperatively and at 3 months postoperatively: the ankle joint line orientation (AJLO), medial proximal tibial angle (MPTA), and the hip-knee-ankle angle (HKA). Results: The ankle pain significantly improved postoperatively and at last follow-up after HTO; VAS significantly reduced from 5 (4–5) preoperatively to 2 (1–2) at last follow-up (P < 0.001). AJLO was substantially decreased from 9.58 ± 2.74° preoperative to 0.41 ± 1.88° postoperative (P < 0.001). MPTA increased significantly following surgery, from a preoperative value of 85.78 ± 1.84° to a postoperative value of 90.71 ± 1.58° (P < 0.001). Similarly, HKA improved significantly from −7.73 ± 1.50° preoperatively to 2.43 ± 0.88° postoperatively (P < 0.001). A positive correlation was found between ankle pain improvement via VAS and changes in AJLO, MPTA, and HKA (P < 0.05). Conclusion: In patients with medial unicompartmental knee OA associated with ankle pain, both ankle pain and ankle joint orientation improved following high tibial osteotomy
Enhancing patellar positioning and tracking in robotic patello-femoral arthroplasty: a step-by-step technique
No full textPatellofemoral arthroplasty (PFA) is useful and effective option for treating patients with isolated patellofemoral osteoarthritis. The concept of functional positioning (FP) in PFA focuses on resurfacing the trochlea and restoring normal patellar tracking, while keeping the joint anatomy and kinematics. Even though the patellar liner cannot yet be placed with robotic assistance, robotic tools still help surgeons manage and optimize patellar tracking during surgery. This surgical technique highlights how the image-based robotic system assists the surgeon in improving patellar positioning and patellar tracking during a PFA. This technique could contribute to reduce complications, although its actual benefits remain to be validated. It may help prevent patellar instability through direct tracking assessment and reduce fracture risk by preserving more patellar bone. Accurate placement of the patellar button and evaluation of anterior offset might alleviate anterior knee pain. A tailored resection could also help protect the patellar vascular supply. Image-based planning may assist in avoiding malpositioning, potentially leading to fewer revisions
Superficial band of the quadriceps tendon harvested with a minimally invasive technique provides adequate graft dimensions: a cadaveric study
No full textIntroduction: This study explored a minimally invasive technique for harvesting the superficial band of the quadriceps tendon. By using a conventional graft tendon stripper, the procedure aims to obtain the full length of tendon fibers necessary for anterior cruciate ligament (ACL) reconstruction. The study aimed to determine if this technique can produce grafts of sufficient length and diameter. Methods: From September to October 2023, we conducted a study using full-body Thiel-embalmed cadavers over 18 years of age without pathology-related alterations in lower limb anatomy. The mid-diameter of the graft was measured at its midpoint, and the peripheral diameter was taken at the ends. The length of the triple-folded graft was measured from end to end. A digital vernier caliper measured the length and mid-diameter, and a graft sizer measured the peripheral diameter. Results: Sixteen quadriceps tendon autografts were harvested from 16 knees of 8 cadavers (mean age: 64.7 ± 9.9 years). The minimally invasive harvesting technique yielded a mean graft length of 289.0 ± 10.3 mm before folding, a mean mid-diameter of 9.7 ± 0.7 mm, a mean peripheral diameter of 8.5 ± 0.4 mm, and a mean length of 93.1 ± 4.7 mm after triple folding. Gender-based comparisons showed no significant differences. Correlations between graft dimensions and height were not statistically significant. Discussion: The findings of this study indicate that the minimally invasive harvesting of the superficial band of the quadriceps tendon resulted in adequate graft dimension. Gender-based comparisons revealed no statistically significant differences in these dimensions between males and females. Additionally, correlation analysis showed weak to moderate correlations between graft dimensions and height, none of which were statistically significant, indicating no meaningful relationship between height and graft dimensions
The rectus abdominis tendon insertion to the pubic bone and its clinical implications: A cadaveric study
No full textPurpose: The primary aim of this study is to determine the rectus abdominis tendon (RAT) insertional anatomy and consequently clarify the extension of secure mobilization of the tendon from the pubic bone in the setting of anterior approaches in pelvic and acetabular reconstruction surgery. Materials and methods: Eleven fresh frozen cadaveric pelvises were dissected by two fellowship-trained orthopaedic trauma surgeons utilizing the anterior intrapelvic approach (AIP). The RAT at the pubic body was dissected, and its footprint on the pubic bone was defined, marked, and measured. Results: Nineteen (19) RAT insertions were analyzed. The average total medial vertical length was 33 mm (range 26–42 mm), and the average total lateral vertical length was 36.5 mm (range 26–46 mm). The total width of the proximal insertion on both sides was measured at an average of 20.42 mm (range 14–24 mm). The average width of the tendon at the transition area between the cranial and caudal areas of the pubic bone was 16.45 mm (range 12–22 mm). The average distal insertion width of the RAT was less than the proximal and middle widths, measuring 10.45 mm (range 8–13 mm). Conclusion: The tendon can be safely mobilized up to an average total medial vertical length of 33 mm (and in no case more than 42 mm) and to an average total lateral vertical length of 36.5 mm (and in no case more than 46 mm). This piece of anatomical information will equip orthopaedic surgeons with a better understanding of the insertional anatomy of the RAT and subsequent safer surgical release when performing anterior approaches to the pelvic ring
Impact of probe tilt on Graf ultrasonography accuracy for neonatal hip dysplasia screening
No full textBackground/objective: Developmental Dysplasia of the Hip (DDH) is the most common congenital musculoskeletal disease of the infantile age. The gold standard for early diagnosis of the disease is the Graf ultrasound method. In our study, we examined the correlation between age of the examined infant and diagnostic errors due to the ultrasound probe tilt effect during examination. Methods: Forty-two newborns who underwent ultrasound examination with the Graf method, were included. We categorized the neonates into three age groups (Group#1: 0–1 weeks, Group#2: 3–4 weeks, Group#3: 5–6weeks). Two ultrasound examinations were performed in every group. In the first examination, images were obtained with the probe in vertical position. In the second examination, images were taken with a 10° caudocranial tilt of the probe. Our aim was to measure the α angle in both examination and to mention the possible Type changes according to the Graf classification. The α angle defines the osseous coverage of the femoral head from the acetabulum in the neonatal hip joint. Results: In many cases, the classification changed from type I to type IIa or D and from type IIa to D, when instead of the vertical acquisition, the ultrasound probe was placed in a 10° caudocranial tilt at the hip joint of the examined infant. At Group#1 of the study we observed 60 Graf classification Type changes (90.91%), while in Group#2 and Group#3 we had 18 (33.33%) and 3 (7.96%) Type changes respectively. Conclusion: As the age of the examined newborns increases, measurement and classification errors due to the tilt effect are significantly reduced. Clinically, the examination will be even more accurate and the use of an incorrect therapeutic approach due to incorrect classification will be avoided. Finally, the optimal time for conducting an ultrasonographic examination is between the 5th and 6th week of life
Management of a rare case of anterior cruciate ligament reconstruction in a Paralympic athlete with a transtibial amputation – a case report
No full textAdvances in technology, prosthetic components and rehabilitation techniques have improved the quality of life for amputees. Wearing a prosthesis enabled them to participate in sports at a high level. Participating in competitive sports puts them at risk of joint injury. This case describes a disabled professional paralympic athlete with a transtibial amputation who has torn his anterior cruciate ligament (ACL). This patient underwent anterior cruciate ligament reconstruction one year before the Paris 2024 Paralympic Games. Surgery had to be adapted in terms of the patient’s operative position, choice of graft and incisions to limit conflict with the prosthesis. Anterior cruciate ligament reconstruction with an ipsilateral quadriceps tendon graft enabled the patient to return to competition and place 4th in his category at the Paris 2024 Paralympic Games. This is the first case of ACL reconstruction in a transtibial amputee reported in the literature. It highlights a rare and difficult surgical procedure that can yield good results
Clinical outcomes and long-term efficacy of high tibial osteotomy in treating knee instability: An updated systematic review
No full textIntroduction: Knee joint stability is influenced by force distribution and ligament structures. High Tibial Osteotomy (HTO) treats knee deformities and redistributes load, reducing further invasive procedures. High Tibial Osteotomy (HTO) is a well-established procedure for addressing knee instability, particularly in cases involving ligament deficiencies such as ACL and PCL insufficiencies. This systematic review aims to evaluate the clinical outcomes and long-term efficacy of HTO in improving knee stability and function. Methods: A systematic literature search was conducted using Cochrane Central, PubMed, MEDLINE, and ProQuest databases for studies published between 2000 and June 2024. Eligible studies included human subjects with at least six months of follow-up and focused on HTO for knee instability. Exclusion criteria included animal studies, non-knee joint studies, and reviews. Data on patient demographics, follow-up duration, subjective and objective outcomes, and complications were extracted. Results: Out of 536 studies identified, 11 met the inclusion criteria, encompassing 303 patients. Combining HTO with ACL or PCL reconstruction significantly improved both subjective instability and objective measures, including Lachman and Pivot Shift test grades. Patient satisfaction was high, and functional scores such as Lysholm and Tegner improved markedly. The incidence of complications was low, with minor issues such as infections and delayed union, and no reported graft failures. Conclusion: HTO, particularly when combined with ligament reconstruction, effectively treats knee instability due to ACL or PCL deficiency. The procedure demonstrates strong mid- to long-term outcomes, high patient satisfaction, and a low rate of complications. It remains a viable option for patients with knee instability
Safety and outcomes of bikini-incision DAA for hip arthroplasty with large acetabular cups (≥56 mm): A single-surgeon series of 215 cases
No full textIntroduction: This study evaluates complications associated with the bikini-incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon on a standard operating table, with a focus on cases requiring large acetabular cups (≥56 mm). Secondary objectives include assessing clinical outcomes and implant survivorship. Methods: A retrospective analysis was conducted on primary bikini-incision DAA THAs performed by a single surgeon between 2013 and 2024. Cases involving acetabular cups ≥56 mm were included, while emergency hip fracture cases and those requiring posterolateral approaches were excluded. Clinical data, radiographs, and Kaplan-Meier survival analysis were used to assess complications, Harris Hip Scores (HHS), and implant survivorship. Results: This study included 215 THA procedures performed on 210 male patients (mean age 67 years, BMI 28.6), with an average follow-up of 3.9 years. The primary indication was osteoarthritis (88.4%). The mean preoperative HHS was 41.8, which significantly improved to 92.6 postoperatively (p < 0.001). Complications included lateral femoral cutaneous nerve (LFCN) neuropraxia (2.3%), periprosthetic fractures (0.93%), and femoral stem subsidence (0.93%). The revision rate was 0.93%, with Kaplan-Meier analysis indicating a 99% survival rate for the stem and 100% survival for the acetabular cup at the final follow-up. Discussion: The bikini-incision DAA THA using a standard operating table provides excellent short- to mid-term functional outcomes and implant survivorship for patients requiring large acetabular cups (≥56 mm). The approach is associated with low complication and revision rates, supporting its safety and efficacy in this cohort
Liposomal bupivacaine versus standard periarticular injections in total hip and knee arthroplasty: a prospective, randomized non-inferiority trial
No full textIntroduction: Numerous multimodal pain protocols have been developed to optimize pain control, reduce narcotics consumption, and shorten the length of stay after total hip and knee arthroplasty (THA/TKA). Liposomal bupivacaine (LB) has been postulated to reduce narcotic requirements after arthroplasty but is not without additional cost. The aim of this study was to determine if the addition of LB to our standard periarticular injection would improve postoperative pain and shorten the length of stay in patients undergoing TKA or THA. Methods: We performed a prospective randomized, blinded non-inferiority study of patients undergoing THA and TKA. Patients were randomized to a periarticular injection with and without LB. There were 118 hips and 64 knees included in the study with no demographic differences between groups. Post-operative pain management was performed by a second provider who was blinded to the patient’s experimental group designation. Results: Cost analysis determined that LB increased cost by $305 dollars per patient when accounting for the cost of injections as well as intravenous and oral pain medications. LB led to a minor reduction in narcotic use in THA patients (equivalent to a single 10 mg oxycodone dose), but this difference may lack clinical relevance. No significant benefits were observed in TKA patients. No difference was identified in self-reported pain scores or lengths of hospital stay. Discussion: The addition of LB did not significantly reduce narcotic consumption in patients undergoing TKA, while the cost of LB is prohibitive and should be considered an area of potential cost savings by surgeons and hospitals. The minor reduction in narcotic use in patients undergoing THA likely lacks clinical significance
Functional alignment is a feasible alignment strategy in robotic assisted total knee arthroplasty for knee osteoarthritis with extra-articular deformity – A case series
No full textIntroduction: Extraarticular deformity (EAD) with knee arthritis is a complex condition involving tri-planar bone deformity with pathological malalignment and chronic soft tissue contracture or laxity in the knee joint. Intraarticular correction by TKA, which was previously performed with conventional manual jig by mechanical alignment technique, had its limits and difficulties especially extensive soft tissue release and risk of jeopardizing the collateral ligaments. Robotic technology allows for reproducible and precise execution of surgical plan and allows adjustment to various new personalised alignment philosophy including functional alignment (FA). FA technique involves the adjustment of components positioning that least compromise the soft tissue envelope while restoring the limb alignment and joint obliquity to create a balanced knee. The aim is to study the outcome of intra-articular correction by robotic assisted TKA using Functional Alignment (FA) technique. Methodology: This is a single surgeon series of 8 patients with extraarticular deformity who underwent robotic assisted total knee arthroplasty (TKA) with FA technique. Soft tissue release was gradually released and followed by adjustments of implant positioning in order to achieve a balanced medio-lateral gap. Results: Postoperatively, the lower limb alignment of all patients were restored within 6° (mean 4.54°) based on functional alignment boundaries. Knee phenotype and joint line obliquity (JLO) were restored in comparison to contralateral lower limb. There were 6 varus and 2 valgus malalignment. 7 patients were implanted with posterior stabilized implants while 1 was implanted with cruciate retaining implant. Arc of knee flexion and extension improved (P = 0.002). There was a large postoperative improvement in the Knee Society Score (KSS) (P < 0.001). Discussion: Intraarticular correction by TKA for EAD with knee arthritis is technically reliable with robotic technology. It allows intraoperative adjustment following functional alignment philosophy, thereby, restoring pre-arthritic alignment, knee phenotype and joint line obliquity