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ACL and varus deformity

Alejandro Lizaur-Utrilla, Daniel Martinez-Mendez, Santiago Gonzalez-Parreño, Luis Marco-Gomez, Francisco A Miralles Muñoz, Fernando A Lopez-Prats
BACKGROUND: Few studies have analyzed the outcomes of total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament (ACL) reconstruction, and the reported outcomes are controversial. The purpose of this study is to assess if prior ACL reconstruction had any impact on the outcome of subsequent TKA. METHODS: A matched case-control study was conducted in patients who underwent TKA, including 37 with prior ACL reconstruction and 37 patients without ACL reconstruction...
February 21, 2018: Journal of Arthroplasty
Davide Edoardo Bonasia, Federico Dettoni, Anna Palazzolo, Roberto Rossi
High tibial osteotomy (HTO) is a valid treatment option for young active patients with medial tibiofemoral osteoarthrosis (OA) and varus deformity. Sometimes medial OA is combined with symptomatic anterior cruciate ligament (ACL) deficiency. Although isolated HTO (with possible delayed ACL reconstruction) might be indicated in the older population, young active patients may require combined HTO and ACL reconstruction. In addition, an abnormally increased tibial slope may predispose to ACL reconstruction failure and should be addressed for a successful ACL revision...
October 2017: Arthroscopy Techniques
Luca Dei Giudici, Roberto Fabbrini, Luca Garro, Serena Arima, Antonio Gigante, Agostino Tucciarone
PURPOSE: To evaluate the 5-year outcome of arthroscopic transphyseal anterior cruciate ligament (ACL) reconstruction in 19 adolescent athletes. METHODS: 14 male and 5 female adolescent athletes aged 12 to 16 (mean, 13.9) years with Tanner stage 2 or 3 open physes underwent arthroscopic transphyseal ACL reconstruction by a single surgeon and were followed up for 5 years. Patients were evaluated using the numerical rating score (NRS) for pain, knee osteoarthritis outcome score (KOOS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lysholm Score, as well as the leg length discrepancy, femorotibial alignment, varus or valgus deformities, active and passive knee range of motion...
December 2016: Journal of Orthopaedic Surgery
Raju Vaishya, Vipul Vijay, Gyanendra Kumar Jha, Amit Kumar Agarwal
INTRODUCTION: Chronic ACL insufficiency with associated varus malalignment due to knee osteoarthritis (OA) is challenging to treat surgically. A combined ACL reconstruction (ACLR) with medial open wedge high tibial osteotomy (HTO) without using any metallic implant for HTO is an effective technique. MATERIALS AND METHOD: All the patients attending the outpatient department ACL injury and with associated medial compartment OA (Kellegren's grade 2 and grade 3) were considered for inclusion in the study...
October 2016: Journal of Clinical Orthopaedics and Trauma
Shaoqi Tian, Bin Wang, Yuanhe Wang, Chengzhi Ha, Lun Liu, Kang Sun
BACKGROUND: Relative young and more active patients with osteoarthritis (OA) of the isolated medial femorotibial compartment in conjunction with anterior cruciate ligament (ACL) deficiency are difficult to treat. The aim of this study was to explore the early clinical outcomes of combined Oxford unicompartmental knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and isolated OA of the medial compartment. METHODS: Twenty-eight patients were included into the study...
August 5, 2016: BMC Musculoskeletal Disorders
Sung-Do Cho, Yoon-Seok Youm, Jong-Hyun Kim, Hye-Yong Cho, Kwang-Ho Kim
PURPOSE: To investigate the patterns of medial meniscus (MM) tears in patients with varus knee osteoarthritis who underwent total knee arthroplasty and analyze the factors that could affect MM tears. MATERIALS AND METHODS: The patients (365 knees, 268 patients) were classified into three groups; group I with MM posterior horn (PH) tear only; group II with MM root tear only; and group III with MMPH plus root tear. The following factors were evaluated: age, gender, body mass index, varus deviation of the mechanical axis, medial proximal tibial angle, posterior tibial slope (PTS), and anterior cruciate ligament (ACL) integrity (normal, degeneration, and tear or absence)...
June 2016: Knee Surgery & related Research
Shaoqi Tian, Bin Wang, Lun Liu, Chengzhi Ha, Wang Yuanhe, Jiangjun Liu, Qicai Li, Xu Yang, Kang Sun
OBJECTIVE: To explore the short- and mid-term effectivenesses of combined unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction for osteoarthritis (OA) and ACL injury. METHODS: Between January 2006 and January 2014, 32 patients with knee OA and ACL injury were treated by combined UKA and ACL reconstruction. There were 12 males and 20 females, aged 41-63 years (mean, 50 years); 17 left knees and 15 right knees were involved...
December 2015: Chinese Journal of Reparative and Reconstructive Surgery
Yang Liu, Xuebin Sun, Keyuan Zhang, Gang Li, Jiati Ni
OBJECTIVE: To evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. METHODS: Between January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation. There were 25 males and 10 females, aged 8-16 years (mean, 14.7 years). The causes included sports injury in 24 cases, traffic accident injury in 9 cases, and daily life injury in 2 cases...
June 2015: Chinese Journal of Reparative and Reconstructive Surgery
Simone Bersini, Valerio Sansone, Carlo A Frigo
Obtaining tibio-femoral (TF) contact forces, ligament deformations and loads during daily life motor tasks would be useful to better understand the aetiopathogenesis of knee joint diseases or the effects of ligament reconstruction and knee arthroplasty. However, methods to obtain this information are either too simplified or too computationally demanding to be used for clinical application. A multibody dynamic model of the lower limb reproducing knee joint contact surfaces and ligaments was developed on the basis of magnetic resonance imaging...
2016: Computer Methods in Biomechanics and Biomedical Engineering
Ashok Rajgopal, Philip C Noble, Attique Vasdev, Sabir K Ismaily, Angraj Sawant, Vivek Dahiya
This study was performed to study the relationship between the degree of varus deformity of osteoarthritic knees and the anatomic distribution of cartilage pathology. Bone wafers resected from the distal femur and proximal tibia were obtained from 107 patients (195 knees) with primary varus osteoarthritis. Severity and distribution of joint damage was scored for each articular surface and related to potential prognostic factors, including varus deformity, the ligamentous status of the knee, age, gender and BMI...
November 2015: Journal of Arthroplasty
James W Pritchett
BACKGROUND: One of the goals of a TKA is to approximate the function of a normal knee. Preserving the natural ligaments might provide a method of restoring close to normal function. Sacrifice of the ACL is common and practical during a TKA. However, this ligament is functional in more than 60% of patients undergoing a TKA and kinematic studies support the concept of bicruciate-retaining (that is, ACL-preserving) TKA; however, relatively few studies have evaluated patients treated with bicruciate-retaining TKA implants...
July 2015: Clinical Orthopaedics and related Research
H Dejour, G Walch, G Deschamps, P Chambat
Arthrosis following rupture of the anterior cruciate ligament has been analysed in two series. The first series was derived from a review of 150 cases of reconstruction of the anterior cruciate ligament with a follow-up of 3 years or more. Arthrosis was seen to have developed in 13.3%. The second series was concerned with 64 cases of unilateral arthrosis treated by upper tibial valgus osteotomy in whom there had been a previous rupture of the anterior cruciate ligament. The 'tolerance interval'--that is the time between the original ligamentous injury and the time of osteotomy--for the development of arthrosis was very variable, ranging in the natural-history cases from 10 to 50 years, with a mean of 35 years...
February 2014: Orthopaedics & Traumatology, Surgery & Research: OTSR
Chao Wan, Zhixiu Hao, Shizhu Wen
The biomechanics and function of the anterior cruciate ligament (ACL) have been widely studied using both experimental and simulation methods. It is known that a constitutive model of joint tissue is a critical factor in the numerical simulation. Some different ligament constitutive models have been presented to describe the ACL material behavior. However, the effect of the variation in the ligament constitutive model on joint kinematics and biomechanics has still not been studied. In this paper, a three-dimensional finite element model of an intact tibiofemoral joint was reconstructed...
April 2013: Journal of Biomechanical Engineering
G Gacon
Unicompartmental knee arthroplasty (UKA) is an excellent operation provided the technique is properly applied and the indication is well established.Obesity (weight > 100 kg, or BMI > 32) is a contraindication.The shape of the femoral prosthetic condyle is a cause of loosening in the medium and long term.There is an important difference between medial UKA and lateral UKA. Indications are different and they correspond to different types of patients.UKA is not an alternative to osteotomy; it is in competition with both osteotomy and total knee prostheses and has its own indications...
December 1995: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
I McNamara, T B Birmingham, P J Fowler, J R Giffin
PURPOSE: This narrative review describes experiences at the Fowler Kennedy Sport Medicine Clinic (FKSMC) with high tibial osteotomy (HTO) for patients with varus gonarthrosis, with particular focus on research published from the unit that has guided practice. METHODS: The goals of surgery are to improve alignment of the weight bearing axis of the lower limb to lessen the load on the medial tibiofemoral compartment and thereby decrease these important risk factors for disease progression...
January 2013: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Roberto Rossi, Davide E Bonasia, Annunziato Amendola
High tibial osteotomy (HTO) is a widely performed procedure, and good results can be achieved with appropriate patient selection and precise surgical technique. Clinical indications include varus alignment of the knee associated with medial compartment arthrosis, knee instability, medial compartment overload following meniscectomy, and osteochondral defects requiring resurfacing procedures. Coronal alignment (ie, varus, valgus) and sagittal alignment (ie, tibial slope) should be thoroughly evaluated in all cases...
October 2011: Journal of the American Academy of Orthopaedic Surgeons
Jennifer L Weh, Michael P Kowaleski, Randy J Boudrieau
OBJECTIVE: To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling osteotomy (TPLO) and transverse corrective osteotomy. STUDY DESIGN: Cases series. ANIMALS: Dogs (n=12; 19 stifle joints). METHODS: Medical records of dogs that had combination TPLO and transverse corrective osteotomy, were reviewed...
August 2011: Veterinary Surgery: VS
Oliver S Schindler, W Norman Scott, Giles R Scuderi
PURPOSE: To survey the current practice of unicompartmental knee arthroplasty (UKA) in the United Kingdom. METHODS: Questionnaires were sent to all 341 local members of the British Association for Surgery of the Knee to inquire into their practice of UKA, including clinical indications, preoperative investigations, surgical approach, preferences in implant design, and the role of UKA in relation to high tibial osteotomy. RESULTS: 56% of respondents performed less than 16 UKAs per year, whereas 16...
December 2010: Journal of Orthopaedic Surgery
Marco Kawamura Demange, Gilberto Luis Camanho, José Ricardo Pécora, Riccardo Gomes Gobbi, Luis Eduardo Passarelli Tirico, Roberto Freire da Mota e Albuquerque
Eight patients, aged 37-50 years, with chronic anterior cruciate ligament (ACL) deficiency, medial compartment osteoarthritis and varus deformity underwent simultaneous arthroscopic ACL reconstruction and open-wedge high tibial osteotomy controlled by a computer navigation system. Despite preoperative planning, the surgeon may need to choose a different osteotomy site during the procedure, invalidating the previous plans. The intraoperative wire control for osteotomies is not precise. The navigation system can help obtain precise alignment during high tibial osteotomy...
December 2011: Knee
Hai-ning Zhang, Ping Leng, Ying-zhen Wang, Cheng-yu Lü, Xiang-da Wang, Chang-yao Wang
OBJECTIVE: To introduce the biplanar opening high tibial osteotomy with rigid fixation for adult varus knee. METHODS: Twelve patients with varus knee and degeneration of medial compartment received the biplanar opening high tibial osteotomy between June 2001 and July 2008. The pre-operative deformity was about 11.5 degrees without osteoarthritis changes in other compartments. The average range of motion was more than 90 degrees . One of the patients had ruptures of LCL and ACL, who received osteotomy after reconstruction of the ligaments...
March 1, 2010: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
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