ObjectiveTo explore the short-term effectiveness of medial open wedge high tibial osteotomy (OWHTO) combined with posterior slope angle of tibial plateau correction to treat the osteoarthritis of limited flexion knee with varus deformity.MethodsThe data of 18 cases (18 knee) with osteoarthritis of limited flexion knee with varus deformity between January 2014 and July 2016 were analyzed retrospectively. There were 6 males and 12 females with an average age of 54.9 years (range, 48-64 years). There were 8 cases of left knee and 10 cases of right knee. The varus of knee ranged from 7.45 to 15.52° (mean, 10.63°). According to Kellgren-Lawrence grading standard, there were 4 cases of grade Ⅱ and 14 of grade Ⅲ. OWHTO was used to adjust the varus deformity, and the posterior slope angle of tibial plateau was adjusted to solve the limited flexion.ResultsThe thickness of osteotomy was 10-19 mm (mean, 14.91 mm). The operation time was 1.2-2.0 hours (mean, 1.4 hours). All incisions healed by first intension. All patients were followed up 1.0-2.5 years, with an average of 1.5 years. At last follow-up, the range of knee flexion and Lysholm score, Hospital for Special Surgery (HSS) score, and International Knee Documentation Committee (IKDC) score were significantly higher than preoperative ones, showing significant differences (P<0.05). X-ray films showed that the osteotomy healed at 3- 7 months (mean, 3.6 months) after operation. At last follow-up, the limb alignment by the relative position of tibial plateau and the posterior slope angle of tibial plateau were significantly improved, showing significant differences when compared with preoperative ones (P<0.05).ConclusionThe OWHTO combined with posterior slope angle of tibial plateau correction can significantly improve the range of flexion and functional score in short-term.
ObjectiveTo investigate the influence of lateral posterior tibial slope (LPTS) on tibial tunnel expansion after anatomical single-bundle anterior cruciate ligament (ACL) reconstruction and the effect of tibial tunnel expansion on knee joint function.MethodsA clinical data of 52 patients with ACL rupture, who underwent arthroscopic anatomical single-bundle reconstruction between November 2018 and December 2019, was retrospectively analyzed. There were 32 males and 20 females with an average age of 34.3 years (range, 14-64 years). There were 22 cases of left knee and 30 cases of right knee. The time from injury to operation ranged from 7 to 30 days, with an average of 15.9 days. The knee function was evaluated by International Knee Documentation Committee (IKDC) score and Lysholm score before operation and at 3 and 6 months after operation. At 3 and 6 months after operation, the LPTS and the width of exit, middle segment, entrance, and 2 cm from the exit of the articular surface of the tibial tunnel were measured based on MRI. The expansion of tibial tunnel was calculated and graded (degrees 0-3). According to LPTS, the patients were divided into group A (<6.0°), group B (6°-12°), and group C (>12°), and the difference in the expansion of tibial tunnel between groups was compared.ResultsAll the 52 patients were followed up 6-12 months (mean, 7.1 months). The IKDC and Lysholm scores at 3 and 6 months after operation were significantly different from those before operation (P<0.05); and the difference of knee scores between 3 and 6 months after operation was significant (P<0.05). The tibial tunnel expanded after operation, and the relative expansion at the exit and the middle segment showed significant difference between 3 months and 6 months after operation (P<0.05). The expansion degree of tibial tunnel was rated as degree 0 in 5 cases, degree 1 in 28 cases, degree 2 in 16 cases, and degree 3 in 3 cases at 3 months after operation, and degree 0 in 5 cases, degree 1 in 20 cases, degree 2 in 25 cases, and degree 3 in 2 cases at 6 months after operation. There was no significant difference in IKDC and Lysholm scores between patients with different expansion degrees of tibial tunnels (P>0.05). The LPTS of 52 patients ranged from –0.8° to 18.7° (mean, 10.6°); there were 7 cases in group A, 24 cases in group B, and 21 cases in group C. There was no significant difference in age, gender, preoperative IKDC and Lysholm scores, and initial width of tibial tunnel between groups (P>0.05). There was no significant difference in the relative expansion of tibial tunnel at exit and middle segment between groups at 3 months after operation (P>0.05), and there was significant difference at 6 months after operation (P<0.05).ConclusionAfter anatomical single-bundle reconstruction of ACL, the tibial tunnel would expand to some extent in a short time. LPTS had a significant effect on tibial tunnel expansion, and the larger the angle was, the more obvious the expansion of the proximal tibial tunnel was. However, early knee function is not affected by tibial tunnel expansion.
Objective To investigate the influence of tibial component posterior slope angle (TCPSA) on the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA). MethodsThe clinical data of the patients with anterior medial knee osteoarthritis (KOA) treated by UKA between May 2014 and May 2019 were retrospectively analysed. There were 10 males and 45 females with a median age of 68 years (range, 49-83 years). The body mass index (BMI) was 27.63-52.26 kg/m2, with an average of 40.04 kg/m2. There were 28 cases of left knee, 21 cases of right knee, and 6 cases of double knees. The disease duration was from 7 months to 12 years, with an average of 4.33 years. Measurements of posterior tibial slope (PTS) and TCPSA were performed on the knee joint X-ray films of patients before operation and at last follow-up, respectively. According to the postoperative TCPSA, patients were divided into TCPSA<4° group (group A), 4°≤TCPSA<9° group (group B), and TCPSA>9° group (group C) with the quartile method. Baseline data such as age, gender, BMI, and affected side were compared among the 3 groups, as well as the Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) before and after operation. ResultsAll 55 patients were followed up 17-72 months, with an average of 36 months. No complication such as prosthesis loosening, infection, tibial plateau collapse, and dislocation of the meniscus pad occurred. The preoperative PTS was (7.38±3.37)°, and the postoperative TCPSA was (6.25±3.22)°, showing no significant difference (t=1.815, P=0.074). According to postoperative TCPSA, there were 12 knees in group A, 32 in group B, and 17 in group C. There was no significant difference in age, gender, BMI, affected side, and preoperative HSS scores, ROM, and VAS scores among the 3 groups (P>0.05). At last follow-up, the HSS scores, ROM, and VAS scores of the 3 groups significantly improved when compared with preoperative ones (P<0.05). There was no significant difference in the difference of the above indicators before and after operation among 3 groups (P>0.05). ConclusionThe patients with anterior medial KOA may have good short- and mid-term effectiveness after UKA. Among the recommended range of TCPSA, there is no significant influence on the postoperative short- and mid-term effectiveness. Long-term effectiveness need to extend the follow-up time and expand the sample size for research verification.
Objective To investigate the effect of knee suspension during titanium plate fixation on postoperative posterior tibial slope (PTS) in knee osteoarthritis (KOA) with medial opening-wedge high tibial osteotomy (OWHTO). Methods The clinical data of 47 patients with KOA treated by OWHTO between January 2019 and December 2020 was retrospectively analyzed. In 24 cases, the knee joint was suspended when titanium plate was fixed (research group), and in 23 cases, the knee joint was naturally straightened when titanium plate was fixed (control group). There was no significant difference in gender, age, side, body mass index, disease duration, preoperative visual analogue scale (VAS) score, American Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Lysholm score, and preoperative PTS between the two groups (P>0.05). PTS were measured at 1 day after operation and last follow-up, and were compared with that before operation. Before operation and at last follow-up, VAS score was used to evaluate the knee pain, HSS score, WOMAC score, and Lysholm score were used to evaluate the knee function. Results The patients in both groups were followed up 13-24 months, with an average of 19.9 months. There was no complication such as incision infection, screw fracture, and deep venous thrombosis of lower limbs in two groups. At last follow-up, the VAS score, HSS score, WOMAC score, and Lysholm score in two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference between the two groups in the each score difference of before and after operation (P>0.05). There was no significant difference in PTS at each time point before and after operation in the research group (P>0.05), but PTS in the control group significantly increased at 1 day after operation and last follow-up (P<0.05). PTS of the research group at 1 day after operation and last follow-up were significantly lower than those of the control group (P<0.05). ConclusionOWHTO can effectively relieve knee pain and improve knee function in KOA, and the increase of postoperative PTS can be effectively avoided by suspending knee joint.
ObjectiveTo investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction. Methods A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups (P>0.05). However, the proportion of female in the injured group was significantly higher than that of male (P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group (P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values. ResultsUnivariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury (P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury (P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] (χ2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years](χ2=302.479, P<0.001). ConclusionFemale and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.