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Kyung Wook Nha - One of the best experts on this subject based on the ideXlab platform.
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High Tibia Osteotomy for a Posterior Root Tear of the Medial Meniscus
Journal of the Korean Orthopaedic Association, 2015Co-Authors: Jong Seong Lee, Yong Suk Chang, Hyun Joo Park, Hyung Hwa Yoon, Kyung Wook NhaAbstract:무릎 반월연골판은 무릎에서 안정성과 충격 흡수능력, 그리고 축 성 압력을 받아주는 중요한 역할을 하고 있다. 각각의 반월연골 판은 환형 구조로 촘촘히 연결되어 있고, 듬성듬성 방사성 구조 로 결합되어 있으며, 무릎에 가해지는 축성 압력을 연골판 장력 (hoop tension)으로 변환시켜 준다. 실제로 체중의 약 50%-70%에 해당되는 하중이 반월연골판을 통해 전달되고 있다. 내측 반월연 골판 기시부 손상은 고리(hoop) 모양의 연속성이 끊어지게 되는 것으로 반월연골판의 이러한 생역학적 기능을 잃게 한다. 그리하 여 연골판 장력으로 변환되지 못한 축성 압력 때문에 무릎 관절 면의 퇴행성 변화를 초래한다고 알려져 있다. 이러한 반월연골판 병변의 진단 및 치료방침은 퇴행성 관절 염을 방지하는 관점에서 매우 중요하다. 내측 반월연골판 기시 부 파열은 크게 외상성 파열과 퇴행성 파열 두 가지로 나눌 수 있 다. 외상성 파열은 드물고 주로 연골판 기시부의 골부착부에서 떨어져 나오는 형태의 손상이며, 젊은 나이에서 전방십자인대 손 상과 잘 동반된다. 퇴행성 파열은 외상성 파열보다 비교적 흔하 며 기시부의 골부착부 자체가 아닌 골부착부 근처 실질에서의 파 열이 대부분이다. 50대 이상의 연령에서 여자에게 빈발하며, 큰 외상이 없이 퇴행성 변화로 생기는 파열이다. 한국에서의 통계 는 내측 반월연골판 파열의 약 25%를 차지할 정도로 수평파열 다 음으로 많다. 과거에는 동양에서 많이 발생한다고 알려졌으나 최근에는 서양에서도 많이 보고되고 있는데, 이는 관절경 검사와 자기공명영상(magnetic resonance imaging, MRI) 진단기술의 발달 pISSN : 1226-2102, eISSN : 2005-8918 372
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second look arthroscopic findings after open wedge high Tibia Osteotomy focusing on the posterior root tears of the medial meniscus
Arthroscopy, 2013Co-Authors: Kyung Wook Nha, Dong Ju Chae, Yong Seuk Lee, Daehee Hwang, Jae Ho Kwon, Young Jee Park, Jong In KimAbstract:Purpose This study examined, at second-look arthroscopy, the results of open-wedge high Tibial Osteotomy (HTO) focusing on root tear of the medial meniscus posterior horn (RTMMP). Methods Among 31 consecutive patients who underwent HTO without a meniscectomy or pullout repair for RTMMP, 20 patients were available for second-look arthroscopic evaluation. All patients had medial unicompartmental arthritis. The healing status of the RTMMP was classified as complete, incomplete, and no healing. The difference in the weight bearing line from presurgery to the last follow-up was evaluated. Osteoarthritis and chondral lesions were evaluated, as were clinical results. Correlations between healing status and other variables (weight bearing line, cartilage status, and clinical scores) were assessed. The healed (10 patients) and nonhealed (incomplete 6 patients + no healing 4 patients) groups were also evaluated with respect to other variables. Results There were 10 (50%) cases with complete healing, 6 (30%) with incomplete healing, and 4 (20%) with no healing. Kellgren-Lawrence grade did not improve according to the standing plain radiograph ( P = .09). Progression of chondral lesions was not observed at second-look arthroscopy; some improvement was even observed ( P = .002). The median Lysholm score improved from 58 preoperatively to 88.5 at the last follow-up. The median Hospital for Special Surgery (HSS) score also increased significantly from 62.4 (range, 50 to 76) to 87.2 (range, 80 to 92; P = .003). The comparison between healed and nonhealed groups revealed no statistical differences in all variables. Conclusions This study revealed a high rate of healing of RTMMP after HTO without attempted repair. Healing of the meniscus was not associated with an improved clinical outcome. Level of Evidence Level IV, therapeutic case series.
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a safe zone in medial open wedge high Tibia Osteotomy to prevent lateral cortex fracture
Knee Surgery Sports Traumatology Arthroscopy, 2013Co-Authors: Seung Boem Han, Dong Ju Chae, Gautam M Shetty, Daehee Lee, Jae Gwang Song, Kyung Wook NhaAbstract:Purpose The purpose of this cadaveric study was to study the effect of plane of Osteotomy on incidence of lateral cortex fracture and to define a “safe zone” through which medial open-wedge high Tibial Osteotomy (HTO) could be performed with minimal risk of lateral cortex fracture.
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A “safe zone” in medial open-wedge high Tibia Osteotomy to prevent lateral cortex fracture
Knee Surgery Sports Traumatology Arthroscopy, 2013Co-Authors: Seung Boem Han, Dong Ju Chae, Gautam M Shetty, Daehee Lee, Jae Gwang Song, Kyung Wook NhaAbstract:Purpose The purpose of this cadaveric study was to study the effect of plane of Osteotomy on incidence of lateral cortex fracture and to define a “safe zone” through which medial open-wedge high Tibial Osteotomy (HTO) could be performed with minimal risk of lateral cortex fracture. Methods Medial open HTO was performed in nine fresh frozen human cadavers (18 knees) with each specimen randomly assigned to a “safe zone” Osteotomy (group A, between the tip of the fibular head and the circumference line of the fibular head,) or a lower level Osteotomy (group B, distal to the circumference line of the fibular head). Results Six out of nine knees developed lateral cortex fracture in group B compared to none in group A ( P = 0.009) when the Osteotomy site was distracted to a maximum of 20 mm. Conclusion Directing the plane of the Osteotomy toward the “safe zone” significantly reduces the risk of lateral cortex fracture compared to an Osteotomy, which is directed at a lower level. Confining the plane of a medial open HTO to within the “safe zone” can prevent lateral cortex fracture and subsequent loss of correction.
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Tibial slope and patellar height after opening wedge high Tibia Osteotomy using autologous tricortical iliac bone graft
Knee, 2008Co-Authors: Dong Ju Chae, Gautam M Shetty, Dong Bong Lee, Hyun Woo Choi, Seung Beom Han, Kyung Wook NhaAbstract:Abstract Our aim was to evaluate the alteration in angle of posterior slope of the Tibia and the degree of patellar height following medial opening wedge high Tibia Osteotomy(HTO) using autologous tricortical iliac bone graft in 32 consecutive patients. Twenty three females and nine males underwent medial opening wedge high Tibia Osteotomy (HTO) using autologous tricortical iliac bone graft in 34 knees (33 primary medial compartment osteoarthritis and 1 idiopathic osteonecrosis of medial Tibial condyle). The posterior slope of Tibia was determined by the proximal Tibial anatomical axis. Patellar height was measured by the Insall-Salvati and the Blackburne-Peel ratios. Preoperative and postoperative (last follow up) values of these three parameters were compared. The intra- and interobserver variability of these methods was determined before and after operation. At the end of mean follow up of 3 years this procedure produced no significant change in posterior slope. Pre and postoperative posterior slope were 8.7°±3.6° and 8.2°±2.8° respectively ( P =0.412). Pre and postoperative Insall-Salvati ratios were 0.93±0.10 and 1.05±0.11 respectively ( P The distance between the patellar and tibiofemoral joint line decreased in 82% of patients. The mean Blackburne-Peel ratio declined from 0.71±0.12 to 0.61±0.13 ( P There was no difference in the intra-and interobserver variability of measurements either before or after HTO. Opening wedge HTO using autologous tricortical iliac bone graft with internal fixation and early mobilisation prevented change in posterior slope of Tibia, lengthened the patellar ligament and elevated the tibiofemoral joint line when the mean ratio of anterior and posterior gap at the Osteotomy site was around two-thirds.
Dong Ju Chae - One of the best experts on this subject based on the ideXlab platform.
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second look arthroscopic findings after open wedge high Tibia Osteotomy focusing on the posterior root tears of the medial meniscus
Arthroscopy, 2013Co-Authors: Kyung Wook Nha, Dong Ju Chae, Yong Seuk Lee, Daehee Hwang, Jae Ho Kwon, Young Jee Park, Jong In KimAbstract:Purpose This study examined, at second-look arthroscopy, the results of open-wedge high Tibial Osteotomy (HTO) focusing on root tear of the medial meniscus posterior horn (RTMMP). Methods Among 31 consecutive patients who underwent HTO without a meniscectomy or pullout repair for RTMMP, 20 patients were available for second-look arthroscopic evaluation. All patients had medial unicompartmental arthritis. The healing status of the RTMMP was classified as complete, incomplete, and no healing. The difference in the weight bearing line from presurgery to the last follow-up was evaluated. Osteoarthritis and chondral lesions were evaluated, as were clinical results. Correlations between healing status and other variables (weight bearing line, cartilage status, and clinical scores) were assessed. The healed (10 patients) and nonhealed (incomplete 6 patients + no healing 4 patients) groups were also evaluated with respect to other variables. Results There were 10 (50%) cases with complete healing, 6 (30%) with incomplete healing, and 4 (20%) with no healing. Kellgren-Lawrence grade did not improve according to the standing plain radiograph ( P = .09). Progression of chondral lesions was not observed at second-look arthroscopy; some improvement was even observed ( P = .002). The median Lysholm score improved from 58 preoperatively to 88.5 at the last follow-up. The median Hospital for Special Surgery (HSS) score also increased significantly from 62.4 (range, 50 to 76) to 87.2 (range, 80 to 92; P = .003). The comparison between healed and nonhealed groups revealed no statistical differences in all variables. Conclusions This study revealed a high rate of healing of RTMMP after HTO without attempted repair. Healing of the meniscus was not associated with an improved clinical outcome. Level of Evidence Level IV, therapeutic case series.
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A “safe zone” in medial open-wedge high Tibia Osteotomy to prevent lateral cortex fracture
Knee Surgery Sports Traumatology Arthroscopy, 2013Co-Authors: Seung Boem Han, Dong Ju Chae, Gautam M Shetty, Daehee Lee, Jae Gwang Song, Kyung Wook NhaAbstract:Purpose The purpose of this cadaveric study was to study the effect of plane of Osteotomy on incidence of lateral cortex fracture and to define a “safe zone” through which medial open-wedge high Tibial Osteotomy (HTO) could be performed with minimal risk of lateral cortex fracture. Methods Medial open HTO was performed in nine fresh frozen human cadavers (18 knees) with each specimen randomly assigned to a “safe zone” Osteotomy (group A, between the tip of the fibular head and the circumference line of the fibular head,) or a lower level Osteotomy (group B, distal to the circumference line of the fibular head). Results Six out of nine knees developed lateral cortex fracture in group B compared to none in group A ( P = 0.009) when the Osteotomy site was distracted to a maximum of 20 mm. Conclusion Directing the plane of the Osteotomy toward the “safe zone” significantly reduces the risk of lateral cortex fracture compared to an Osteotomy, which is directed at a lower level. Confining the plane of a medial open HTO to within the “safe zone” can prevent lateral cortex fracture and subsequent loss of correction.
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a safe zone in medial open wedge high Tibia Osteotomy to prevent lateral cortex fracture
Knee Surgery Sports Traumatology Arthroscopy, 2013Co-Authors: Seung Boem Han, Dong Ju Chae, Gautam M Shetty, Daehee Lee, Jae Gwang Song, Kyung Wook NhaAbstract:Purpose The purpose of this cadaveric study was to study the effect of plane of Osteotomy on incidence of lateral cortex fracture and to define a “safe zone” through which medial open-wedge high Tibial Osteotomy (HTO) could be performed with minimal risk of lateral cortex fracture.
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Tibial slope and patellar height after opening wedge high Tibia Osteotomy using autologous tricortical iliac bone graft
Knee, 2008Co-Authors: Dong Ju Chae, Gautam M Shetty, Dong Bong Lee, Hyun Woo Choi, Seung Beom Han, Kyung Wook NhaAbstract:Abstract Our aim was to evaluate the alteration in angle of posterior slope of the Tibia and the degree of patellar height following medial opening wedge high Tibia Osteotomy(HTO) using autologous tricortical iliac bone graft in 32 consecutive patients. Twenty three females and nine males underwent medial opening wedge high Tibia Osteotomy (HTO) using autologous tricortical iliac bone graft in 34 knees (33 primary medial compartment osteoarthritis and 1 idiopathic osteonecrosis of medial Tibial condyle). The posterior slope of Tibia was determined by the proximal Tibial anatomical axis. Patellar height was measured by the Insall-Salvati and the Blackburne-Peel ratios. Preoperative and postoperative (last follow up) values of these three parameters were compared. The intra- and interobserver variability of these methods was determined before and after operation. At the end of mean follow up of 3 years this procedure produced no significant change in posterior slope. Pre and postoperative posterior slope were 8.7°±3.6° and 8.2°±2.8° respectively ( P =0.412). Pre and postoperative Insall-Salvati ratios were 0.93±0.10 and 1.05±0.11 respectively ( P The distance between the patellar and tibiofemoral joint line decreased in 82% of patients. The mean Blackburne-Peel ratio declined from 0.71±0.12 to 0.61±0.13 ( P There was no difference in the intra-and interobserver variability of measurements either before or after HTO. Opening wedge HTO using autologous tricortical iliac bone graft with internal fixation and early mobilisation prevented change in posterior slope of Tibia, lengthened the patellar ligament and elevated the tibiofemoral joint line when the mean ratio of anterior and posterior gap at the Osteotomy site was around two-thirds.
Gautam M Shetty - One of the best experts on this subject based on the ideXlab platform.
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A “safe zone” in medial open-wedge high Tibia Osteotomy to prevent lateral cortex fracture
Knee Surgery Sports Traumatology Arthroscopy, 2013Co-Authors: Seung Boem Han, Dong Ju Chae, Gautam M Shetty, Daehee Lee, Jae Gwang Song, Kyung Wook NhaAbstract:Purpose The purpose of this cadaveric study was to study the effect of plane of Osteotomy on incidence of lateral cortex fracture and to define a “safe zone” through which medial open-wedge high Tibial Osteotomy (HTO) could be performed with minimal risk of lateral cortex fracture. Methods Medial open HTO was performed in nine fresh frozen human cadavers (18 knees) with each specimen randomly assigned to a “safe zone” Osteotomy (group A, between the tip of the fibular head and the circumference line of the fibular head,) or a lower level Osteotomy (group B, distal to the circumference line of the fibular head). Results Six out of nine knees developed lateral cortex fracture in group B compared to none in group A ( P = 0.009) when the Osteotomy site was distracted to a maximum of 20 mm. Conclusion Directing the plane of the Osteotomy toward the “safe zone” significantly reduces the risk of lateral cortex fracture compared to an Osteotomy, which is directed at a lower level. Confining the plane of a medial open HTO to within the “safe zone” can prevent lateral cortex fracture and subsequent loss of correction.
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a safe zone in medial open wedge high Tibia Osteotomy to prevent lateral cortex fracture
Knee Surgery Sports Traumatology Arthroscopy, 2013Co-Authors: Seung Boem Han, Dong Ju Chae, Gautam M Shetty, Daehee Lee, Jae Gwang Song, Kyung Wook NhaAbstract:Purpose The purpose of this cadaveric study was to study the effect of plane of Osteotomy on incidence of lateral cortex fracture and to define a “safe zone” through which medial open-wedge high Tibial Osteotomy (HTO) could be performed with minimal risk of lateral cortex fracture.
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Tibial slope and patellar height after opening wedge high Tibia Osteotomy using autologous tricortical iliac bone graft
Knee, 2008Co-Authors: Dong Ju Chae, Gautam M Shetty, Dong Bong Lee, Hyun Woo Choi, Seung Beom Han, Kyung Wook NhaAbstract:Abstract Our aim was to evaluate the alteration in angle of posterior slope of the Tibia and the degree of patellar height following medial opening wedge high Tibia Osteotomy(HTO) using autologous tricortical iliac bone graft in 32 consecutive patients. Twenty three females and nine males underwent medial opening wedge high Tibia Osteotomy (HTO) using autologous tricortical iliac bone graft in 34 knees (33 primary medial compartment osteoarthritis and 1 idiopathic osteonecrosis of medial Tibial condyle). The posterior slope of Tibia was determined by the proximal Tibial anatomical axis. Patellar height was measured by the Insall-Salvati and the Blackburne-Peel ratios. Preoperative and postoperative (last follow up) values of these three parameters were compared. The intra- and interobserver variability of these methods was determined before and after operation. At the end of mean follow up of 3 years this procedure produced no significant change in posterior slope. Pre and postoperative posterior slope were 8.7°±3.6° and 8.2°±2.8° respectively ( P =0.412). Pre and postoperative Insall-Salvati ratios were 0.93±0.10 and 1.05±0.11 respectively ( P The distance between the patellar and tibiofemoral joint line decreased in 82% of patients. The mean Blackburne-Peel ratio declined from 0.71±0.12 to 0.61±0.13 ( P There was no difference in the intra-and interobserver variability of measurements either before or after HTO. Opening wedge HTO using autologous tricortical iliac bone graft with internal fixation and early mobilisation prevented change in posterior slope of Tibia, lengthened the patellar ligament and elevated the tibiofemoral joint line when the mean ratio of anterior and posterior gap at the Osteotomy site was around two-thirds.
Rachael J Da Cunha - One of the best experts on this subject based on the ideXlab platform.
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biomechanical and functional improvements gained by proximal Tibia Osteotomy correction of genu varum in patients with knee pain
HSS Journal, 2020Co-Authors: Austin T. Fragomen, Rachael J Da Cunha, Andrew P Kraszewski, Howard J Hillstrom, Robert S RozbruchAbstract:Mechanical axis malalignment contributes to abnormal forces across the knee joint. Genu varum, or increased medial mechanical axis deviation (MAD), increases force transmission and contact pressures to the medial compartment. With increasing MAD and femoral-Tibial mechanical axis angle (MAA), contact forces within the medial or lateral compartment of the knee significantly increase with increasing deformity. This may lead to knee pain, further deformity, and medial compartment degenerative joint disease, which can interfere with participation in sports and diminish quality of life. We sought to evaluate patients with knee pain with bilateral genu varum and determine the effect of bilateral proximal Tibial osteotomies on knee biomechanics, deformity correction, and functional outcomes. This was a single-center, prospective study of eight limbs in four patients. Consecutive patients presenting with knee pain and bilateral genu varum originating from the proximal Tibia were included. All patients underwent staged bilateral proximal Tibial osteotomies with gradual deformity correction with an external fixator. Subjects underwent a three-dimensional (3D) instrumented motion analysis during level walking. A 3D lower extremity model was built and bilateral knee frontal plane kinematics and kinetics during the stance phase of gait were determined. Radiographic analysis was performed including assessment of MAD, MAA, and medial proximal Tibial angle (MPTA). Functional outcomes were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS), the 36-item Short-Form Survey (SF-36), the Lower Limb Questionnaire (LLQ), and a visual analog scale (VAS) for pain. The average time in the external fixator for a single limb was 97 days. The average follow-up period was 310 days. All biomechanical outcomes significantly improved, including knee adduction angle (7.8° to 1.8°), knee adduction moments (first peak, − 0.450 to − 0.281 nm/kg, and second peak, − 0.381 to − 0.244 nm/kg), and knee adduction moment impulse (− 0.233 to − 0.150 nm s/kg). There was a significant improvement in MAA, MAD, and MPTA. All patients showed qualitative improvement in mean scores on VAS (11.8 to 0.0), LLQ (77 to 93), KOOS (64 to 84), and SF-36 (71 to 88). These findings suggest that bilateral proximal Tibial Osteotomy may be effective in improving knee biomechanics during gait and correcting mechanical alignment in patients with bilateral genu varum. Patients also demonstrated improvement in functional outcome scores. This technique should thus be considered in patients with varus knee osteoarthritis in the setting of genu varum to alleviate symptoms and potentially decrease further clinical deterioration.
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Biomechanical and Functional Improvements Gained by Proximal Tibia Osteotomy Correction of Genu Varum in Patients with Knee Pain
HSS Journal ®, 2020Co-Authors: Rachael J Da Cunha, Austin T. Fragomen, Andrew P Kraszewski, Howard J Hillstrom, S. Robert RozbruchAbstract:Background Mechanical axis malalignment contributes to abnormal forces across the knee joint. Genu varum, or increased medial mechanical axis deviation (MAD), increases force transmission and contact pressures to the medial compartment. With increasing MAD and femoral-Tibial mechanical axis angle (MAA), contact forces within the medial or lateral compartment of the knee significantly increase with increasing deformity. This may lead to knee pain, further deformity, and medial compartment degenerative joint disease, which can interfere with participation in sports and diminish quality of life. Purposes/Questions We sought to evaluate patients with knee pain with bilateral genu varum and determine the effect of bilateral proximal Tibial osteotomies on knee biomechanics, deformity correction, and functional outcomes. Methods This was a single-center, prospective study of eight limbs in four patients. Consecutive patients presenting with knee pain and bilateral genu varum originating from the proximal Tibia were included. All patients underwent staged bilateral proximal Tibial osteotomies with gradual deformity correction with an external fixator. Subjects underwent a three-dimensional (3D) instrumented motion analysis during level walking. A 3D lower extremity model was built and bilateral knee frontal plane kinematics and kinetics during the stance phase of gait were determined. Radiographic analysis was performed including assessment of MAD, MAA, and medial proximal Tibial angle (MPTA). Functional outcomes were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS), the 36-item Short-Form Survey (SF-36), the Lower Limb Questionnaire (LLQ), and a visual analog scale (VAS) for pain. Results The average time in the external fixator for a single limb was 97 days. The average follow-up period was 310 days. All biomechanical outcomes significantly improved, including knee adduction angle (7.8° to 1.8°), knee adduction moments (first peak, − 0.450 to − 0.281 nm/kg, and second peak, − 0.381 to − 0.244 nm/kg), and knee adduction moment impulse (− 0.233 to − 0.150 nm s/kg). There was a significant improvement in MAA, MAD, and MPTA. All patients showed qualitative improvement in mean scores on VAS (11.8 to 0.0), LLQ (77 to 93), KOOS (64 to 84), and SF-36 (71 to 88). Conclusion These findings suggest that bilateral proximal Tibial Osteotomy may be effective in improving knee biomechanics during gait and correcting mechanical alignment in patients with bilateral genu varum. Patients also demonstrated improvement in functional outcome scores. This technique should thus be considered in patients with varus knee osteoarthritis in the setting of genu varum to alleviate symptoms and potentially decrease further clinical deterioration.
Armando Campos - One of the best experts on this subject based on the ideXlab platform.
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Rare case of bilateral anterolateral and symmetrical bowing of Tibia successfully treated with a distal Tibial opening wedge Osteotomy
Journal of surgical case reports, 2019Co-Authors: Margarida Miranda, Carolina Afonso, Carla Martins, João Carvalho, Armando CamposAbstract:The anterolateral bowing of the Tibia is closely associated with the development of its pseudarthrosis. Roughly, all deformities are unilateral so the shortening and angulation are easy to identify. We present a 6-year-old boy with an exuberant bilateral anterolateral bowing of Tibia. He has short stature, disturbed gait and callosity at the lateral border of the foot. Deformity was successfully treated by opening wedge Tibia Osteotomy and filled the remaining gap with structural fibular graft. It was fixed with two crossed K-wires and cast immobilization for 6 weeks. We decided to correct it before skeletal maturity due to the significant disturbance of the gait and esthetic impairment. It was obtained a satisfactory morphological and functional result with a simple and fast technique.