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Irfan Esenkaya - One of the best experts on this subject based on the ideXlab platform.
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a new distractor with angle scale for proximal tibia medial opening Wedge Osteotomy
Knee Surgery Sports Traumatology Arthroscopy, 2006Co-Authors: Irfan EsenkayaAbstract:Lateral tibial plateau fractures or lateral cortex fractures may occur when performing medial opening Wedge Osteotomy. Some special tools have been described to prevent lateral tibial plateau or lateral cortex fracture during the medial separation of the Osteotomy planes in medial opening Wedge Osteotomy. The author has developed a distractor with angle-scale to prevent such complications. Between December 2001 and April 2004, 40 opening Wedge osteotomies stabilised with the plate with Wedge were performed on 38 patients. The distraction of initial osteotomies in 25 knees was done with different techniques and there were three lateral tibial plateau fractures and nine lateral cortex fractures. The remaining, recently operated, 15 knees were treated with the aid of the above described angle-scale distractor to prevent lateral tibial plateau and lateral cortex fractures. There was no lateral tibial plateau fractures during the surgery when we used this instrument for the distraction of the Osteotomy sites. A subsequent prospective study evaluated this new device.
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proximal tibia medial open Wedge Osteotomy using plates with Wedges early results in 58 cases
Knee Surgery Sports Traumatology Arthroscopy, 2006Co-Authors: Irfan Esenkaya, Nurzat ElmaliAbstract:We evaluated in this study indications, surgical technique, and results of Wedge plates for fixation in proximal tibia medial opening Wedge Osteotomy. Fifty-eight knees in 56 consecutive patients (9 men, 47 women; mean age 52 years; ranging between 36 and 66 years) with medial compartment osteoarthrosis were treated with proximal tibia medial open-Wedge Osteotomy. For fixation, plates which were designed by the first author and which support the Osteotomy surface with Wedge-shaped projections were used. The plates were either rectangular in shape with two or four holes or had an inverse “L” shape with four holes, and had bearing metal Wedges of varying heights from 5 to 15 mm. Tricortical (n=8) and bicortical (n=43) iliac bone autografts and allografts (n=7) were used. The average follow-up time was 21 months (ranging between 6 and 44 months). The mean preoperative tibiofemoral angle was 4.6° varus (0°–11°) while it was 5.6° valgus (2°–11°) postoperatively. The mean preoperative HSS score was 58 (range 51–75) and it was found 89 (range 79–96) postoperatively. As complications, lateral tibial plateau fracture in 5 knees (8.6%) and lateral cortex fracture in 15 knees (25.8%) were encountered during surgery. Deep vein thrombosis in two cases (3.4%) and nonfatal pulmonary embolism in one case (1.7%), delayed wound healing in two knees (3.4%), and delayed union as well as breakdown of a distal screw in one knee (1.7%) were encountered postoperatively. In conclusion, using Wedge plates for fixation of proximal tibia medial opening Wedge Osteotomy in the treatment of medial osteoarthritis with unicompartmental involvement of the knee, provides adequate stabilization to allow early movement for functional rehabilitation and keeps the obtained correction level.
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fixation of proximal tibia medial opening Wedge Osteotomy using plates with Wedges
Acta Orthopaedica et Traumatologica Turcica, 2005Co-Authors: Irfan EsenkayaAbstract:Objectives: The indications, surgical technique, and the results of fixation using plates with metal Wedges were assessed in proximal tibia medial opening Wedge Osteotomy. Methods: Forty knees in 38 consecutive patients (5 men, 33 women; mean age 51 years; range 36 to 65 years) with medial compartment osteoarthritis of the knee were treated with proximal tibia medial opening Wedge Osteotomy using plates with Wedges. Following arthroscopic debridement, medial proximal tibial Osteotomy was performed laterally and proximally on an oblique line and 3-4 cm distal to the medial joint space. Disruption of the lateral cortex was avoided. Fixation of the Osteotomy was performed using plates with Wedges. The plates which were designed by the author were either rectangular in shape with two or four holes or had an inverse “L” shape with four holes, bearing metal Wedges at varying heights from 5 to 15 mm. The plates were fixed with screws. Tricortical (n=8) or bicortical (n=25) iliac bone autografts and allografts (n=7) were used. Clinical and functional evaluations were made using the HSS scoring system. The mean follow-up was 17 months (range 9 to 36 months). Results: The mean preoperative and postoperative tibiofemoral angles were 4.3° varus (0°-10°) and 5.8° valgus (3°-11°), respectively. The mean HSS score increased from 59 (range 52 to 75) preoperatively to 90 (range 79 to 96) on final evaluations. During surgery, lateral tibial plateau fissures and lateral cortex fractures occurred in three (7.5%) and 11 (27.5%) knees, respectively. Delayed healing and delayed union and breakdown of a distal screw were encountered in one patient (2.5%). Conclusion: Fixation of proximal tibia medial opening Wedge Osteotomy using plates with Wedges provides adequate stabilization to maintain the desired correction and to allow early functional rehabilitation in the treatment of medial osteoarthritis of the knee.
Robert F. Laprade - One of the best experts on this subject based on the ideXlab platform.
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anterolateral proximal tibial opening Wedge Osteotomy to treat symptomatic genu recurvatum with valgus alignment a case report
Journal of Bone and Joint Surgery American Volume, 2014Co-Authors: Trevor R Gaskill, Casey M Pierce, Evan W James, Robert F. LapradeAbstract:A proximal tibial medial opening Wedge Osteotomy is commonly used to treat combined genu varus and medial compartment osteoarthritis1-3. Additionally, the ability to perform both coronal and sagittal plane corrections makes these osteotomies useful in treating chronic complex knee ligament instabilities4-13. Valgus-producing proximal medial opening or lateral closing Wedge tibial osteotomies have been performed for chronic combined varus alignment and cruciate or collateral ligament injuries1,11,14. While closing Wedge techniques provide the advantage of direct bone surface apposition, opening Wedge osteotomies reportedly facilitate more precise angular corrections15. Moreover, an opening Wedge Osteotomy is preferred when an increase in the posterior tibial slope is desired because it tends to increase posterior tibial slope16-19, while a closing Wedge Osteotomy tends to decrease posterior tibial slope20,21. Patients with valgus coronal plane malalignment are commonly treated with a distal femoral Osteotomy22. This technique, however, does not allow concomitant correction of sagittal-plane tibial slope. A lateral tibial-based opening Wedge Osteotomy to increase posterior tibial slope and correct genu valgus can be useful, yet remains infrequently discussed23,24. This case report describes the surgical technique for and outcomes after an anterolateral proximal tibial Osteotomy for symptomatic genu recurvatum and valgus alignment. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A twenty-two-year-old woman presented with left knee pain and instability following a motorcycle accident one year prior. She had experienced a hyperextension injury of the left knee, which had resulted in persistent instability despite considerable rehabilitation. Lateral movements, in particular, produced knee hyperextension and giving way. Despite more than a year of physical therapy, the left knee instability remained …
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the effect of a proximal tibial medial opening Wedge Osteotomy on posterolateral knee instability a biomechanical study
American Journal of Sports Medicine, 2008Co-Authors: Robert F. Laprade, Fred A Wentorf, Steinar Johansen, Lars Engebretsen, Chad KurtenbachAbstract:BackgroundIncreased stability of posterolateral corner knee injuries has been observed clinically after proximal tibial medial opening Wedge osteotomies.HypothesisStatic varus and external rotatory stability will be significantly improved in a knee with a grade 3 posterolateral knee injury after a proximal tibial medial opening Wedge Osteotomy.Study DesignControlled laboratory study.MethodsBiomechanical testing of 10 nonpaired, cadaveric knees was performed in the intact state, after transection of the posterolateral corner (fibular collateral ligament, popliteus tendon, and popliteofibular ligament), and after a 10-mm proximal tibial medial opening Wedge Osteotomy. Loading conditions consisted of 12 N.m varus moments and 6 N.m external rotation torques. Six degrees of freedom motion analysis was used to assess motion changes, and a buckle transducer was used to measure the force on the superficial medial collateral ligament during applied loads.ResultsAfter transection of the posterolateral corner struct...
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proximal tibial opening Wedge Osteotomy as the initial treatment for chronic posterolateral corner deficiency in the varus knee a prospective clinical study
American Journal of Sports Medicine, 2007Co-Authors: Andrew Arthur, Robert F. Laprade, Julie AgelAbstract:BackgroundNonoperative treatment of posterolateral knee injuries tends to yield poor results. In patients with chronic posterolateral knee injuries, failure to correct genu varus alignment will often result in failure of the posterolateral knee repair or reconstruction.PurposeTo prospectively assess the functional outcomes of patients with combined grade 3 posterolateral instability and genu varus alignment initially treated with a proximal tibial opening Wedge Osteotomy.Study DesignCohort study (prognosis); Level of evidence, 2.MethodsTwenty-one patients with combined chronic posterolateral corner deficiency and genu varus alignment were initially treated with a proximal tibial opening Wedge Osteotomy and observed prospectively. Second-stage ligamentous reconstruction was performed in patients with continued clinical and functional instability after the osteotomies had healed and they had undergone at least 3 months of rehabilitation.ResultsAt a mean follow-up of 37 months, 8 of 21 patients (38%) had suf...
Hiroshi Mizuta - One of the best experts on this subject based on the ideXlab platform.
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development and validation of formulae to predict leg length following medial opening Wedge Osteotomy of the proximal tibia with hemicallotasis
Knee, 2014Co-Authors: Eiichi Nakamura, Nobukazu Okamoto, Hiroaki Nishioka, Hiroki Irie, Hiroshi MizutaAbstract:Abstract Background A medial open-Wedge Osteotomy of the proximal tibia with hemicallotasis (HCO) affects the relative coronal alignment of the femur and tibia with respect to the floor; this also potentially reflects a change in leg length. Purpose The aims of this study are to develop and verify formulae for predicting the postoperative whole leg length (WLL) in HCO. Methods We analyzed a training set of 25 HCOs in 25 patients. Formulae for predicting the postoperative leg length were developed using various factors including the length and coronal alignment of the femur and tibia, the length of the proximal or distal fragment from the tibial Osteotomy site, the femoro–tibial angle, and the correction angle. The formulae were then verified using the interclass correlation coefficient in an independent consecutive set of 25 HCOs. Results Significant postoperative increases in tibial bone length and WLL were noted with no postoperative change in femoral bone length. Furthermore, the coronal alignments of femoral and tibial bone axes were significantly abducted. For the formulae for predicting postoperative WLL developed in the training set, the interclass correlation coefficients between the predicted values and the real radiographic measurements in the validation set were more than 0.90, showing great consistency. Conclusion The mathematical models established in this study seemed to predict almost completely the change in leg length after HCO. Our results suggest that these formulae may offer accurate, extremely useful information about the postoperative possibility of leg lengthening for patients planning an HCO. Level of evidence Therapeutic case series; level 4.
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the long term outcome of open Wedge Osteotomy of the proximal tibia with hemicallotasis
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: Eiichi Nakamura, Nobukazu Okamoto, Hiroaki Nishioka, Tatsuki Karasugi, Jun Hirose, Hiroshi MizutaAbstract:We report the long-term outcome of 33 patients (37 knees) who underwent proximal tibial open-Wedge Osteotomy with hemicallotasis (HCO) for medial osteoarthritis of the knee between 1995 and 2000. Among these, 29 patients with unilateral HCO were enrolled and 19 were available for review at a mean of 14.2 years (10 to 15.7) post-operatively. For these 19 patients, the mean Hospital for Special Surgery knee score was 60 (57 to 62) pre-operatively and 85 (82 to 87) at final follow-up (p t -test). The femorotibial angle and tibial inclination angle (IA) were measured at short-term follow-up, one to four years post-operatively, and showed no significant subsequent changes. The clinical scores and radiological measurements showed little change over time. One patient required conversion to total knee replacement during this time. These results suggest that the coronal angle achieved at operation is maintained at long-term follow up after HCO without alteration of the IA, providing a good long-term clinical outcome. Cite this article: Bone Joint J 2014;96-B:467–72.
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open Wedge Osteotomy of the proximal tibia with hemicallotasis
Journal of Bone and Joint Surgery-british Volume, 2001Co-Authors: Eiichi Nakamura, Hiroshi Mizuta, Satoshi Kudo, K Takagi, K SakamotoAbstract:Conventional high tibial Osteotomy for losteoarthritis of the medial compartment of the knee with closed-Wedge or dome Osteotomy (DMO) may produce shortening of the patellar tendon and loss of inclination of the proximal tibial plateau or of the offset of the tibial condyle relative to its bony axis. This can make subsequent total knee arthroplasty technically demanding. We undertook a prospective study comparing these changes after DMO with those after using open-Wedge Osteotomy hemicallotasis (HCO). A total of 50 knees with arthritis of the medial compartment in 46 consecutive patients was randomly allocated to either DMO or HCO. There were no significant differences between the groups with regard to age, gender, femorotibial angle before operation or the angle of correction. Radiological studies showed that HCO caused little change in the length of the patellar tendon or the inclination angle of the tibial plateau, while after DMO both gradually decreased. The degree of tibial condylar offset increased in both groups, but less so in the HCO group.
Nurzat Elmali - One of the best experts on this subject based on the ideXlab platform.
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proximal tibia medial open Wedge Osteotomy using plates with Wedges early results in 58 cases
Knee Surgery Sports Traumatology Arthroscopy, 2006Co-Authors: Irfan Esenkaya, Nurzat ElmaliAbstract:We evaluated in this study indications, surgical technique, and results of Wedge plates for fixation in proximal tibia medial opening Wedge Osteotomy. Fifty-eight knees in 56 consecutive patients (9 men, 47 women; mean age 52 years; ranging between 36 and 66 years) with medial compartment osteoarthrosis were treated with proximal tibia medial open-Wedge Osteotomy. For fixation, plates which were designed by the first author and which support the Osteotomy surface with Wedge-shaped projections were used. The plates were either rectangular in shape with two or four holes or had an inverse “L” shape with four holes, and had bearing metal Wedges of varying heights from 5 to 15 mm. Tricortical (n=8) and bicortical (n=43) iliac bone autografts and allografts (n=7) were used. The average follow-up time was 21 months (ranging between 6 and 44 months). The mean preoperative tibiofemoral angle was 4.6° varus (0°–11°) while it was 5.6° valgus (2°–11°) postoperatively. The mean preoperative HSS score was 58 (range 51–75) and it was found 89 (range 79–96) postoperatively. As complications, lateral tibial plateau fracture in 5 knees (8.6%) and lateral cortex fracture in 15 knees (25.8%) were encountered during surgery. Deep vein thrombosis in two cases (3.4%) and nonfatal pulmonary embolism in one case (1.7%), delayed wound healing in two knees (3.4%), and delayed union as well as breakdown of a distal screw in one knee (1.7%) were encountered postoperatively. In conclusion, using Wedge plates for fixation of proximal tibia medial opening Wedge Osteotomy in the treatment of medial osteoarthritis with unicompartmental involvement of the knee, provides adequate stabilization to allow early movement for functional rehabilitation and keeps the obtained correction level.
Eiichi Nakamura - One of the best experts on this subject based on the ideXlab platform.
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development and validation of formulae to predict leg length following medial opening Wedge Osteotomy of the proximal tibia with hemicallotasis
Knee, 2014Co-Authors: Eiichi Nakamura, Nobukazu Okamoto, Hiroaki Nishioka, Hiroki Irie, Hiroshi MizutaAbstract:Abstract Background A medial open-Wedge Osteotomy of the proximal tibia with hemicallotasis (HCO) affects the relative coronal alignment of the femur and tibia with respect to the floor; this also potentially reflects a change in leg length. Purpose The aims of this study are to develop and verify formulae for predicting the postoperative whole leg length (WLL) in HCO. Methods We analyzed a training set of 25 HCOs in 25 patients. Formulae for predicting the postoperative leg length were developed using various factors including the length and coronal alignment of the femur and tibia, the length of the proximal or distal fragment from the tibial Osteotomy site, the femoro–tibial angle, and the correction angle. The formulae were then verified using the interclass correlation coefficient in an independent consecutive set of 25 HCOs. Results Significant postoperative increases in tibial bone length and WLL were noted with no postoperative change in femoral bone length. Furthermore, the coronal alignments of femoral and tibial bone axes were significantly abducted. For the formulae for predicting postoperative WLL developed in the training set, the interclass correlation coefficients between the predicted values and the real radiographic measurements in the validation set were more than 0.90, showing great consistency. Conclusion The mathematical models established in this study seemed to predict almost completely the change in leg length after HCO. Our results suggest that these formulae may offer accurate, extremely useful information about the postoperative possibility of leg lengthening for patients planning an HCO. Level of evidence Therapeutic case series; level 4.
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the long term outcome of open Wedge Osteotomy of the proximal tibia with hemicallotasis
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: Eiichi Nakamura, Nobukazu Okamoto, Hiroaki Nishioka, Tatsuki Karasugi, Jun Hirose, Hiroshi MizutaAbstract:We report the long-term outcome of 33 patients (37 knees) who underwent proximal tibial open-Wedge Osteotomy with hemicallotasis (HCO) for medial osteoarthritis of the knee between 1995 and 2000. Among these, 29 patients with unilateral HCO were enrolled and 19 were available for review at a mean of 14.2 years (10 to 15.7) post-operatively. For these 19 patients, the mean Hospital for Special Surgery knee score was 60 (57 to 62) pre-operatively and 85 (82 to 87) at final follow-up (p t -test). The femorotibial angle and tibial inclination angle (IA) were measured at short-term follow-up, one to four years post-operatively, and showed no significant subsequent changes. The clinical scores and radiological measurements showed little change over time. One patient required conversion to total knee replacement during this time. These results suggest that the coronal angle achieved at operation is maintained at long-term follow up after HCO without alteration of the IA, providing a good long-term clinical outcome. Cite this article: Bone Joint J 2014;96-B:467–72.
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open Wedge Osteotomy of the proximal tibia with hemicallotasis
Journal of Bone and Joint Surgery-british Volume, 2001Co-Authors: Eiichi Nakamura, Hiroshi Mizuta, Satoshi Kudo, K Takagi, K SakamotoAbstract:Conventional high tibial Osteotomy for losteoarthritis of the medial compartment of the knee with closed-Wedge or dome Osteotomy (DMO) may produce shortening of the patellar tendon and loss of inclination of the proximal tibial plateau or of the offset of the tibial condyle relative to its bony axis. This can make subsequent total knee arthroplasty technically demanding. We undertook a prospective study comparing these changes after DMO with those after using open-Wedge Osteotomy hemicallotasis (HCO). A total of 50 knees with arthritis of the medial compartment in 46 consecutive patients was randomly allocated to either DMO or HCO. There were no significant differences between the groups with regard to age, gender, femorotibial angle before operation or the angle of correction. Radiological studies showed that HCO caused little change in the length of the patellar tendon or the inclination angle of the tibial plateau, while after DMO both gradually decreased. The degree of tibial condylar offset increased in both groups, but less so in the HCO group.
