Tibial tubercle osteotomy hinged on the tibialis anterior muscle and fixed by circumferential cable cerclage in revision total knee arthroplasty.

BACKGROUND: Difficulties in knee exposure during revision total knee arthroplasty (RTKA) may require tibial tubercle osteotomy (TTO). The main objective of this study was to assess union after TTO hinged on the lateral soft tissues and fixed using circumferential cable cerclage during RTKA. HYPOTHESIS: Non-union is uncommon with this technique. PATIENTS AND METHODS: We retrospectively included consecutive patients who underwent RTKA between 2008 and 2010 with TTO. Chevron osteotomy was performed and the fragment was left hinged laterally on the tibialis anterior muscle then fixed using circumferential cerclage with one or two steel cables. The primary evaluation criterion was TTO union as assessed on radiographs. Secondary evaluation criteria were time to union, osteotomy fragment migration, patellar height, and the IKS score at last follow-up. We included 65 patients with a mean age of 72±11.3 years including 39 (60%) undergoing septic revision and 26 (40%) aseptic revision. Mean follow-up was 27.8±10.7 months; there was 1 early death, which was unrelated to the surgery, and another patient was lost to follow-up. RESULTS: TTO union was achieved in 59/63 (93.7%) patients. Fragment migration occurred in 4 (6.3%) patients. Mean time to union was 16.9±5.1 weeks overall, 12.4±2.0 in the aseptic revision group, and 18.9±4.8 in the septic revision group (P=0.0005). Patellar height at last follow-up was not significantly changed compared to the preoperative value (P=0.09). At last follow-up, the mean IKS knee and function scores were significantly improved (P<10-5). CONCLUSION: TTO hinged on the lateral soft tissues and fixed by circumferential cable cerclage ensured union in the vast majority of patients, with a low rate of tubercle migration. LEVEL OF EVIDENCE: IV, retrospective study.

[Arthroscopic partial trapezectomy. A radio-anatomical study about 14 cases]. / Trapézectomie partielle arthroscopique : étude radioanatomique de 14 cas.

OBJECTIVES: The aim of the study was to assess the accessibility of the trapezium surface to arthroscopic resection related to the degenerative stage, to define the surgical approach and to determine the efficacy of the X-rays for evaluating the amount of resected bone. METHODS: Fourteen trapezectomies were performed on seven cadaveric specimens using an arthroscopic procedure. Pre- and post-procedure X-rays were used to assess the initial trapeziometacarpal osteoarthritis and the resection performed. Each subject was randomized for using two posterior portals or two posterior portals and one anterior portal. At the end of the procedure, a dissection was performed for evaluating the quality of resection and the anatomical relationship of each surgical approach. RESULTS: The stages of preprocedure osteoarthritis were comparable between the two sides of the same cadaveric specimen. On post-procedure X-rays, the resection appeared complete in only six out of 14 wrists. During dissection, no injury to neurovascular structures was observed, and the resection was visible macroscopically in 11/14 wrists. Three resections were incomplete, i.e., less than 20 % of total trapezial surface: two of them were seen in the most osteoarthritic cases of the study. CONCLUSIONS: The arthroscopic approach presents an opportunity to access the entire trapezial surface, even if a high stage of osteoarthritis appears to be a risk for incomplete resection. The addition of a systematic anterior approach to the traditional dorsal approach does not increase the accessibility. Although radiography is not the most appropriate tool to assess the resected surface, it does help to locate the defects of resection and can guide the surgical procedure in situations where there is a risk of incomplete resection.