TT-TG distance decreases after open wedge distal femoral varization osteotomy in patients with genu valgum & patellar instability. A pilot 3D computed tomography simulation study.

BACKGROUND: Genu valgum is considered to be a risk factor for patellar instability. Correction of valgus alone or combined with a tibial tuberosity medialization has been described. However, changes occurring in the tibial tuberosity-trochlear groove (TT-TG) distance after a lateral distal femoral opening wedge osteotomy (LDF-OWO) are not known. PURPOSE: This study aimed to define changes in TT-TG distance with increasing amounts of valgus correction after LDF-OWO. METHODS: Three-Dimensional Computed Tomography (3D-CT) scans of six patients (two females and four males) aged between 19 and 35 years with genu valgum and patellar instability were analyzed. 3D models of femoral, tibial, and patellar bones were created with the advanced segment option of Mimics 21® software. An oblique lateral opening wedge osteotomy of the distal femur was simulated in 2-degree increments up to 12 degrees of varus opening. Change in TT-TG distance was measured in mm on 3D models of the knee. RESULTS: Compared to baseline without osteotomy, the TT-TG distance decreased significantly (p < 0.05) for all corrections from 2 to 12 degrees in 2° steps. The TT-TG distance decreased by an average of 1.7 mm for every 2 degrees of varus opening. CONCLUSION: Lateral opening wedge distal femoral osteotomy causes a decrease in TT-TG distance. The surgeon should be aware of the magnitude of this change (1.7 mm decrease for every 2° increment of valgus opening).

[Development of osteonecrosis after arthroscopic meniscal and chondral knee surgery: a report of five cases]. / Artroskopik menisküs ve kikirdak cerrahisinden sonra osteonekroz gelisimi: bes olgu sunumu.

The development of osteonecrosis after arthroscopic surgery has been associated with meniscectomy, chondral surgery, and the use of thermal energy. This paper presents five cases, four of which fulfilled the temporal criteria for postarthroscopy necrosis, i.e. presurgical magnetic resonance imaging was obtained at least four weeks after the onset of symptoms). Four cases were treated conservatively while one underwent arthroscopic debridement and microfracturing. The diagnosis of osteonecrosis should be kept in mind in osteoarthritic patients whose knee symptoms manifest a sudden increase without trauma, and in cases with worsening knee symptoms after arthroscopic surgery. The optimal treatment strategy in these patients is still debatable.

Pedunculated synovium grafts in articular cartilage defects in rabbits.

A rabbit model was used to assess the nature of healing tissues in hyaline cartilage defects and to compare the healing in defects treated with pedunculated synovium grafts to those in defects without synovial grafting. Both knees of 28 1-year-old rabbits were operated. A 3 x 2-mm cartilage defect that exposed cancellous bone was created in the non-weight-bearing area of each medial femoral condyle. Each right-knee defect was covered with a pedunculated synovial graft obtained from the same joint, and the left-knee defects were left uncovered as controls. Groups of rabbits were sacrificed at 3, 6, 12, and 24 weeks postsurgery. Sections from each knee were stained with hematoxylin-eosin and safranin O-fast green staining, and were immunohistochemically stained for type II collagen. The healing at each site was histologically scored, and the intensity of staining for type II collagen was graded. At 12 and 24 weeks, statistical comparisons of histological scores revealed significantly more hyaline cartilage tissue in the synovium-grafted defects. At 24 weeks, these same defects showed significantly more type II collagen. Thus, pedunculated synovium transplantation appears to hold promise as a method for repairing hyaline cartilage defects.

Is prematurity important in ultrasonographic hip typing?

The aim of this study was to determine whether prematurity is important with respect to hip typing and planning of treatment/follow-up in newborns assessed with the Graf's ultrasonography method. Between January 1998 and 2003, 1592 neonates; preterm (n=432) and term (n=1160), had their hips ultrasonographically evaluated with Graf typing. There were no statistical differences between the two groups with respect to the numbers of hips that required follow-up assessment, or treatment. The results suggest that prematurity is irrelevant and use of chronological age as opposed to corrected age for prematurity will further simplify diagnosis and planning of follow-up and treatment in the Graf system for neonatal hip assessment.

Multilevel vertebral hemangiomas: two episodes of spinal cord compression at separate levels 10 years apart.

This case report presents a 66-year-old woman with multiple vertebral hemangiomas causing spinal cord compression at different levels with a long symptom-free interval between episodes of compression. She presented with back pain and progressive weakness and numbness in her lower limbs for 3 months. Ten years earlier, she had had a symptomatic T4 vertebral hemangioma operated successfully, and had made a full recovery. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine revealed multiple thoracic and lumbar vertebral hemangiomas. Extraosseous extension of a hemangioma at T9 was causing spinal cord compression. Selective embolization was performed preoperatively, and cord decompression was achieved via anterior T9 corpectomy. The patient's neurological status improved rapidly after surgery. After a course of radiotherapy, she was neurologically intact and could walk independently. One year later, MRI showed complete resolution of the cord edema at T9, and showed regression of the high signal intensity that had been observed at unoperated levels. These findings indicated diminished vascularity and reduced aggression of the tumor.