A Single-Stage Medial Opening Wedge High Tibial Osteotomy for Varus Alignment Correction With Revision Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction.

Anterior cruciate ligament (ACL) injuries are a common clinical entity among people involved in contact sports activities. With the number of primary ACL reconstructions increasing, there has been a proportional increase in the revision of failed ACL reconstruction surgeries. As our understanding of knee kinematics improves over time, there has been evidence that alignment of the lower limb weight-bearing axis also plays an important part in ACL functioning. Medial opening wedge high tibial osteotomy (MOWHTO) is one such procedure that has been used extensively worldwide to correct the varus lower limb alignment. This procedure is usually reserved for young active patients with varus lower limb weight-bearing alignment. The technical dilemma for the surgeon arises when there is a need to revise a failed ACL reconstruction while at the same time correcting the axis malalignment. The general dictum says that alignment correction is done first followed by ligament reconstruction in a dual-stage procedure. However, single-stage surgery is possible in certain indications. In this case report, we present the case of a 31-year-old male involved in recreational sports who sustained a repeat ACL tear five years post the index surgery. He also had a significant varus alignment of the lower limb weight-bearing axis which was considered to be one of the causes of index surgery failure. In this report, we would like to highlight the problems we encountered in a single-stage procedure and certain surgical facets of a single-stage alignment surgery with arthroscopic revision ACL reconstruction.

[Evolving indications for partial knee replacement : New aspects]. / Update Indikation Teilprothese : Neue Aspekte.

BACKGROUND: Partial knee replacement has proven to be an effective therapy for advanced unicompartmental arthrosis of the knee. Despite continuous advancements in implants and surgical techniques over the past decades, the global preference for total knee arthroplasty still persists for historical reasons. OBJECTIVES: This report aims to illuminate advantages and disadvantages of partial knee replacement considering long-term results, the evolution of indication criteria over recent decades and new aspects in patient selection with potential improvements through emerging technologies. MATERIAL AND METHODS: The analysis involves the examination of long-term results from clinical studies and registry data, highlighting the risk factors for potential failures and their influence on the development of indication criteria. RESULTS: Present-day long-term results demonstrate excellent prosthetic survival, aligning with outcomes from total knee arthroplasty. New perspectives for expanding indication criteria are discussed, including the possible application of partial knee replacement in cases of severe varus deformity > 15°, anterior cruciate ligament insufficiency, young active patients, anterior knee pain, and/or patellofemoral arthritis, as well as mild radiographic arthritis with degenerative medial meniscus root tear and meniscal extrusion. DISCUSSION: Indication criteria have consistently expanded in recent years, taking into account modern insights, and the application of advanced technologies can enhance precision and minimize surgical errors. Furthermore, this report emphasizes that revision rates are not the sole criterion for success and underscores the necessity for a comprehensive examination of clinical results.

A Physiotherapeutic Approach to a Rare Case of Windswept Deformity in a Male Adolescent.

Primary hyperparathyroidism (PHPT) can lead to a rare condition in children and adolescents known as windswept deformity. This deformity involves one knee exhibiting an abnormal outward angulation (valgus deformity), while the other knee shows an abnormal inward angulation (varus deformity). This asymmetrical syndrome, resembling the effect of strong winds, gives the impression that the knees are being swept in opposite directions. Various factors, such as structural bone or joint defects, accidents, or underlying disorders, can contribute to the development of windswept deformity. PHPT, a common endocrine condition characterized by elevated levels of parathyroid hormone and blood calcium, is unusual in the pediatric and adolescent populations. It can result in complications like osteoporosis and bone abnormalities, with genu valgus (outward knee angulation) being an exceptionally rare symptom. This case discusses a 19-year-old male who underwent corrective surgery for genu valgus and presented with windswept deformity due to teenage hyperparathyroidism. The case study outlines the physiotherapeutic rehabilitation strategy, emphasizing treatments such as cryotherapy, patellar mobilization, and gait training. Tailored physical therapy rehabilitation plays a crucial role in the postoperative care of patients undergoing corrective osteotomies. The results indicated a significant improvement in muscle strength, an expansion of the range of motion (ROM), and a noticeable enhancement in the individual's functional autonomy following adherence to the postoperative physiotherapy (PT) plan.

Severe genu varus deformity does not affect enhanced recovery after surgery total knee arthroplasty outcomes.

INTRODUCTION: Enhanced recovery after surgery (ERAS) has been increasingly adopted in orthopaedic surgery. Although not an exclusion criterion, patients undergoing total knee arthroplasty (TKA) with preoperative severe varus deformity may be less likely to be enrolled for ERAS. This study aimed to compare the success of ERAS TKA between patients with severe preoperative varus deformities (≥ 15° varus) and the control group (< 15° varus to 14° valgus). Our secondary aim was to compare postoperative complications and functional outcomes between the two groups. MATERIALS & METHODS: 310 TKAs performed from August 2019 to February 2021 were analyzed with a follow-up of 6 months postoperatively. The primary outcome, ERAS TKA success, was defined as length of hospital stay of < 24 h. Other parameters included 30-day postoperative complications and clinical outcomes such as the original Oxford Knee Score (OKS), the Knee Society Knee (KSKS) and Function Score (KSFS), Visual Analog Scale for Pain (VAS-P), 36-Item Short-Form Health Survey (SF-36) Physical Component Summary (PCS) and SF-36 Mental Component Summary (MCS). RESULTS: There were 119 patients in the severe deformity group and 191 patients in the control group. There were no significant differences in ERAS success between the severe deformity group and control group, with both groups achieving similarly high rates (> 90%) of ERAS success. There were also no differences in 30-day postoperative complications and 6-month postoperative clinical outcomes. CONCLUSION: Patients with severe preoperative varus deformity undergoing ERAS TKA achieved high ERAS success rates (> 90%). Genu varum is not a contraindication for ERAS TKA.

Novel ideas for the comprehensive evaluation of varus knee osteoarthritis: radiological measurements of the morphology of the lateral knee joint.

BACKGROUND: The lateral anatomical and morphological characteristics of knees with varus knee osteoarthritis (OA) have not received sufficient attention. This study used several radiological parameters to describe the morphological characteristics of the lateral knee with OA to determine whether there are relationships between varus knee OA and parameters such as lateral plateau widening (LPW), proximal fibula curvature (PFC), and fibula height (FH). METHODS: The study retrospectively analyzed 1072 subjects who underwent standard radiography for diagnosing or evaluating symptomatic knee joint disease. The 163 Kellgren and Lawrence (K-L) grades 0 and I knees were categorized into the no-knee-OA group, and the 909 K-L grades II-IV knees were classified into the knee-OA group. Medial proximal tibial angle, joint line convergence angle, hip-knee-ankle angle, LPW, PFC, and FH were measured. T tests and chi-square tests were used to compare each index between the two groups. Binary logistic regression was performed to examine the correlation between indexes and knee OA occurrence. Ordinal logistic analysis, principal component analysis, and multivariable linear regression analysis were performed to examine the correlations between the three lateral parameters and K-L grades and the degree of varus deformity. RESULTS: LPW and PFC were significantly greater and FH was significantly smaller in the knee-OA group than in the no-knee-OA group. LPW, PFC, and FH were correlated with knee OA occurrence. One principal component, named the comprehensive principal component score of varus deformity, was extracted from the three indexes, and the total variance of the principal component interpretation was 76.60%. Ordinal logistics and multivariable linear regression analysis showed that, after adjusting for age and BMI, LPW and PFC were positively correlated with K-L grading and varus deformity. FH was significantly and negatively correlated with K-L grading and varus deformity (all P < 0.05). CONCLUSIONS: Regular morphological changes take place in the lateral knee with varus OA, including lateral dislocation of the tibial plateau, proximal fibula bending, and upward movement of the fibular head. Changes in LPW, PFC, and FH could enable a more comprehensive assessment of varus knee OA occurrence, severity, and deformity. Level of evidence Retrospective Study Level III.

Long-term effects of shoe mileage on knee and ankle joints muscle co-contraction during walking in females with genu varus.

BACKGROUND: Shoe mileage may influence the risk of sustaining injuries during walking. RESEARCH QUESTION: What are the effects of shoe mileage on knee and ankle muscle co-contraction during walking in females with genu varus? METHODS: Fifteen healthy and 15 women diagnosed with genu varus received a new pair of running shoes. They were asked to wear these shoes over 6 months. Pre and post intervention, muscle activities of the dominant limb were recorded during a walking test at preferred gait speed. Two dependent variables were assessed to examine muscle co-contraction: (1) directed co-contraction ratios of agonists and antagonists, and (2) general joint muscle co-contraction. FINDINGS: Results demonstrated significant main effects of the "shoe" factor for general ankle co-contraction during the push-off phase (p = 0.013, d = 1.503). Irrespective of experimental group, paired comparisons revealed significantly lower general ankle co-contraction during the push-off phase after the intervention. A significant main effects of "shoe" for general knee co-contraction during loading phase (p = 0.025, d = 0.895) was also observed. In both groups, paired comparison revealed significantly lower general knee co-contraction during the push-off phase in the post condition. We did not find any significant main effect of group nor group-by-shoe interaction for general ankle co-contraction during the stance phase. Likewise, we did not observe any significant main effect of "shoe", "group" and "group-by-shoe" interaction for mediolateral directed knee co-contraction during stance phase of walking (p > 0.05). SIGNIFICANCE: Our findings showed that the shoe mileage but not the genu varus condition affects the general and directed co-contraction of the muscles stabilizing the knee and ankle joints. Together with the observed findings on ankle and knee muscle co-contraction, it is essential to change running shoes after a long wearing time in both healthy and genu varus females.

[Knee realignment osteotomy in adults]. / Kniegelenksnahe Umstellungsosteotomien des Erwachsenen.

BACKGROUND: Nowadays, osteotomy near the knee joint for axial deformities has become an indispensable surgical procedure for joint preservation in the orthopaedic-surgical spectrum. The exact localization and analysis of the deformity are crucial to restoring physiological loading conditions of the entire leg by means of a suitable osteotomy. PROCEDURES: Thus, above all, the medial "open-wedge" osteotomy has established itself as a standard procedure for the treatment of gonarthrosis caused by varus malalignment. Furthermore, the varus closed-wedge osteotomy of the distal femur also shows very good long-term results. Basically, osteotomies close to the knee are causal corrections in which biological and mechanical aspects must be taken into account. Thus, the correct indication, attention to risk factors, and surgical technique determine the long-term success of the procedure. The doctrine of femoral valgus deformity and the resulting lateral arthrosis, on the other hand, must be reconsidered according to the latest knowledge.

Clinical Significance of Combined Weight-Bearing and Non-Weight-Bearing Positions and MRI Examination in Evaluating Genu Varus.

OBJECTIVE: To siscuss the clinical significance of the early diagnosis of knee varus and knee osteoarthritis with the combination of negative position and non-negative position and radiography. METHODS: One hundred and eighty patients whose femorotibial angles <182° (genu varus positive) measured by X-ray at the weight-bearing position and femorotibial angles ≥182° (genu varus negative) measured by X-ray at the non-weight-bearing position were selected as the sample group from those patients who received knee joint Magnetic resonance imaging (MRI) examination from July 2015 to July 2017. One hundred and eighty patients whose femorotibial angles ≥182° (genu varus negative) measured at both the weight-bearing position and the non-weight-bearing position were selected as the control group. Femorotibial angles of both groups were respectively measured, to respectively compare and analyze the effect of non-weight-bearing false-negative genu varus on the occurrence and severity of injury of medial meniscus and femorotibial articular cartilage. The two groups of patients had no previous history of knee surgery, and no lower limb fracture, inflammation, tumor, metabolic bone disease, or congenital disease. RESULTS: The weight-bearing tibiofemoral angles of the non-weight-bearing false-negative genu varus group and the negative genu varus group (180.998° ± 0.589°) were lower than the non-weight-bearing tibiofemoral angles (182.501° ± 0.290°), and they were positively correlated (t = -15.048, P < 0.01). The non-weight-bearing knee varus medial meniscus incidence of false- negative group. Medial meniscus injury that occurred in the sample group were 86.7% (156/180) in the anterior horn, 91.7% (165/180) in the body, 88.3% (159/180) in the posterior horn. Medial meniscus injury that occurred in the control group were 46.7% (84 /180) in the anterior horn, 40.6.3% (73/180) in the body, 43.3% (78/180) in the posterior horn. The incidence of degenerative groups, the differences were statistically significant. The incidence and severity of injury were as follows: medial meniscus anterior horn (χ2 = 41.966, P = 0.000), body (χ2 = 104.94, P = 0.000), posterior horn (χ2 = 81.025, P = 0.000). The incidence and severity of medial meniscus injury in the non-weight-bearing knee varus false negative group was higher than in the control group. The non-weight-bearing knee varus false-negative group medial tibiofemoral articular cartilage degeneration rate was 95.0% (171/180); in the control group, medial tibiofemoral articular cartilage degeneration was 65.1% (117/180). Two medial tibiofemoral articular cartilage degeneration incidence were statistically significant. The incidence and severity of injury were as follows: medial tibiofemoral articular cartilage (χ2 = 50.625, P = 0.000). The incidence and severity of medial tibiofemoral articular cartilage injury in the non-weight-bearing knee varus false negative group was higher than in the control group. CONCLUSION: The combined weight-bearing position and non-weight-bearing position imaging examination for diagnosing the non-weight-bearing false-negative genu varus patients at an early date is of significant importance to the early diagnosis and treatment of knee osteoarthritis.

Effect of Lower-Extremity Angular Imbalance on Foot and Ankle Pain in Patients With Genu Varus Deformity.

When there is a varus knee deformity, the ankle and foot compensate. However, the association between pain and angular change in the compensatory mechanism is not well understood. Therefore, we investigated the relationship between pain and angular change of the lower extremity in genu varus patients. Standing whole-lower-leg plain radiographs of 127 legs (77 patients) with >4° of genu varum were evaluated. Pain was assessed separately at the ankle, forefoot, and hindfoot. Knee, ankle, and subtalar joint angles were measured. Patients were divided into 3 groups according to the degree of lower leg angular imbalance (group 1, mild; group 2, moderate; group 3, severe). The presence of multiple pain locations differed significantly between groups and was significantly higher in group 3 than group 1 (p = .0061). Likewise, the subtalar angle was significantly more varus in group 3 than group 1 (p = .012). In conclusion, an unbalanced lower extremity with genu varum was associated with multiple foot and ankle pain, and the subtalar joint played a primary role in compensation for genu varum deformity.

Clinical measurement of angular profile of the knee and correlation with intermalleolar distance in children in Enugu metropolis.

BACKGROUND: Angular deformities of the lower limbs are commonly encountered deformities in pediatric orthopedic clinics. The values of the tibiofemoral angle undergoes changes as the child grows and these changes are self-limiting. The aim of the study is to establish the normal variation of knee angles of children between 2 and 12 years of age in Enugu metropolis and to establish any correlation between the knee angles and the intermalleolar distances (IMDs). SUBJECTS AND METHODS: This study was done on 630 school children in Enugu metropolis between the age groups of 2 and 12 years. Multistage sampling was used in the study. The tibiofemoral angles and intermalleolar/intercondylar distances were measured. RESULTS: The maximum tibiofemoral angle from this study was 7.6° ± 2.4° and the age corresponding to this value was 4 years. Only 23 subjects (3.5%) had varus knee angle. The values of the mean tibiofemoral angle and IMDs plateaued from 8 to 12 years. There was a significant positive correlation between average knee angle and IMD (r = 0.785, P < 0.001). CONCLUSION: The physiological changes in the knee angle (tibiofemoral) follow a similar pattern as established in the literature and there was positive correlation between IMD and the tibiofemoral angle.

Advantages of individualized open wedge high tibial osteotomy in treatment of medial compartment knee osteoarthritis / 中国组织工程研究

BACKGROUND: Open wedge high tibial osteotomy can achieve significant clinical efficacy for patients with medial compartment knee osteoarthritis and genu varus. However, Fujisawa point has been recognized as a reference for the correction of lower limb alignment. Can individualized orthopedics in lower limb alignment obtain better clinical efficacy? OBJECTIVE: To explore short-term efficacy of individualized orthopedics in lower limb alignment for medial compartment knee osteoarthritis through open wedge high tibial osteotomy. METHODS: Totally 46 patients with medial compartment knee osteoarthritis treated by open wedge high tibial osteotomy from June 2016 to May 2018 in Department of Orthopedics, Wuxi People's Hospital were enrolled in this study. X-ray and MRI were used to evaluate the knee and I-III degeneration grades were classified. Patients at Grade I and II were randomly divided into individualized orthopedics group and control group with 16 cases in each group. Patients at grade III were classified as Fujisawa group with 14 cases. In the individualized orthopedics group, mild grade I and moderate grade II respectively corrected lower limb alignment to 50% and 55% of lateral tibial plateau, while control group and Fujisawa group all corrected the alignment to 62.5% point. Postoperative lower limb alignment, pre- and post-operative range of motion, femoral-tibial angle and medial proximal tibial angle of the knee were measured and evaluated. The hospital for special surgery score and the Western Ontario and McMaster Universities osteoarthritis index score were followed up before operation, 3, 6 and 12 months after operation, while postoperative self-satisfaction of patients was also compared. RESULTS AND CONCLUSION: (1) All patients were followed up for 12 months. (2) Three groups achieved satisfactory lower limb alignment. Range of motion and medial proximal tibial angle increased and femoral-tibial angle decreased at postoperative stage (P 0.05). (4) All patients were satisfied with the surgical efficacy. Postoperative self-satisfaction scores of individualized orthopedics group were superior to that of control group (P < 0.05). (5) According to the results, individualized open wedge high tibial osteotomy is benefit to obtain early functional rehabilitation of the knee through accurate correction of lower limb alignment. It can also improve patient satisfaction.

Rehabilitation improves walking kinematics in children with a knee varus: Randomized controlled trial.

BACKGROUND: Previous studies have demonstrated increased medial stresses in knee varus alignment. Selecting a suitable treatment strategy for individuals with knee malalignment should be a priority. OBJECTIVES: We aimed to investigate the effects of a 16-week corrective exercise continuum (CEC) program on 3-D joint angles of the dominant and non-dominant lower limbs in children with genu varus during walking. METHODS: Overall, 28 male children with genu varus (age range 9-14 years) volunteered to participate in this study. They were randomly divided into 2 equal groups (experimental and control). The participants of the experimental group received CEC for 16 weeks. 3-D gait analysis involved using a Vicon Motion System. Paired and independent sample t-tests were used for within- and between-group comparisons, respectively. RESULTS: For the experimental group, comparison of pre- and post-test joint kinematics of the dominant lower limb revealed that CEC decreased the peak ankle dorsiflexion angle by 26% (P=0.020), peak foot internal rotation angle by 53% (P=0.001), peak knee internal rotation angle by 40% (P=0.011), peak hip abduction by 47% (P=0.010), and peak hip external rotation angle by 60% (P=0.001). In contrast, peak knee external rotation angle of the dominant limb was increased after the training program by 46% (P=0.044). For the non-dominant lower limb, CEC decreased the peak ankle inversion by 63% (P<0.01), peak ankle eversion by 91% (P<0.01), peak foot internal rotation by 50% (P<0.01), peak knee internal rotation by 29%; P=0.042), peak hip abduction angle by 38% (P<0.01), and peak hip external rotation angle by 60% (P<0.01). CONCLUSIONS: CEC therapy reduced excessive foot and knee internal rotations as well as excessive hip external rotation during walking in children with genu varus.

Genu varo artrósico inestable: seguimiento a 2 años / Unstable varus osteoarthritic knee. Follow-up of two years

Introducción: La osteotomía tibial valguizante de apertura es un procedimiento ampliamente realizado para tratar la gonartrosis unicompartimental medial. Existen pacientes que se encuentran al límite de la indicación de dicha técnica quirúrgica. El objetivo del presente trabajo es comunicar nuestro algoritmo diagnóstico terapéutico y técnica quirúrgica empleada. Material y métodos: Estudio observacional, serie de casos, retrospectivo. Población de 14 pacientes (15 rodillas) sometidos a osteotomía valguizante aditiva de tibia asociada a plástica ligamentaria de LCA (mismo tiempo quirúrgico) durante el año 2015. Seguimiento promedio de 24 meses. Se evaluaron parámetros pre y postoperatorios. Resultados: Parámetros postoperatorios (14 rodillas): Dolor (EVA) 0.45/10; Lachman 40% negativos (-) y 60% una cruz (+); Lysholm 98,77 puntos y trofismo muscular cuadricipital 1,05 cm (negativo). En todos los casos, volvieron a la práctica deportiva recreacional. Se registró un caso con evolución negativa (6.66% de la población). Conclusión: La osteotomía tibial de apertura asociada a reconstrucción artroscopia de LCA la indicamos en aquellos pacientes que presentan un síndrome de inestabilidad (ruptura crónica de LCA) con deseje en varo independientemente de la presencia o no de dolor; o en presencia de un síndrome osteoartrítico (artrosis con predominio en compartimiento medial) con deseje en varo e inestabilidad. Obtuvimos buenos resultados a corto y mediano plazo, sin complicaciones médicas, en donde los pacientes regresan a la práctica recreacional deportiva previa, con un alto porcentaje de satisfacción en nuestra serie presentada (mayor al 93%). Nivel de evidencia: IV (serie de casos).

Introduction: The tibial valgus aperture osteotomy is a procedure widely used to treat medial unicompartmental gonarthrosis. There are patients who are at the limit of the indication of said surgical technique. The objective of the present work is to communicate our therapeutic diagnostic algorithm and surgical technique used. Material and Methods: Observational study, case series, retrospective. Population of 14 patients (15 knees) submitted to additive valgus osteotomy of tibia associated with ligamentous plastic of ACL, during the year 2015. Average follow-up of 24 months. Pre and postoperative parameters were evaluated. Results: Postoperative parameters (14 knees): Pain (EVA) 0.45 / 10; Lachman 40% negative (-) and 60% one cross (+); Lysholm 98,77 points and quadricipital muscle trophy 1.05 cm (negative). In all cases, they returned to recreational sports. There was a case with a negative evolution (6.66% of the population). Conclusion: The tibial opening osteotomy associated with ACL arthroscopy reconstruction is indicated in those patients who present with an instability syndrome (chronic ACL rupture) with varus malalignment independently of the presence or absence of pain; or in the presence of an osteoarthritic syndrome (osteoarthritis with predominance in medial compartment) with varus desire and instability. We obtained good results in the short and medium term, without medical complications, where patients return to previous recreational sports practice, with a high percentage of satisfaction in our presented series (greater than 93%). Level of evidence: IV (case series).

Incidence and Risk Factors of Rachitic Genu Varus in Preschool Children in a Paediatric Health Institute in Egypt as One of the Developing Countries.

BACKGROUND: Rachitic genu varus is one of the common conditions among the Egyptian children, despite the shinning sun of Egypt all the year. PURPOSE: The aim of the study was to estimate the incidence of rachitic genu varus among the Egyptian children, and to assess the risk factors contributing to it. PATIENTS AND METHODS: This prospective study recruited a total of 250 consecutive children, being 130 males and 120 females, with rachitic bow legs or genu varus, between 2 - 4 years of age, together with 250 controls of the same age group, out of a total number of 1900 children with other types of rickets, and other children's orthopaedic diseases, who presented to the National Institute of Neuromotor System in Egypt between September 2014 to September 2015. The cases and the controls were subjected to clinical, laboratory biochemical, and plain radiographic examinations. Their parents were subjected to epidemiological, maternal, and nutritional questionnaires. RESULTS: The calculations revealed high incidence (13.1%) of rachitic genu varus. The risk factors were low socioeconomic status, insufficient family income, poor housing conditions, lack of exposure to sunlight due to cultural practices, sole breast feeding, and inadequate supplementation of vitamin D to the children and the pregnant women. The p value was <0.05. CONCLUSION: Vitamin D deficiency rachitic genu varus is a multifactorial condition in Egypt. Raising the standard of living, level of education, housings, and dietary supplementation of vitamin D to the pregnant women and infants are the solution.

Lower limb joint alignment and postural control in elderly women / Alinhamento articular de membros inferiores e controle postural em idosas

The aim of this study was to test whether quiet stance body sway is associated with ankle and knee joint angles in elderly women. Joint angles were measured using a manual goniometer and body sway was assessed using a force platform and four postural tasks with a combination of feet positions and eye condition. The sample (N = 58) showed the following angle values: 102 (100-104) for the tibiotarsal joint, 176 (174-180) for the subtalar joint, 184 (181-187) for knee flexion-extension, and 13 (10-15) for the Q-angle. Q-angle was significantly correlated (p < 0.05) with center of foot pressure (CP) displacement area (r = 0.36), anteroposterior (SDy, r = 0.34) and lateral (SDx, r = 0.31) CP standard deviation, and anteroposterior CP range (r = 0.38) during the closed base, eyes opened trial (CBEO). The valgus group showed statistically higher values than the normal and varus groups for SDy (0.56 vs. 0.52 and 0.46 mm; p = 0.02), SDx (0.55 vs. 0.49 and 0.36 mm; p = 0.02) and anteroposterior range (3.32 vs. 2.78 and 2.38 mm; p = 0.01), CBEO. The displacement velocity of the CP was significantly higher for the asymmetric than the symmetric Q-angle group (8.0 vs. 5.3 mm/s - closed base, eyes closed trial). Knee alignment was correlated with measures of body sway in elderly women, but ankle alignment showed no correlation. Knee morphology should be considered an associated factor for quiet stance postural control.

O objetivo do estudo foi verificar se a oscilação corporal na postura quieta está associada aos ângulos articulares de tornozelo e joelho em idosas. Os ângulos foram medidos por um goniômetro manual e a oscilação corporal foi obtida por uma plataforma de força em quatro situações (combinando posição dos pés e condição visual). A amostra (N = 58) apresentou os seguintes valores angulares: 102 (100-104) para o tibiotársico, 176 (174-180) para o subtalar, 184 (181-187) para flexão-extensão de joelho e 13 (10-15) para ângulo Q. O ângulo Q se correlacionou significativamente (p < 0,05) com a área do deslocamento do centro de pressão dos pés (CP) (r = 0,36); com o desvio padrão anteroposterior (SDy, r = 0,34) e lateral (SDx, r = 0,31) do CP; e com a amplitude anteroposterior do CP (r = 0,38), durante a condição de base fechada, olhos abertos (BFOA). O grupo valgo, quando comparado aos grupos normal e varo, apresentou valores estatisticamente maiores de SDy (0,56 vs. 0,52 and 0,46 mm; p = 0,02), SDx (0,55 vs. 0,49 and 0,36 mm; p = 0,02) e amplitude anteroposterior (3,32 vs. 2,78 and 2,38 mm; p = 0,01), BFOA. A velocidade de deslocamento do CP foi significativamente maior para o grupo com ângulo Q assimétrico, comparando com o simétrico (8,0 vs. 5,3 mm/s - condição de base fechada, olhos fechados). O alinhamento do joelho se correlacionou com medidas de oscilação corporal em idosas, mas o tornozelo não mostrou nenhuma correlação. A morfologia do joelho deve ser considerada um fator influenciador no controle postural estático.

Comparison of Two Kinds of Internal Fixation after High Tibia Osteotomy for the Treatment of Osteoarthritis of Knee with Genu Varus Deformity / 中国康复理论与实践

@#ObjectiveTo compare the effect and prognosis of two kinds of internal fixation (improved Giebel blade plate and traditional straddle nail) after high tibial osteotomy (HTO) on osteoarthritis of knee with genu varus deformity. Methods37 knees of 32 cases were treated with straddle nail (25 knees) or Giebel blade plate (12 knees). All the cases were followed up for 6～28 months. ResultsThe clinical bone healing time of osteotomy was 8～12 weeks. There was no significant differences between 2 groups in the increased score in HSS Standard and in the clinical bone healing time. ConclusionBoth internal fixation with improved Giebel blade plate and traditional straddle nail get similarly satisfactory prognosis, while the former shows more advantages to allow early functional exercises.