Return to sport following isolated opening wedge high tibial osteotomy.

BACKGROUND: The purposes of the study are as follows: (1) examine the timeline of return to sport (RTS) following isolated high tibial osteotomy (HTO), (2) evaluate the degree of participation and function upon RTS and (3) identify reasons that patients do not return or discontinue participation in sport activity. METHODS: Patients undergoing isolated HTO were reviewed retrospectively at a minimum of two years post-operatively. Patients completed a subjective sports questionnaire, a visual analog scale for pain, Single Assessment Numerical Evaluation, and a satisfaction questionnaire. RESULTS: Thirty-eight patients (70.4%) were included at an average of 9.0 ±â€¯3.3 years. Thirty-four patients (average age 42.7 ±â€¯7.2 years, 90.0% with a Kellgren-Lawrence grade of III/IV) participated in sports within three years prior to surgery. Eighteen patients (52.9%) returned to the operating room by the time of final follow-up, including 13 patients (38.2%) who underwent salvage arthroplasty by 6.1 ±â€¯3.6 years following HTO. Thirty patients (88.2%) returned to ≥1 sport at an average of 7.5 ±â€¯5.0 months; however only 41.2% were able to return to preinjury level of participation. CONCLUSIONS: In patients with medial osteoarthritis and varus deformity, isolated high tibial osteotomy provides a high rate (88.2%) of return to sport by 7.5 months postoperatively, yet only a fraction of patients returned to their preinjury level. HTO is not a definitive treatment option as nearly 40% of patients underwent knee arthroplasty by 6.1 years post-operatively. Patient expectations regarding return to sport can be appropriately managed with adequate preoperative patient education. LEVEL OF EVIDENCE: IV.

Effect of kinesio taping on lower limb joint powers in individuals with genu varum.

OBJECTIVE: Therapeutic lateral knee joint muscle taping potentially offers a low-risk, economical and effective alternative for the clinical treatment of light to moderate knee overload, due to misalignment in patients with genu varum. In this study, we aimed at investigating the immediate effect of lateral knee joint muscular kinesio taping on lower limb joint powers, during the stance phase of walking, in individuals with genu varum. METHODS: Fifteen male subjects with genu varum misalignment (age: 24.2±3.7 years) participated in the study. Subjects performed three walking trials without, and three with, biceps femoris and vastus lateralis kinesio taping. The three-dimensional position coordinate data of reflective markers were collected at 100 Hz using a six-cameras Vicon system (Motion Analysis Corp., UK). Additionally, two Kistler force plates (Kistler AG, Winterthur, Switzerland) were used to record the Ground Reaction Forces (GRF) components at 1000 Hz during stance phase of walking. A three-way ANOVA with post-hoc testing (using paired samples Student's t-test with Bonferroni correction) was performed to compare the power values of lower limb joints before and after the use of KT. RESULTS: With kinesio taping, we observed that the average negative power increased at the ankle level in dominant limb, (P<0.05, 10-20% of gait cycle, GC), and at the knee level in both limbs (10-20% and 60-80% GC). Further, average negative power of the non-dominant knee joint (80-100% GC) and positive power of the non-dominant hip joint (60-80% GC) significantly reduced (P<0.05) in kinesio taping condition. CONCLUSION: The biomechanical analysis of joint power during walking using kinesio taping provided essential information about the possible mechanisms involved in gait analysis with this intervention in adults with genu varus.

Osteotomía del peroné, nueva técnica quirúrgica en el genu varo doloroso. Proceder y presentación de dos casos / Fibular osteotomy, new surgical technique in the painful genu varum: procedure and two-case presentation

La artrosis de rodilla puede llegar a ser una patología muy invalidante por los síntomas que produce, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa cuya prevalencia ha ido en aumento en las últimas décadas. Está muy ligada al aumento de las expectativas de vida de la población, fenómeno que ocurre en países del primer mundo con un alto nivel de salud y que ocurre igualmente en nuestro país dado el desarrollo de nuestro sistema de salud. Existen múltiples técnicas quirúrgicas para corregir la deformidad y aliviar el dolor; van desde osteotomías correctoras hasta las artroplastias, todas encaminadas al alivio del dolor en primer lugar y a corregir las deformidades, pero las últimas conllevan mayor tiempo de rehabilitación y son más costosas. Este trabajo va encaminado a la presentación de dos pacientes operados con la nueva técnica del Dr. Ying Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China, con la cual, a través de una osteotomía, se descomprime el compartimento interno y se quita tensión ósea en el externo por la resección peronea. Sus objetivos son actuar sobre el dolor, mejorar la función y la marcha como beneficios de este proceder de mínima acción sobre las partes articulares y lograr la rápida incorporación del paciente a su vida social; esto es tema para la obtención del doctorado por parte del autor principal del presente trabajo (AU).

Knee osteoarthritis could be a very disabling disease due to the symptoms it produces, characterized by pain, insecurity and functional loss. It is a degenerative disease which prevalence has increased in the last decades tightly related to the increment of the population's life expectancy, phenomenon occurring in the developed countries with a high life level and also occurring in our country because of the development of our health system. There are several surgical techniques to correct deformation and to relieve pain. They go through correcting osteotomies to arthroplasties, all of them aimed, firstly to pain relieving and also to correcting deformations. The last ones need more rehabilitation time and are more expensive. This work is devoted to presenting two patients operated with the new technique of Dr. Yin-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of the Medical University of Hebei, in Shijiazhuang, China, with which, through an osteotomy, the internal compartment is decompressed and the bone tension in the external one is finished due to the peroneal excision. Its aims are acting upon the pain, improving function and gait as a benefit of this minimal action procedure on the articular parts and achieving the faster incorporation of the patient to his social life; this is the theme the main author of this article is going to develop for obtaining the doctorate in sciences (AU).

Osteotomía del peroné, nueva técnica quirúrgica en el genu varo doloroso. Proceder y presentación de dos casos / Fibular osteotomy, new surgical technique in the painful genu varum: procedure and two-case presentation

La artrosis de rodilla puede llegar a ser una patología muy invalidante por los síntomas que produce, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa cuya prevalencia ha ido en aumento en las últimas décadas. Está muy ligada al aumento de las expectativas de vida de la población, fenómeno que ocurre en países del primer mundo con un alto nivel de salud y que ocurre igualmente en nuestro país dado el desarrollo de nuestro sistema de salud. Existen múltiples técnicas quirúrgicas para corregir la deformidad y aliviar el dolor; van desde osteotomías correctoras hasta las artroplastias, todas encaminadas al alivio del dolor en primer lugar y a corregir las deformidades, pero las últimas conllevan mayor tiempo de rehabilitación y son más costosas. Este trabajo va encaminado a la presentación de dos pacientes operados con la nueva técnica del Dr. Ying Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China, con la cual, a través de una osteotomía, se descomprime el compartimento interno y se quita tensión ósea en el externo por la resección peronea. Sus objetivos son actuar sobre el dolor, mejorar la función y la marcha como beneficios de este proceder de mínima acción sobre las partes articulares y lograr la rápida incorporación del paciente a su vida social; esto es tema para la obtención del doctorado por parte del autor principal del presente trabajo (AU).

Knee osteoarthritis could be a very disabling disease due to the symptoms it produces, characterized by pain, insecurity and functional loss. It is a degenerative disease which prevalence has increased in the last decades tightly related to the increment of the population's life expectancy, phenomenon occurring in the developed countries with a high life level and also occurring in our country because of the development of our health system. There are several surgical techniques to correct deformation and to relieve pain. They go through correcting osteotomies to arthroplasties, all of them aimed, firstly to pain relieving and also to correcting deformations. The last ones need more rehabilitation time and are more expensive. This work is devoted to presenting two patients operated with the new technique of Dr. Yin-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of the Medical University of Hebei, in Shijiazhuang, China, with which, through an osteotomy, the internal compartment is decompressed and the bone tension in the external one is finished due to the peroneal excision. Its aims are acting upon the pain, improving function and gait as a benefit of this minimal action procedure on the articular parts and achieving the faster incorporation of the patient to his social life; this is the theme the main author of this article is going to develop for obtaining the doctorate in sciences (AU).

Effectiveness of Hip External Rotator Strengthening Exercise in Korean Postural Bowleg Women.

Postural bowleg is a subclinical entity with both aesthetic and functional outcomes and appears to be common in East Asian countries. Internal rotation of the hip joint is associated with varus alignment at the knee joint of the bowleg. Strengthening exercise for the hip external rotator muscles seems to be effective in improving varus alignment of bowleg, but no standardized exercise program exists. A standardized active resistance strengthening exercise for hip external rotator muscles could improve varus alignment of the lower limb in bowlegged Korean women. In this article, a case series study was conducted to observe changes following a standardized 3-month program using equipment designed for strengthening of the hip external rotator muscles. Photogrammetric and radiographic data were used to compare the gap between knees and tibiofemoral (TF) angles before and after the exercise program. As a result, on average, the knee gap decreased by 1.6 cm. The TF angle decreased by 1.5°. Regression analysis revealed a statistically significant association between changes in knee gap and TF angle. The standardized 3-month active resistance strengthening exercise program of hip external rotator muscles was effective in improving postural deviation and cosmetic outcomes in bowlegged Korean women. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques.

PURPOSE: The purpose of our study was to compare clinical and radiological results of two groups of patients treated for medial compartment osteoarthritis of the knee with either conventional or computer-assisted open-wedge high tibial osteotomy (HTO). Goals of surgical treatment were a correction of the mechanical axis between 2° and 6° of valgus and a modification of posterior tibial slope between -2° and +2°. METHODS: Twenty-four patients (27 knees) affected by varus knee deformity and operated with HTO were prospectively followed-up. They were randomly divided in two groups, A (11 patients, conventional treatment) and B (13 patients, navigated treatment). The American Knee Society Score and the Modified Cincinnati Rating System Questionnaire were used for clinical assessment. All patients were radiologically evaluated with a comparative lower limb weight-bearing digital radiograph, a standard digital anteroposterior, a latero-lateral radiograph of the knee, and a Rosenberg view. RESULTS: Patients were followed-up at a mean of 39 months. Clinical evaluation showed no statistical difference (n.s.) between the two groups. Radiological results showed an 86% reproducibility in achieving a mechanical axis of 182°-186° in group B compared to a 23% in group A (p = 0.0392); furthermore, in group B, we achieved a modification of posterior tibial slope between -2° and +2° in 100% of patients, while in group A, this goal was achieved only in 24% of cases (p = 0.0021). CONCLUSION: High tibial osteotomy with navigator is more accurate and reproducible in the correction of the deformity compared to standard technique. LEVEL OF EVIDENCE: Therapeutic study, Level II.

Return to work and clinical outcome after open wedge HTO.

PURPOSE: The purpose of this study was to examine the incapacity of work related to work load according to the classification that has been introduced by the REFA Association and the clinical outcome after open wedge HTO with autologous bone graft from the iliac crest. METHODS: A total of 32 patients who were employed and able to work at the time of the surgery as well as treated with an open wedge HTO with the LC-DCP and autologous bone wedges from the iliac crest could be included in the radiological and clinical examination (77 months, SD ± 19). Postoperative duration of the incapacity of work and subjective ratings were based on the information provided by the patients themselves. The German classification that has been established by the REFA Association was used to classify the work load. Several clinical scores were used for clinical assessment. RESULTS: The duration of incapacity of work (median, 87 days; range, 14-450) demonstrated a relation to work load according to REFA. The Lysholm score, the HSS score and the score according to Lequesne augmented by 19.2 ± 16.8 (p < 0.0001), 15.6 ± 13.2 (p < 0.0001) and -6.0 ± 5.1 (p < 0.0001), respectively. The Tegner score gained from median 3 (range, 1-5) to 4 (range, 1-8). CONCLUSION: In this study, a relation was found between work load divided into different categories according to the classification established by the REFA Association and the duration of incapacity of work after open wedge HTO. An improvement of all clinical scores was observed. Typical neurological complications after autologous bone transplantation from the iliac crest were observed in 19% of our patient population. LEVEL OF EVIDENCE: IV.

Mi hijo no crece, ¿y dice usted que esto es normal? / My child doesn’t grow, and you say this is normal?

El genu varum es un proceso fisiológico en los dos primeros años de vida, evolucionando en ocasiones hacia genu valgum. No obstante, su diagnóstico diferencial abarca patologías importantes que deben ser descartadas para decidir el tratamiento. En los niños con genu varum se debe tranquilizar a la familia y adoptar una actitud expectante, dado que no reviste gravedad y es un proceso autolimitado. Presentamos el caso de dos hermanos con genu varum extremo, llegando incluso a producir un estacionamiento de la talla en uno de ellos. Ambos han evolucionado a la normalidad sin intervención médica (AU)

Genu varum is a physiologic finding in children p to 2 years old that sometimes becomes genu valgum. However, it may present accompanying systemic conditions that must be ruled out in order to treat them or not. The relatives of children with genu varum should be reassured and doctors should assume an expectant management due to its favourable natural history. We show the case of two brothers with a pronounced genu varum, one of them with a temporary stop in growth. Both evolved in a right way without treatment (AU)

Congenital postero-medial bowing of the tibia and fibula: is early surgery worthwhile?

We report the results of surgical treatment of congenital postero-medial bowing of the tibia and fibula. Twenty patients with congenital postero-medial bowing were seen with nine patients treated surgically (corrective osteotomy or lengthening and deformity correction with Ilizarov fixator) and 11 patients managed conservatively. The angles of medial and posterior angulation and limb length discrepancy were recorded serially and compared. Surgical complications were recorded. The mean follow-up was 9.5 and 6.1 years after surgery. Although there was a reduction in angulation and correction of limb length discrepancy, we encountered complications in the surgically treated patients. There was no statistically significant difference between the surgically treated and conservatively managed groups with respect to mean angulation, though there was a significant difference in the mean limb length discrepancy. In conclusion, we advocate a one-stage lengthening and correction of the residual deformity closer to skeletal maturity.