A closing wedge distal femoral osteotomy is a procedure to reduce pain and delay the progression of degenerative arthritis of knee by moving the weight bearing line from the lateral compartment to the medial side while preserving the knee joint. Age, weight bearing line, and the degree of arthritis are the essential factors to be considered at the time of surgery. The indications for distal femoral osteotomy are as follows. All patients are aged less than 65 years old, normal medial compartment of the knee with normal patello femoral joint, valgus deformity with lateral degenerative arthritis, younger patients with lateral osteochondritis, congenital osteochondrosis, and recurrent patellar dislocation with genu valgum. The distal femoral osteotomy provides the advantages of rapid pain reduction and short rehabilitation in young and active patients and patients who are subjected to heavy loads on the knee.
Arthritis ; Congenital Abnormalities ; Femur* ; Genu Valgum ; Humans ; Joints ; Knee ; Knee Joint ; Osteoarthritis ; Osteochondritis ; Osteochondrosis ; Osteotomy* ; Patellar Dislocation ; Rehabilitation ; Weight-Bearing

Proximal tibial osteotomy is the preferred method for treating medial compartment knee arthritis with varus deformity. The purpose of this treatment is to reduce the weight burden of the lesion by correcting the mechanical axis of the patient with degenerative arthritis of medial tibiofemoral joint and abnormal alignment. In general, the proximal tibial osteotomy provides satisfactory clinical results when suitable patient are selected by considering the extent of cartilaginous injury and the age of the patient and the correct technique is performed. In tibial osteotomy, medial open wedge osteotomy is used widely because of its short operation time and relatively simple technique. This review describes the current knowledge of patient selection, preoperative evaluation and planning, treatment principles, surgical techniques, rehabilitation procedures and complications in open wedge high tibial osteotomy.
Arthritis ; Congenital Abnormalities ; Humans ; Joints ; Knee ; Knee Joint ; Methods ; Osteoarthritis ; Osteotomy* ; Patient Selection ; Rehabilitation ; Tibia*

PURPOSE: To compare the clinical outcomes between the open posterior approach and arthroscopic suture fixation for displaced posterior cruciate ligament (PCL) avulsion fractures. METHODS: A literature search was performed on MEDLINE, EMBASE, and the Cochrane Library databases. The inclusion criteria were as follows: papers written in English on displaced PCL avulsion fractures, clinical trial(s) with clear description of surgical technique, adult subjects, a follow-up longer than 12 months and modified Coleman methodology score (CMS) more than 60 points. RESULTS: Twelve studies were included with a mean CMS value of 72.4 (standard deviation, 7.6). Overall, 134 patients underwent the open posterior approach with a minimum 12-month follow-up, and 174 patients underwent arthroscopic suture fixation. At final follow-up, the range of Lysholm score was 85–100 for the open approach and 80–100 for the arthroscopic approach. Patients who were rated as normal or nearly normal in the International Knee Documentation Committee subjective knee assessment were 92%–100% for the open approach and 90%–100% for the arthroscopic approach. The range of side-to-side difference was 0–5 mm for both approaches. CONCLUSIONS: Both arthroscopic and open methods for the treatment of PCL tibial-side avulsion injuries resulted in comparably good clinical outcomes, radiological healing, and stable knees.
Adult ; Arthroscopy ; Follow-Up Studies ; Humans ; Knee ; Posterior Cruciate Ligament ; Sutures

PURPOSE: Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral release for recurrent patellar instability with genu valgum. MATERIALS AND METHODS: Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performed with reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. RESULTS: At a mean follow-up of 20±11.7 months (range, 12–42 months), KSS scores improved significantly, from 46.7±5.2 preoperatively to 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly, from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). CONCLUSION: Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, corrects deformity, and improves clinical outcomes.
Congenital Abnormalities ; Follow-Up Studies ; Genu Valgum* ; Knee ; Osteotomy* ; Patellar Dislocation* ; Weight-Bearing

PURPOSE: We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern. MATERIALS AND METHODS: We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern. RESULTS: Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%). CONCLUSION: The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.
Arthritis ; Classification ; External Fixators* ; Prognosis ; Tibial Fractures*

PURPOSE: We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern. MATERIALS AND METHODS: We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern. RESULTS: Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%). CONCLUSION: The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.
Arthritis ; Classification ; External Fixators* ; Prognosis ; Tibial Fractures*

PURPOSE: We aimed to determine whether navigated opening wedge high tibial osteotomy (HTO) is superior to the conventional technique in terms of accuracy of the coronal and sagittal alignment correction, functional outcome, and operative time. METHODS: Studies comparing navigated and conventional HTO were included in this meta-analysis. We compared the incidence of radiological outliers in coronal alignment and tibial slope maintenance, mean differences in functional outcome scales, and operative time. Subgroup analyses were performed on coronal alignment accuracy based on the intraoperative method of alignment confirmation: fluoroscopy vs. gap measurement method. RESULTS: Twelve studies were included: there were 434 knees in the navigated HTO studies and 405 knees in the conventional HTO studies. The risk of outlier was lower in navigated HTO than in conventional HTO; however, the difference was not significant when navigated HTO was compared with conventional HTO performed using the gap measurement method. Tibial slope maintenance was comparable or better in navigated HTO. No difference was found in the American Knee Society function and Lysholm scores. Navigated HTO necessitated a longer operative time of approximately 10 minutes. CONCLUSIONS: The use of navigation in HTO can improve accuracy in both coronal and sagittal alignments, but its clinical benefit is unclear.
Fluoroscopy ; Incidence ; Knee ; Methods ; Operative Time ; Osteoarthritis ; Osteotomy ; Surgery, Computer-Assisted ; Tibia ; Weight-Bearing ; Weights and Measures

PURPOSE: To assess 1) the characteristics and the ability of MRI to detect, 2) incidence and 3) association with preexisting lesions in the radial tears of medial meniscus MATERIALS AND METHODS: 260 consecutive arthroscopic meniscectomy was performed. Of the 260 cases, 226 cases performed knee MR images preoperatively. Two radiologic signs were used to detect: 1)Cleft sign and 2) increased signal or absence of posterior meniscus (ghost meniscus). RESULTS: Forty-seven cases cases with radial tears of medial meniscus were identified(18.0%, mean age 60.5years) by arthroscopy. All of them were located in the posterior root and were full thickness tears except three cases. Thirty-four cases(72.3%) had preexisting cartilage degeneration(Outerbridge 1-4) and osteonecrosis. The sensitivity and specificity of the cleft sign and ghost sign were 72.9%, 98.8% and 93.7%, 98.8%, respectively. When combined these two criteria, accuracy was 97.7%. CONCLUSION: Radial tears located in the posterior root of the medial meniscus are common type in korea. They were frequently developed in elderly patients with preexisting cartilage damage or osteonecrosis. We can accurately diagnose the radial tear with the cleft sign and ghost sign
Aged ; Arthroscopy ; Cartilage ; Humans ; Incidence ; Knee ; Korea ; Magnetic Resonance Imaging ; Menisci, Tibial* ; Osteonecrosis ; Sensitivity and Specificity

Paraarticular chondroma of the knee is a very rare benign tumor that seems to develop from cartilageous metaplasia. This lesion should be differentiated from calcifying soft tissue lesions like tumoral calcinosis, and cartilageous lesions like chondrosarcoma and synovial chondromatosis. We experienced a case of paraarticular chondroma of the knee in an Osgood-Schlatter disease patient.
Calcinosis ; Chondroma* ; Chondromatosis, Synovial ; Chondrosarcoma ; Humans ; Knee* ; Metaplasia ; Osteochondrosis

Bucket-handle tears less frequently occur in the lateral meniscus than in the medial meniscus. An 11-year-old male patient complained of painful swelling and locking due to a displaced bucket-handle tear of the lateral meniscus. We recommended an arthroscopic surgery; however, the patient left the hospital without surgical treatment. Six weeks afterwards, he returned without any complain of pain and he regained full range of motion. The final follow-up magnetic resonance imaging showed reduction of the torn meniscal fragment without any signal changes suggestive of a meniscal tear. We report a rare case of an isolated displaced bucket-handle tear of the lateral meniscus in an 11-year-old patient that healed spontaneously without surgical intervention.
Arthroscopy ; Child ; Follow-Up Studies ; Humans ; Knee ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial ; Range of Motion, Articular