Joint preservation procedures: osteotomies about the knee.

IF 0.5 4区 医学 Q4 ORTHOPEDICS
Annals of Joint Pub Date : 2025-04-15 eCollection Date: 2025-01-01 DOI:10.21037/aoj-24-68
Michael S Rocca, Karina Dias, Jonathan D Hughes
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引用次数: 0

Abstract

Osteotomies around the knee are an effective method for preserving the knee joint by correcting overall alignment. Although osteotomies have historically been used in treatment of knee pathology, they have recently regained a renewed interest as a treatment strategy for alignment correction, ligamentous stability, and cartilage preservation. Osteotomies are a powerful way to correct alignment in both the sagittal and coronal plane to preserve and/or protect the cartilage in the medial, lateral, and patellofemoral compartments of the knee and improve the ligamentous stability of the knee. Medial opening wedge high tibial osteotomy (MOW-HTO) and lateral closing wedge high tibial osteotomy (LCW-HTO) are commonly performed osteotomies for correcting varus malalignment, each with distinct indications, surgical techniques, and associated complications. Similarly, distal femoral osteotomy (DFO) plays a critical role in the correction of both varus and valgus malalignment, and may be particularly important in cases where a tibial osteotomy alone would lead to excessive joint line obliquity (JLO). In complex cases where single-level osteotomy does not provide optimal correction, double-level osteotomy may be necessary to achieve appropriate mechanical axis restoration while maintaining joint congruence. Beyond coronal plane corrections, increasing attention has been given to sagittal plane osteotomies for managing ligamentous instability, particularly anterior and posterior cruciate ligament (PCL) deficiencies. Modifying the posterior tibial slope (PTS) through anterior closing wedge or anterior opening wedge high tibial osteotomy can improve knee biomechanics and stability in both anterior cruciate ligament (ACL) and PCL-deficient patients. Additionally, tibial tubercle osteotomies (TTO) have emerged as an important surgical adjunct in the treatment of patellofemoral malalignment and cartilage preservation strategies. The goal of knee osteotomies is to offload the affected compartment, preserve and protect cartilage and menisci, and enhance ligamentous stability, thereby delaying the need for arthroplasty. Therefore, osteotomies represent an intriguing procedure for young and active patients. Recently, with the renewed interest in osteotomy procedures about the knee, studies have demonstrated that osteotomies continue to play a critical role in treatments for limb alignment and cartilage protection.

关节保存手术:膝关节截骨术。
膝关节周围截骨术是一种有效的方法,通过纠正膝关节的整体排列来保护膝关节。虽然截骨术历来被用于治疗膝关节病理,但最近作为一种治疗策略重新引起了人们的兴趣,这种治疗策略可用于矫正关节位、韧带稳定和软骨保护。截骨术是纠正矢状面和冠状面排列的一种有效方法,可以保存和/或保护膝关节内侧、外侧和髌股间室的软骨,并改善膝关节韧带的稳定性。内侧开口楔形高胫骨截骨术(MOW-HTO)和外侧闭合楔形高胫骨截骨术(LCW-HTO)是矫正内翻畸形的常用截骨术,各有不同的适应症、手术技术和相关并发症。同样,股骨远端截骨术(DFO)在矫正内翻和外翻错位中起着至关重要的作用,在单独胫骨截骨术会导致关节线倾斜度过高(JLO)的情况下可能尤为重要。在单节段截骨不能提供最佳矫正的复杂情况下,可能需要双节段截骨来实现适当的机械轴修复,同时保持关节一致性。除了冠状面矫正外,矢状面截骨术越来越受到关注,以治疗韧带不稳定,特别是前后交叉韧带(PCL)缺陷。通过前闭合楔形或前开放楔形高位胫骨截骨术改变胫骨后斜率(PTS)可以改善前交叉韧带(ACL)和pcl缺陷患者的膝关节生物力学和稳定性。此外,胫骨结节截骨术(TTO)已成为一种重要的手术辅助治疗髌骨股骨错位和软骨保存策略。膝关节截骨术的目的是卸载受影响的腔室,保存和保护软骨和半月板,增强韧带的稳定性,从而推迟关节置换术的需要。因此,截骨术对于年轻和活跃的患者来说是一种有趣的手术。最近,随着对膝关节截骨术的重新关注,研究表明,截骨术在肢体对齐和软骨保护治疗中继续发挥关键作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Joint
Annals of Joint ORTHOPEDICS-
CiteScore
1.10
自引率
-25.00%
发文量
17
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