Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"High-energy tibial plateau fracture","authors":"Pierre Martz ,&nbsp;Marie Le Baron","doi":"10.1016/j.otsr.2024.104072","DOIUrl":"10.1016/j.otsr.2024.104072","url":null,"abstract":"<div><div>High-energy tibial plateau fracture is complex and hard to treat, with functional sequelae and frequent soft-tissue lesions. Several classifications, strategies, approaches and fixation techniques have been reported. High-energy trauma is defined by high-velocity impact: fall from height, high-speed road or sport accident, firearm injury, etc.</div><div>Description should include all components, and notably posterior components (on the “3 column” theory), for integral management. A sequential strategy, with temporary fixation, imaging assessment and then definitive fixation, seems mandatory, controlling cutaneous and infectious risks. Long-term results suffer from serious functional sequelae and progression toward osteoarthritis, with a rate of at least 5% secondary knee arthroplasty.</div><div>The present review addresses 6 questions:</div><div><ul><li><span>•</span><span><div>How to describe these fractures so as to understand them and plan treatment?</div></span></li><li><span>•</span><span><div>What should be the immediate treatment, to avoid acute complications?</div></span></li><li><span>•</span><span><div>What are the principles of definitive treatment?</div></span></li><li><span>•</span><span><div>How to deal with associated meniscal and ligament lesions?</div></span></li><li><span>•</span><span><div>Is there a role for arthroscopic assistance? - navigation? – balloon reduction?</div></span></li><li><span>•</span><span><div>What are the long-term results?</div></span></li></ul></div><div>These fractures should ideally be described according to mechanism and to the involvement of the various columns or quadrants (medial/lateral, anterior/posterior) on the modified Schatzker classification. Immediate management comprises systematic neurovascular and soft-tissue assessment. For such high-energy fractures, a sequential “scan-span-plan” strategy with temporary external fixation is indicated. Definitive treatment consists in internal fixation by plate, with reduction and fixation of the various bone lesions, and especially fixation of posterior lesions. The surgical approach should be adapted to the fracture. Arthroscopy can be useful for controlling reduction and treating any meniscal and/or ligament lesions and fractures showing little or no displacement. A strategy that avoids acute complications provides satisfactory medium-to-long-term results if definitive treatment objectives are achieved. Despite a fairly low rate of 5% conversion to total knee replacement, progression often shows impaired quality of life and of activities.</div></div><div><h3>Level of evidence</h3><div>V; expert opinion</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104072"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic nerve injury during upper limb surgery (excluding the hand)","authors":"Laurent Obert ,&nbsp;Sophie Spitael ,&nbsp;François Loisel ,&nbsp;Matthieu Mangin ,&nbsp;Victor Rutka ,&nbsp;Christophe Lebrun ,&nbsp;Frédéric Sailhan ,&nbsp;Philippe Clavert","doi":"10.1016/j.otsr.2024.104056","DOIUrl":"10.1016/j.otsr.2024.104056","url":null,"abstract":"<div><div>Nerve injury is the most feared complication of upper limb surgery. In about 17% of cases, the injury is iatrogenic and the potential for recovery is poor. In this context, patients file for compensation in about a quarter of cases. Defective patient installation or locoregional anaesthesia are rarely the cause of nerve injury. Nerves may be injured during creation of the surgical approach, implantation of the material or reduction of a traumatic injury. The injury is usually related to nerve release, retractor positioning or inappropriate limb-segment lengthening. Stretching and/or compression of a nerve trunk or branch is thus often the main cause.</div><div>Among diagnostic tools, imaging studies (ultrasonography, computed tomography, and magnetic resonance imaging) provide information on nerve structure but not on the potential for recovery. Electromyography combined with a neurological examination establishes the diagnosis, guides the management strategy, allows nerve-function monitoring, and indicates when nerve repair or palliative surgery is indicated. Electromyography also has prognostic value, both at diagnosis and during follow-up, by showing whether nerve regeneration is taking place. When creating the surgical approaches, thorough familiarity with anatomic safe zones and nerve trajectories is crucial to ensure full control of the zones at highest risk for nerve injury.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104056"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric soft tissue tumors","authors":"Pierre Mary ,&nbsp;Clelia Thouement ,&nbsp;Tristan Langlais","doi":"10.1016/j.otsr.2024.104058","DOIUrl":"10.1016/j.otsr.2024.104058","url":null,"abstract":"<div><div>The initial approach to soft tissue tumors in children and teenagers is everyone’s responsibility. While the vast majority is benign, all practitioners dread missing a malignant lesion. The first step involves taking the patient’s history and performing a clinical examination. Useful information can be gained from radiographs, ultrasound imaging and MRI. If there is no diagnosis at this stage, a biopsy (preferably percutaneous) is essential because unplanned excision can have serious consequences in terms of morbidity and even mortality. This should only be undertaken at a specialized facility after careful planning by the surgeon and interventional radiologist. Once the diagnosis has been made, the case should be discussed at a tumor board meeting to benefit from multidisciplinary expertise and input. Surgery is an essential component of the treatment and must be done at the appropriate time, after potential systemic (chemotherapy, targeted therapy) or local treatment (radiation therapy).</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104058"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What does the SOFCOT-RENACOT 2024 hip prosthesis register tell us?","authors":"Christian Delaunay ,&nbsp;Christian Brand ,&nbsp;Antoine Poichotte ,&nbsp;Alexandre Poignard ,&nbsp;Stéphane Boisgard","doi":"10.1016/j.otsr.2024.103996","DOIUrl":"10.1016/j.otsr.2024.103996","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The French Society of Orthopedic and Traumatology Surgery (SOFCOT) multicenter register of hip prostheses (HP) has been collecting data from nearly 100 centers in France since 2006. After 18 years of collection, this analysis was carried out to deduce the main conclusions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;Despite its low representativeness (3%), this register provides instructive information on the evolution of hip arthroplasty techniques and implants in France.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and methods&lt;/h3&gt;&lt;div&gt;As of the 31st of December 2023, 58,314 primary HP were recorded, mainly for primary osteoarthritis (44,535 hips, 76.4%), followed by femoral neck fractures (4,880, 8.4%). The mean age was 71 years (SD, 11.6) with 57% (33,305) women. In total, 73% of the implants were uncemented and 170 brand names were listed. Over the same period, 5,853 first reoperations were recorded. Social security number matching identified 777 revisions of an already registered primary HP. The revision index for 100 components observed per year (RCOY) allows the performance of implants to be compared (alert threshold if &gt;1.3).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The causes of these 777 early first revisions at a short mean follow-up (MF) of 1.4 years were: dislocation (191/777, 24.6%), peri-prosthetic fracture (175, 22.5%), aseptic loosening (103, 13.3%) and acute infection (101, 13%). The RCOY for all primary HP was 0.25 at 5.4 years of MF. This index: (i) Depended on the type of implant: 0.23 for HP with dual-mobility cups (DMC) at 4.7 years of MF; 0.25 for HP with short femoral stems at 4.4 years; and 0 for resurfacing after only 2.5 years (due to the creation of a specific mandatory register, since 2015, which put an end to the voluntary inclusion of resurfacing in this general register). (ii) Depended on the method of fixation: 0.21 for completely cemented HP at 7.8 years of MF and 0.29 at 4.9 years for completely uncemented HP. (iii) Based on the friction torque: 0.12 for conventional metal-metal HP at 9.7 years of MF and 0.29 at 5.1 years for alumina-alumina HP. (iv) Finally, 3 arthroplasties with 3 uncemented stems had an RCOY &gt; 1.3.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;Although the RCOY of HP with conventional cemented femoral stems is only 0.16 at 6.6 years of MF, while that of HP with conventional uncemented stems is 0.29 at 4.9 years, the trend towards uncemented femoral fixation has continued to intensify. Resurfacing gives good results following careful selection of implants but with a short MF of 2.5 years. Conventional metal-metal bearings continue to give excellent results at almost 10 years of MF. The 10-year survival of HP with short femoral stems is favorable compared to that of HP with conventional stems. There is no significant difference between the survival of HP with conventional versus highly cross-linked polyethylene liner.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Despite its low representati","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103996"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments to: “Management of periprosthetic femoral fractures following total knee arthroplasties using locking plates or intramedullary nailing. Comparative study of 567 cases” by J Abboud, M-K Moussa, Z Sader, H Favreau, T Bégué, X Flecher, M Ehlinger, Sofcot, published in Orthop Traumatol Surg Res 2024;110:103814. doi: 10.1016/j.otsr.2024.103814","authors":"Xiaohua Jiang,&nbsp;Yabin Liu,&nbsp;Guowu Chen","doi":"10.1016/j.otsr.2024.104043","DOIUrl":"10.1016/j.otsr.2024.104043","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104043"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-operative treatment of adolescent idiopathic scoliosis","authors":"Audrey Angelliaume ,&nbsp;Clémence Pfirrmann ,&nbsp;Toulla Alhada ,&nbsp;Jérôme Sales de Gauzy","doi":"10.1016/j.otsr.2024.104078","DOIUrl":"10.1016/j.otsr.2024.104078","url":null,"abstract":"<div><div>Adolescent idiopathic scoliosis worsens mainly during growth at puberty. This is when non-operative treatment, by brace and physiotherapy, comes into its own. Only the brace has proven efficacy in stabilizing Cobb’s angle. There are numerous types of brace and modalities of application, to be adapted to the scoliosis and the patient. What is crucial is that the patient should accept the brace, as compliance is one of the keys to success. The aim is, by the end of growth, to have a balanced spine with as little curvature as possible, to avoid aggravation and impaired quality of life in adulthood.</div></div><div><h3>Level of evidence</h3><div>Expert opinion</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104078"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior ankle impingement","authors":"Frédéric Leiber-Wackenheim","doi":"10.1016/j.otsr.2024.104063","DOIUrl":"10.1016/j.otsr.2024.104063","url":null,"abstract":"<div><div>Our understanding of the pathophysiology of anterior ankle impingement has steadily progressed since the princeps description almost 70 years ago. The same is true of diagnosis and treatment, which have greatly changed over time.</div><div>The present study provides an update on this pathology, addressing the following questions:</div><div><ul><li><span>•</span><span><div>What definition?</div></span></li><li><span>•</span><span><div>What pathophysiology?</div></span></li><li><span>•</span><span><div>What classification?</div></span></li><li><span>•</span><span><div>What treatment strategy?</div></span></li><li><span>•</span><span><div>What results?</div></span></li></ul></div><div>Anterior ankle impingement is suspected in case of anterior ankle pain reproducible by palpation and exacerbated by dorsiflexion imposed by the examiner or squatting, and Molloy’s sign. Etiologies are varied: tumoral, post-traumatic, lateral ankle instability, osteoarthritis and microtrauma. Complementary cross-sectional imaging, and especially MRI, is indispensable for identifying the cause. A dichotic classification in terms of anterolateral impingement of tissular origin and anteromedial impingement of osteophytic origin is incompatible with current pathophysiological concepts. An etiological classification, completed by a topographic classification in 3 zones, provides a better guide for treatment strategy. Tumoral or post-traumatic impingement requires a specialized team. Impingement by microtrauma associated with instability or osteoarthritis is best treated arthroscopically, for exhaustive exploration of intra-articular elements that may be implicated. Treatment consists in removing osteophytes and any pathological synovial or ligamentous soft tissue. Anterior talofibular ligament or medial collateral ligament repair may be associated. Results can be expected to be good, with clear improvement in pain and function and excellent patient satisfaction.</div></div><div><h3>Level of evidence</h3><div>V, expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104063"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal junctional kyphosis above long spinal fusions","authors":"Léonard Chatelain,&nbsp;Abbas Dib,&nbsp;Louise Ponchelet,&nbsp;Emmanuelle Ferrero","doi":"10.1016/j.otsr.2024.104065","DOIUrl":"10.1016/j.otsr.2024.104065","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal deformity in adults is a major public health problem. After failure of conservative treatment, correction and fusion surgery leads to clinical and radiological improvement. However, mechanical complications and more particularly – proximal junctional kyphosis (PJK) – are common with an incidence of 10%–40% depending on the studies.</div></div><div><h3>Analysis</h3><div>Several risk factors have been identified and can be grouped into three categories. Among the patient-related factors, advanced age, comorbidities, osteoporosis and sarcopenia play a determining role. Among the radiological factors, changes in sagittal alignment (cranial migration of thoracolumbar inflection point, over-correction of lumbar hyperlordosis, preoperative thoracolumbar kyphosis) play a key role. Finally, the fusion technique itself may increase the risk of PJK (use of screws instead of hooks) as a surgical factor.</div></div><div><h3>Prevention</h3><div>Prevention happens at each phase of treatment. A patient assessment is done preoperatively to identify those at risk of PJK. Treating osteoporosis is beneficial. The surgical strategy must also be adapted: the choice of transitional implants such as sublaminar links or hooks and the use of ligament reinforcement techniques can help minimize the risk of PJK. Finally, methodical clinical and radiological follow-up will help to detect early signs of PJK and allow a surgeon to reoperate right away.</div></div><div><h3>Treatment</h3><div>Not all PJK requires surgical revision. Radiological monitoring and functional treatment is sometimes sufficient. However, if the patient develops pain, neurological complications or instability detected by imaging (unstable fracture, spondylolisthesis, spinal cord compression), revision surgery is necessary. It may consist of proximal extension of the fusion combined with decompression of the stenosis levels at a minimum.</div></div><div><h3>Conclusion</h3><div>PJK is a major challenge for surgeons. The best treatment is prevention, with a thorough analysis of risk factors leading to a well-planned and personalized surgery. Regular postoperative follow-up is essential.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104065"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rate of complications and short-term Functional Results of Revision Total Knee Arthroplasty for Tibio-femoral Instability: do stability and range of motion are restored in 62 revisions","authors":"Antoine Labouyrie ,&nbsp;Julien Dаrtus ,&nbsp;Sophie Putman ,&nbsp;Teddy Trouillez ,&nbsp;Henri Migаud ,&nbsp;Gilles Pаsquier","doi":"10.1016/j.otsr.2024.103986","DOIUrl":"10.1016/j.otsr.2024.103986","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Tibio-femoral instability (TFI) due to ligament imbalance is a growing cause of revision total knee arthroplasty (TKA). The results are heterogeneous in the event of revision and literature is scarce regarding this issue particularly when use of hinge prostheses is not exclusive to manage this complication. Therefore, a retrospective investigation was conducted aiming to (1) analyze the one-year functional results, (2) determine the rate of complications after revision for TFI using posterior-stabilized or condylar constrained knees (CCK), 3) identify the factors that could influence the function outcome.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;Patients undergoing revision TKA for TFI would show an improvement in Oxford Knee Score at one year postoperative.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Sixty-two patients were included (40 females, 22 males) mean age 62,9 years ± 8.2 (range, 45,7–78,4). Instability was classified as instability in extension (n = 28), midflexion (n = 12), flexion (n = 12) or global (n = 15). Revisions were done because of isolated instability. Revision consisted in implant revision using a CCK (n = 42), a hinge prosthesis (n = 12) or an isolated polyethylene insert exchange (n = 8). Patients were assessed at one year by the difference between the preoperative Oxford Knee Score (OKS) and the score at one year postoperatively. The results were deemed satisfactory if the variation between preoperative OKS and one-year follow-up was greater than or equal to 5 points (Minimal Clinically Important Difference (MCID) following TKA). Complication rate and risk factors influencing the outcome were also analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 62 patients, 59 could be assessed at one year using postoperative OKS (one death at 0.66 years from unrelated reason, and two had repeated revision within one year postoperative [1 aseptic loosening and 1 Co-Cr allergy]). Preoperative OKS was 15.5 points ± 7.1 (range, 2–37), rising to 28.9 points ± 8.7 (range, 11–45) at follow-up. The mean OKS improvement was 13.4 points ± 10.3 (range, -8 to 33) (p &lt; 0.001) and 47 patients (79.6%) reached the MCID at follow-up. Female gender was associated with a worse evolution of OKS (-5.8, 95% CI: −11.26 to −0.34 (p = 0.038)). In contrast, there was no significant difference in the evolution of the OKS according to the type of TFI in extension or in flexion, in midflexion or global (p = 0.5). Likewise, there was no significant difference in the evolution of the OKS between RTKA using CCK, hinged prosthesis or isolated polyethylene insert exchange (p = 0.3). There was no recurrence of instability at final follow-up (3.04 years ± 1.5 (range, 0.66–6.25)). Revision for instability did not drive to stiffness since mean flexion prior to RTKA was 116 ° ± 13 ° (range, 90 ° to 130 °) versus 116.7 ° ± 12 ° (range, 90 ° to 130 °) at follow-up. Fourteen patients (22.6%) experienced postoperative complications, including 3 revi","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103986"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-level osteotomy for varus knees using patient-specific cutting guides allow more accurate correction but similar clinical outcomes as compared to conventional techniques","authors":"Grégoire Micicoi ,&nbsp;Francesco Grasso ,&nbsp;Lukas Hanak ,&nbsp;Kristian Kley ,&nbsp;Raghbir Khakha ,&nbsp;Merwane Ayata ,&nbsp;Jean-Marie Fayard ,&nbsp;Matthieu Ollivier","doi":"10.1016/j.otsr.2024.103949","DOIUrl":"10.1016/j.otsr.2024.103949","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Patient-specific cutting guides are increasingly used in the field of osteotomies around the knee and can improve the accuracy of planned correction and more specifically in the case of double-level osteotomy (DLO). The purpose of this study was to analyse the accuracy of postoperative coronal alignment after DLO using patient-specific cutting guides techniques (PSI) compared to conventional techniques.&lt;/div&gt;&lt;div&gt;The secondary objective was to compare the functional results between the two groups at short-term follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The accuracy of global correction (HKA angle) is better with patient-specific cutting guides compared to conventional techniques for double-level osteotomy&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This multicentric comparative retrospective study included 53 patients (mean age: 53.8 ± 5.2 years, male/female: 44/9) who underwent a DLO for knee varus malalignment. The coronal correction accuracy (as expressed by the difference between postoperative angular values and preoperative targeted correction) was compared between techniques using patient-specific cutting guides (PSI group, n = 27) or conventional techniques (n = 26) for the medial proximal tibial angle (MPTA) and the lateral distal femoral angle (LDFA). Postoperatively, the global alignment expressed by the hip-knee-ankle angle and the joint line obliquity were compared between groups. The postoperative functional results for KOOS and UCLA activity scale score were also compared at a mean follow-up of 1.7 years (1.0–3.1 years).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;No difference was observed for the postoperative global alignment between the PSI and the conventional groups (Δ = 0.6 °, &lt;em&gt;p&lt;/em&gt; = 0.11) neither for the postoperative posterior proximal tibial angle (Δ = 1.6°, &lt;em&gt;p&lt;/em&gt; = 0,99) or the joint line obliquity (Δ = 0.3°, &lt;em&gt;p&lt;/em&gt; = 0,17). In the coronal plane, the postoperative MPTA was lower in the PSI group (Δ = 2.3°, &lt;em&gt;p&lt;/em&gt; &lt; 0.001) as well as the postoperative LDFA (Δ = 0.9°, &lt;em&gt;p&lt;/em&gt; = 0.01).&lt;/div&gt;&lt;div&gt;Concerning correction accuracy in the coronal plane, the results showed a significant higher accuracy of the planned correction in the PSI group compared to the conventional group for MPTA (2.2 ± 0.2 versus 0.8 ± 0.7, Δ = 1.5 °, &lt;em&gt;p&lt;/em&gt; &lt; 0.001) and LDFA (1.3 ± 1.0 versus 0.6 ± 0.9, Δ = 0.7°, &lt;em&gt;p&lt;/em&gt; &lt; 0.001).&lt;/div&gt;&lt;div&gt;No improvement difference was observed between the conventional group and the PSI group respectively for the KOOS symptoms (&lt;em&gt;p&lt;/em&gt; = 0.12), the KOOS Pain (&lt;em&gt;p&lt;/em&gt;&lt;span&gt; = 0,57), the KOOS activities of daily living (&lt;/span&gt;&lt;em&gt;p&lt;/em&gt; = 0.61), the KOOS sport/rec (&lt;em&gt;p&lt;/em&gt;&lt;span&gt; = 0.65), or for the KOOS Quality of Life (&lt;/span&gt;&lt;em&gt;p&lt;/em&gt; = 0.99) neither for the UCLA (&lt;em&gt;p&lt;/em&gt; = 0.97).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study suggests that the use of custom-made cutting guides improves the accuracy of planned correction in double-level osteotom","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103949"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}