Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, 9, Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, France.
Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):3007-3014. doi: 10.1007/s00167-023-07325-y. Epub 2023 Jan 27.
Double-level knee osteotomy (DLO) is a challenging procedure that requires precision in preoperative planning and intraoperative execution to achieve the desired correction. It is indicated in cases of severe varus or valgus deformities where a single-level osteotomy would yield significantly tilted joint line obliquity (JLO). This study aimed to evaluate the effectiveness of DLO in achieving accurate correction without compromising JLO, using patient-specific cutting guides (PSCGs), in cases of bifocal valgus maligned knees.
A single-centre, retrospective analysis of prospectively collected data for a total of 26 patients, who underwent DLO by PSCGs for valgus malaligned knees, between 2015 and 2020. Post-operative alignment was evaluated and the delta for different lower limb0.05, not statistically significant (ns)). All KOOS subs alignment parameters was calculated; the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), and lateral distal femoral angle (ΔLDFA). At the two-year follow-up, changes in the KOOS sub-scores, UCLA scores, lower limb discrepancy (LLD), and mean time to return to work and sport were recorded. All intraoperative and postoperative complications were recorded. The Mann-Whitney U test with a 95% confidence interval (95% CI) was used to evaluate the differences between two variables; one-way ANOVA between more than two variables and the paired Student's t-test was used to estimate the evolution of functional outcomes.
The postoperative mean ΔHKA was 0.9 ± 0.9°, the mean ΔMPTA was 0.7 ± 0.7°, and the mean ΔLDFA was 0.7 ± 0.8° (all values with p > 0.05, not statistically significant (ns)). All KOOS subscore's mean values were improved to an extent two-fold superior to the reported minimal clinically important difference (MCID) (all with p < 0.0001). There was a significant increase in the UCLA score at the final follow-up (5.4 ± 1.5 preoperatively versus 7.7 ± 1.4, p < 0.01). The mean time to return to sport and work was 4.7 ± 1.1 and 4.3 ± 2.1 months, respectively. There was an improvement in Lower-limb discrepancy preoperative (LLD = 1.3 ± 2 cm) to postoperative measures (LLD = 0.3 ± 0.4 cm), ns. Complications were 2 femoral hinge fractures, 2 deep vein thromboses, 1 delayed tibial healing, and 1 hardware removal for hamstring irritation syndrome.
DLO is effective and safe in achieving accurate correction in bifocal valgus malaligned knees with maintained lower limb length and low complication rate with no compromise of JLO.
III.
双平面膝关节截骨术（DLO）是一项具有挑战性的手术，需要在术前规划和术中执行方面具有精确性，以达到预期的矫正效果。当存在严重的内翻或外翻畸形，单平面截骨术会导致明显倾斜的关节线倾斜角（JLO）时，该手术适用于这种情况。本研究旨在评估使用患者特异性截骨导板（PSCG）在双焦点外翻畸形膝关节中实现准确矫正而不影响 JLO 的效果。
对 2015 年至 2020 年间共 26 例接受 DLO 治疗的外翻畸形膝关节患者进行前瞻性数据的单中心回顾性分析。评估术后的对线情况，并计算不同下肢的差值：0.05，无统计学意义（ns））。所有 KOOS 亚组的排列参数均进行了计算；髋膝踝角（ΔHKA）、内侧胫骨近端角（ΔMPTA）和外侧股骨远端角（ΔLDFA）。在两年随访时，记录 KOOS 亚组评分、UCLA 评分、下肢差异（LLD）以及返回工作和运动的平均时间的变化。记录所有术中及术后并发症。使用具有 95%置信区间（95%CI）的 Mann-Whitney U 检验评估两个变量之间的差异；使用单向方差分析比较三个及以上变量之间的差异，使用配对学生 t 检验评估功能结果的变化。
术后平均 ΔHKA 为 0.9°±0.9°，平均 ΔMPTA 为 0.7°±0.7°，平均 ΔLDFA 为 0.7°±0.8°（所有值的 p 值均>0.05，无统计学意义（ns））。所有 KOOS 亚组的平均分值均提高了两倍，优于报告的最小临床重要差异（MCID）（均 p<0.0001）。最终随访时 UCLA 评分显著升高（术前 5.4±1.5 分，术后 7.7±1.4 分，p<0.01）。重返运动和工作的平均时间分别为 4.7±1.1 个月和 4.3±2.1 个月。下肢差异（术前 LLD=1.3±2cm）在术后得到改善（LLD=0.3±0.4cm），无统计学意义（ns）。并发症包括 2 例股骨铰链骨折、2 例深静脉血栓形成、1 例胫骨延迟愈合和 1 例因腘绳肌激惹综合征而去除内固定。
DLO 在治疗双焦点外翻畸形膝关节时，能有效且安全地实现准确矫正，同时维持下肢长度，降低并发症发生率，不影响 JLO。
III 级。
