Braaten Jacob A, Banovetz Mark T, Homan Morgan D, Monson Jill K, Kennedy Nicholas I, LaPrade Robert F
University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Twin Cities Orthopedics, Edina, Minnesota, USA.
Video J Sports Med. 2023 May 18;3(3):26350254231155498. doi: 10.1177/26350254231155498. eCollection 2023 May-Jun.
Valgus malalignment leads to excessive loading of the lateral compartment and has been associated with lateral compartment meniscal injuries and early-onset knee osteoarthritis. Distal femoral osteotomy (DFO) is a treatment option that allows correction of the mechanical access to offload the lateral compartment. Lateral opening-wedge distal femoral osteotomy and medial meniscal root repairs are both aimed to address the pathologic biomechanics of the tibiofemoral joint and when successful can delay or even prevent progression to end-stage osteoarthritic changes in the lateral and medial compartment, respectively.
Distal femoral osteotomy is indicated for patients with normal metabolic bone health and valgus malalignment who may present with concurrent lateral meniscal injury, symptomatic lateral compartment arthritis, or a chronic medial collateral ligament tear/laxity.
Long-leg alignment radiographs and preoperative magnetic resonance images are required to evaluate the degree of mechanical access deviation and to evaluate for soft tissue injury, as there is often concomitant lateral meniscal or cartilage pathology present. This technique demonstrates the optimal order of surgical steps for DFO with a concurrent medial meniscal root repair. The senior author's preferred order is to first perform the open lateral approach and expose the lateral cortex for the placement of plate prior to arthroscopic work and excess fluid extravasation. Intra-articular work is then performed with a diagnostic arthroscopy followed by medial meniscal root repair. Finally, the osteotomy and subsequent internal fixation are performed.
The literature on opening-wedge DFO outcomes is heterogeneous, with variable rates of successful outcomes and complications. Saithna et al reported that International Knee Documentation Committee and the pain subdomain of Knee injury and Osteoarthritis Outcome Scores significantly improved postoperatively following lateral opening-wedge DFOs in patients with lateral compartment osteoarthritis. The 10-year success rate of varus-producing DFO has been reported to be 64% to 85%.
We describe a technique for correction of a valgus deformity with opening-wedge DFO and concurrent meniscal root repair. This surgical technique effectively restores the native femoral and tibial axis with appropriate load distribution and also concurrently restores the appropriate function of the medial meniscus which allows axial force dispersion via hoop stresses for the medial compartment.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
外翻畸形会导致外侧间室负荷过重，并与外侧间室半月板损伤和早发性膝关节骨关节炎相关。股骨远端截骨术（DFO）是一种治疗选择，可通过纠正力学力线来减轻外侧间室的负荷。外侧开放楔形股骨远端截骨术和内侧半月板根部修复均旨在解决胫股关节的病理生物力学问题，成功实施后可分别延缓甚至预防外侧和内侧间室发展为终末期骨关节炎改变。
股骨远端截骨术适用于代谢性骨健康正常且存在外翻畸形，可能并发外侧半月板损伤、有症状的外侧间室关节炎或慢性内侧副韧带撕裂/松弛的患者。
需要长腿力线X线片和术前磁共振成像来评估力学力线偏差程度以及评估软组织损伤情况，因为通常会伴有外侧半月板或软骨病变。本技术展示了DFO联合内侧半月板根部修复手术步骤的最佳顺序。资深作者倾向的顺序是，在进行关节镜操作和过多液体外渗之前，先采用外侧开放入路，暴露外侧皮质以便放置钢板。然后进行关节内操作，先进行诊断性关节镜检查，接着进行内侧半月板根部修复。最后进行截骨术及后续内固定。
关于开放楔形DFO结果的文献参差不齐，成功结果和并发症发生率各不相同。赛特纳等人报告称，对于外侧间室骨关节炎患者，外侧开放楔形DFO术后，国际膝关节文献委员会评分以及膝关节损伤和骨关节炎疗效评分中的疼痛子域评分均有显著改善。据报道，产生内翻的DFO的10年成功率为64%至85%。
我们描述了一种采用开放楔形DFO和联合半月板根部修复来纠正外翻畸形的技术。这种手术技术能有效恢复股骨和胫骨的自然轴线，实现适当的负荷分布，同时还能恢复内侧半月板的适当功能，从而通过环向应力实现内侧间室的轴向力分散。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
