Introduction Eight hundred and fifty-eight consecutive osteotomies around the knee joint were analyzed retrospectively to detect intra- and early postoperative complications in a period of 4 weeks postoperative. Indications for osteotomy were unilateral gonarthritis or torsional deformities resulting in femoropatellar instability or anterior knee pain. Materials and methods Etiology of deformity, technique and mode of correction and level of osteotomy were registered. Complications were detected and divided in minor complication (superficial wound infection, and deep-vein thrombosis) and major complication (compartment syndrome, deep infection, and vascular lesion). Results Fifteen major (1.7%) and 17 minor complications (2.0%) were detected: 5 vascular lesions (0.58%), 4 compartment syndromes (0.47%) and 6 deep infections (0.70%), 14 superficial wound infections (1.6%) and 3 deep-vein thrombosis (0.35%). In posttraumatic osteotomies and continuous corrections, risk for a superficial wound infection was significantly higher and with osteoclasia risk for vascular lesion was higher compared to osteotomy with oscillating saw. No difference was found for anatomical level of osteotomy and for the other complications in terms of etiology of deformity, technique of osteotomy and mode of correction. Conclusion Osteotomy around the knee is a safe procedure in the treatment of unicompartmental gonarthritis in terms of intra- and postoperative complications. Major complications are rare. Pit falls for compartment syndromes (LCW and torsional corrections) have to kept in mind. There is no difference in frequency of complications between HTO and supracondylar osteotomies. Risk for superficial wound infection is higher in posttraumatic osteotomies and with continuous corrections. Osteoclasia contains a higher risk for vascular lesion compared to oscillating saw.

INTRODUCTION:Medial open wedge (MOW) and lateral closed wedge (LCW) osteotomies are established methods to treat medial gonarthritis. Advantages and differences in the outcome of the two techniques have been discussed controversially and there is still no precise recommendation for either technique. We now aimed to assess the effect of each technique on tibial slope (TS), patella height (PH) and leg length discrepancy.METHOD:In a study of 50 consecutive cases of MOW and 50 of LCW osteotomies were registered. The decision for either technique was made pre-operatively according to an algorithm. Demographic data, operation procedures (time of operation, correction angle, torsional correction) and measurement of patellar height, tibial slope, leg length discrepancy, clinical outcome after one year and bone and wound healing were obtained. Pre- and post-operative values were compared between the two groups.RESULTS:In absence of randomization demographic data demonstrate comparability of the two groups. No difference in bone and wound healing, time of operation and clinical outcome was seen. In the MOW group PH decreased significantly, no relevant alteration of PH was detected in the LCW group. In the latter group a statistically significant decrease of TS compared to a slightly decrease in the MOW group was recorded post-operatively. A significant leg lengthening with the MOW and shortening of the leg with the LCW method can be achieved.DISCUSSION:With respect to similar results in operating procedures, bone and wound healing and clinical outcome decision making factors for either technique should be leg length discrepancy and torsional deformities. Changes of PH and TS have to be known and may influence the technique of osteotomy in cases of patella infera / alta or borderline PH.CONCLUSION:An algorithm for valgus high tibial osteotomies based on TS, PH and leg length discrepancy may be proposed.

The purpose of corrective osteotomies in posttraumatic and congenital deformities is anatomic limb reconstruction and joint preservation. The aim of the present study was to analyse intra- and perioperative complications of osteotomies in the lower limb.

Anterior knee pain or patellofemoral instability is common symptom of patellofemoral dysbalance or maltracking. Tibial torsional deformities can be the reason of this pathology. After appropriate diagnostic investigation, the treatment of choice is a torsional osteotomy. This study addresses the diagnostic investigation, treatment, and the outcome of torsional osteotomies of the tibia. Does this treatment result in patellofemoral stability and provide pain relief?

Patellofemoral dysbalance may be caused by trochlear dysplasia, an elevated TTTG distance, femoral or tibial torsional deformities, patella alta, or a genu valgum. The surgical procedure for the treatment of a genu valgum is varisation osteotomy, usually in the femoral aspect. Several authors believe that a genu valgum is one cause of patellofemoral dysbalance, but studies about the outcome of the treatment with a varisation osteotomy are rare.

Aims and Objectives:Anterior knee pain or patellofemoral instability are typical symptoms of patellofemoral dysbalance. Beside other reasons, this pathology can be caused by a femoral deformity. The two dimensions leading to this problems are torsional- and valgus deformities. This constellation often stays unrecognized. When diagnosed and analyzed, a femoral torsional or varization-osteotomy is the adequate treatment. Aim of this study was to show the diagnostic approach, the gold standard of therapy and the follow up results. Can patellofemoral stability be archived? Is the pain relief significant and how do clinical scores develop at the follow up? Materials and Methods:33 femoral torsional osteotomies and 18 femoral varization osteotomies were included in this study, 5 of these were combined femoral varization and torsional corrections so that 46 knees are included in 41 patients, as 5 patients were operated on both legs. Major symptoms were patellofemoral dislocations in 28 cases and anterior knee pain in 26 cases. Beside clinical and radiographic evaluation full weight bearing long leg views and a torsional computertomography was always performed. Follow up examination was after 41 (6-113) months. Visual analog scala score, Japanese Knee Society Score, Tegner activity score and Lysholm score were taken before surgery and at the follow up. Results:Mechanical femorotibial valgus was on average 6,4° (5°-10°), femoral internal torsion was in average 40,9° (29°-66°; normal: 24°). Surgical treatment was performed with an arthroscopy followed by an acute femoral varization 7,2°(5°-10°) and / or external torsion osteotomy of 13.8° (5°-26°). Tegner activity score, Japanese knee society score and Lysholm score all significantly improved. Pain relief could be demonstrated as shown by a significant decrease of the VAS score. No further dislocation was reported during the follow up period. Conclusion:Valgus or torsional deformities of the femur frequently lead to symptoms of the patellofemoral joint associated with anterior knee pain or instability. These deformities often stay undetected, leading to a long history of illness and surgical interventions not adressing the source of the symptoms. After thorough assessment and diagnostics a treatment plan involving an acute femoral varization / external torsion osteotomy should be scheduled. Correct surgical indication and performance leads to a significant pain relief and patellofemoral stability as can be demonstrated during follow up examination.

Introduction: Medial open-wedge high tibial osteotomy (MOWHTO) is an established method to treat unicompartimental osteoarthritis of the knee joint. However, augmentation of the created tibial gap after osteotomy is controversially discussed.Methods: We performed a prospective investigation of 49 consecutive cases of MOWHTO at our department. Patients were divided into two groups: group A consisted of 19 patients while group B consisted of 30 patients. In group A, the augmentation of the opening gap after osteotomy was filled with a synthetic bone graft, whereas group B received no augmentation. As an indicator for bone healing we investigated the non-union rate in our study population and compared the non-union-rate between the two groups.Results: The non-union rate was 28% in group A (five of 19 patients had to undergo revision) which received synthetic augmentation, while it was 3.3% in group B (one of 30 patients had to undergo revision) which received no augmentation. The difference between the groups was statistically significant (p-value 0.027).Conclusions; With regard to bone healing after MOWHTO, synthetic augmentation was not superior to no augmentation in terms of non-union rates after surgery. In fact, we registered a significantly higher rate of nonunion after augmentation with synthetic bone graft. (C) 2015 Elsevier B.V. All rights reserved.

The Q-angle has been used for years to quantify lateralization of the patella. The tibial tuberosity–trochlea groove distance (TT–TG distance) was introduced to analyse patellar tracking. Does a significant correlation exist between these two parameters? Do other significant interrelations exist between the Q-angle/TT–TG distance, torsion of the femur and tibia, the frontal axis, overall leg length, gender, former patellar dislocation, BMI?

Various pathologies of the hip or knee, such as patellofemoral malalignment or femoroacetabular impingement may be caused by a femoral torsional deformity. When diagnosed and analyzed, it is treated by femoral torsional osteotomy. Thirty femoral torsional osteotomies in 25 patients were included, the principal symptoms were patellar dislocation in 15 patients, anterior knee pain in 17, and femoroacetabular impingement in two. A computed‐tomography‐based measurement of the torsional angle was performed in all patients. Japanese Knee Society score, Tegner activity score, Lysholm score, and visual analog scale score were determined before surgery and at follow‐up after 41 (6–113) months. Femoral internal torsion was on average 40.9° (29° − 66°; normal 24°). Surgical treatment consisted of a femoral external torsional osteotomy of on average 13.8° (5° − 26°). Tegner activity score increased non‐significantly (p‐value 0.326) from 3.57 to 3.71. Japanese Knee Society score improved significantly from 72 to 87 (p‐value 0.004) while Lysholm score rose significantly from 66 to 84 points (p‐value 0.004). Pain relief was demonstrated by a significant decrease in the VAS score from 5.6 to 2.4 (p‐value 0.007). No further patellar dislocation was reported. Torsional deformities of the femur frequently cause symptoms in the knee or hip joint. After thorough assessment and diagnostic investigation, a femoral external torsional osteotomy provides significant pain relief as well as patellofemoral stability. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:???–???, 2015.

Displaced fractures of the greater tuberosity are common findings in trauma surgical patients. Nevertheless, osteosynthesis of these fractures impairs the risk of secondary dislocation or secondary impingement due to the implant (e.g., 4.5 mm cancellous screws with spiked washers). We present an easy and simple technique/implant to perform an osteosynthesis of multiple-fractured greater tuberosity fractures. We use a self-adjusted calcaneus titanium plate (Litos®) which is cut into a 6 or more holed small plate. In ten patients we had excellent postoperative outcomes with no complications and no secondary loss of reduction. The surgical technique is easy and efficient.

A femoropatellar syndrome may be caused by a deformity in the torsional axis of the femur or the tibia. The two cardinal symptoms are anterior knee pain and patellar instability.

We report the case of a 24-year-old driving instructor with osteonecrosis of the talus and a large articular cartilage and osseous defect. The cystic lesion was caused by villonodular synovitis. After magnetic resonance imaging detection and arthoscopic analysis, the defect was filled with a bone graft, followed by matrix-associated autologous chondrocyte transplantation (MACT) combined with a total synovectomy. In general, lesions similar to the one described in this case are treated using osteochondral autografts, but in our case the osseous defect was too large to perform an osteochondral autograft. Our choice of treatment with an iliac crest bone graft combined with a MACT simultaneously has not yet been published, as far as we know. The patient returned to his former activities of daily living and sport activities, without restrictions or complaints, and with only a slight deficit in range of motion. Morphological and biochemical magnetic resonance imaging 12 months after surgery showed excellent bone healing with no intraosseous edema. The MACT resulted in a good clinical outcome, with 100% defect filling and excellent integration and surface and signal intensity of the cartilage repair tissue, and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score increased from 47 to 79 points.

Voraussetzung für jede Korrektur kniegelenknaher Deformitäten ist eine umfassende Analyse der knöchernen Geometrie, der Gelenkfunktion und -stabilität sowie der jeweiligen Weichteil- und Knochensituation. Die Planung der Deformitätenkorrektur schließt bereits die Entscheidung bezüglich des Orts der Korrektur, sei er femoral suprakondylär oder am Tibiakopf, der Art und der Technik der Knochendurchtrennung und der nachfolgenden knöchernen Rekonstruktion ein. Die gängigsten Korrekturverfahren femoral und tibial werden vorgestellt, ebenso wie bewährte Planungs- und Osteotomietechniken.

Die Durchführung einer Arthroskopie im Rahmen einer kniegelenknahen Korrekturosteotomie wird in Fachkreisen kontrovers bewertet.

The planning analysis of leg deformities around the knee joint is based on a standardized clinical examination and on long leg standing anteroposterior (AP) radiographs, which may be complemented by spot-film radiographs and stress radiographs. The principles of true-nominal analysis in six steps are used to characterize the deformity and plan the corrective osteotomy: 1. Drawing in the anatomic points of reference. 2. Establishing the mechanical weight-bearing axis. 3. Determining the axis and orientation angles around the knee joint. 4. Determining the correction goal. 5. Deciding on the osteosynthesis technique and the osteotomy level. 6. Measuring the angle of correction. All the steps are exemplified on a valgus deformity and a varus deformity.