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Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO).

Materials and methods: This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border.

Results: The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group.

Conclusions: In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.

No MeSH data available.


Related in: MedlinePlus

Cable method. (A) The center of the hip was identified with fluoroscopy. (B) The center of the ankle was identified with fluoroscopy. (C) The hip and ankle centers were connected using an electrocautery cord under fluoroscopic guidance. The osteotomy site was spread until the electrocautery cord was placed at the target point on the medial-to-lateral tibial plateau of the knee joint. Then, the metal plate was fixed.
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f1-ksrr-28-283: Cable method. (A) The center of the hip was identified with fluoroscopy. (B) The center of the ankle was identified with fluoroscopy. (C) The hip and ankle centers were connected using an electrocautery cord under fluoroscopic guidance. The osteotomy site was spread until the electrocautery cord was placed at the target point on the medial-to-lateral tibial plateau of the knee joint. Then, the metal plate was fixed.

Mentions: The superficial medial collateral ligament and pes anserinus were completely separated in both groups. In the cable group, a biplanar osteotomy was performed behind the tibial tuberosity. Then, the posteromedial tibial osteotomy site was opened using a chisel and a bone spreader, and the hip and ankle centers were connected using an electrocautery cord under fluoroscopic guidance. The osteotomy site was spread until the electrocautery cord could be placed at the target point on the medial-to-lateral tibial plateau of the knee joint while applying axial load at the foot sole. Then, the metal plate was fixed (Fig. 1)1). The PACS group underwent anteroposterior full-length lower limb radiography with valgus stress applied to the bilateral knee joints under weight bearing condition in order to correct widening of the lateral joint space induced by ligament laxity. Using the preoperative radiograph, the lower limb weight bearing line was drawn (line 1, S). After calculating the 62.5% point from the medial border along the longest medial-to-lateral width of the tibial plateau, an extension line connecting the hip center and the target point (line 2, S′) was drawn. Then, a line connecting the lateral tibial osteotomy site (D) and the center of the ankle joint (line 3, DS) and a line connecting the osteotomy site and S′ (line 4, DS′) were drawn (Fig. 2A). The angle formed by lines 3 and 4 was determined to be the predicted correction wedge angle (α). A predicted osteotomy line (O) was drawn from the proximal extremity of the fibular head to the predicted medial osteotomy site (approximately 4 cm inferior to the medial border of the tibial plateau), and a predicted opening line (O′) was drawn from Line O at the determined correction angle (wedge angle, α). Using the triangle formed, we measured the predicted correction gap (wedge gap, mm) at the cortical bone of the posteromedial tibia (Fig. 2B and C)12). After performing an osteotomy using the same surgical technique as in the cable group, we spread the osteotomy site matching the predicted wedge angle and gap and fixed the metal plate. Allogeneic bone and autologous bone marrow harvested from the anterior superior iliac spine on the same side were mixed and grafted onto the bone defect. The grafted site was covered with the superficial medial collateral ligament, and the pes anserinus was resutured to the periosteal membrane. An active exercise program for joint rehabilitation began in the second postoperative week. The Aescula plate group (cable group) and TomoFix plate group (PACS group) were allowed to commence body weight bearing in the sixth and second postoperative weeks, respectively.


Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy
Cable method. (A) The center of the hip was identified with fluoroscopy. (B) The center of the ankle was identified with fluoroscopy. (C) The hip and ankle centers were connected using an electrocautery cord under fluoroscopic guidance. The osteotomy site was spread until the electrocautery cord was placed at the target point on the medial-to-lateral tibial plateau of the knee joint. Then, the metal plate was fixed.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134794&req=5

f1-ksrr-28-283: Cable method. (A) The center of the hip was identified with fluoroscopy. (B) The center of the ankle was identified with fluoroscopy. (C) The hip and ankle centers were connected using an electrocautery cord under fluoroscopic guidance. The osteotomy site was spread until the electrocautery cord was placed at the target point on the medial-to-lateral tibial plateau of the knee joint. Then, the metal plate was fixed.
Mentions: The superficial medial collateral ligament and pes anserinus were completely separated in both groups. In the cable group, a biplanar osteotomy was performed behind the tibial tuberosity. Then, the posteromedial tibial osteotomy site was opened using a chisel and a bone spreader, and the hip and ankle centers were connected using an electrocautery cord under fluoroscopic guidance. The osteotomy site was spread until the electrocautery cord could be placed at the target point on the medial-to-lateral tibial plateau of the knee joint while applying axial load at the foot sole. Then, the metal plate was fixed (Fig. 1)1). The PACS group underwent anteroposterior full-length lower limb radiography with valgus stress applied to the bilateral knee joints under weight bearing condition in order to correct widening of the lateral joint space induced by ligament laxity. Using the preoperative radiograph, the lower limb weight bearing line was drawn (line 1, S). After calculating the 62.5% point from the medial border along the longest medial-to-lateral width of the tibial plateau, an extension line connecting the hip center and the target point (line 2, S′) was drawn. Then, a line connecting the lateral tibial osteotomy site (D) and the center of the ankle joint (line 3, DS) and a line connecting the osteotomy site and S′ (line 4, DS′) were drawn (Fig. 2A). The angle formed by lines 3 and 4 was determined to be the predicted correction wedge angle (α). A predicted osteotomy line (O) was drawn from the proximal extremity of the fibular head to the predicted medial osteotomy site (approximately 4 cm inferior to the medial border of the tibial plateau), and a predicted opening line (O′) was drawn from Line O at the determined correction angle (wedge angle, α). Using the triangle formed, we measured the predicted correction gap (wedge gap, mm) at the cortical bone of the posteromedial tibia (Fig. 2B and C)12). After performing an osteotomy using the same surgical technique as in the cable group, we spread the osteotomy site matching the predicted wedge angle and gap and fixed the metal plate. Allogeneic bone and autologous bone marrow harvested from the anterior superior iliac spine on the same side were mixed and grafted onto the bone defect. The grafted site was covered with the superficial medial collateral ligament, and the pes anserinus was resutured to the periosteal membrane. An active exercise program for joint rehabilitation began in the second postoperative week. The Aescula plate group (cable group) and TomoFix plate group (PACS group) were allowed to commence body weight bearing in the sixth and second postoperative weeks, respectively.

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO).

Materials and methods: This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border.

Results: The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group.

Conclusions: In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.

No MeSH data available.


Related in: MedlinePlus