PMID- 36705689
OWN - NLM
STAT- MEDLINE
DCOM- 20230619
LR  - 20230619
IS  - 1433-7347 (Electronic)
IS  - 0942-2056 (Linking)
VI  - 31
IP  - 7
DP  - 2023 Jul
TI  - Double-level knee osteotomy accurately corrects lower limb deformity and provides 
      satisfactory functional outcomes in bifocal (femur and tibia) valgus malaligned 
      knees.
PG  - 3007-3014
LID - 10.1007/s00167-023-07325-y [doi]
AB  - PURPOSE: 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. METHODS: 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 
      (DeltaHKA), medial proximal tibial angle (DeltaMPTA), and lateral distal femoral angle 
      (DeltaLDFA). 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. RESULTS: The postoperative mean DeltaHKA was 0.9 +/- 0.9 degrees , the 
      mean DeltaMPTA was 0.7 +/- 0.7 degrees , and the mean DeltaLDFA was 0.7 +/- 0.8 degrees  (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. CONCLUSION: 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. LEVEL OF EVIDENCE: III.
CI  - (c) 2023. The Author(s) under exclusive licence to European Society of Sports 
      Traumatology, Knee Surgery, Arthroscopy (ESSKA).
FAU - Pioger, Charles
AU  - Pioger C
AUID- ORCID: 0000-0003-1180-4955
AD  - Department of Orthopaedic Surgery, Ambroise Pare Hospital, Paris Saclay 
      University, 9, Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. 
      charles.pioger@aphp.fr.
FAU - Mabrouk, Ahmed
AU  - Mabrouk A
AD  - Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du 
      Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, 
      France.
FAU - Siboni, Renaud
AU  - Siboni R
AD  - Department of Orthopaedic Surgery, Reims Teaching Hospital, Hopital Maison 
      Blanche, 45 Rue Cognacq-Jay, 51092, Reims, France.
FAU - Jacquet, Christophe
AU  - Jacquet C
AD  - Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du 
      Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, 
      France.
FAU - Seil, Romain
AU  - Seil R
AD  - Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 
      Luxembourg, Luxembourg.
FAU - Ollivier, Matthieu
AU  - Ollivier M
AD  - Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du 
      Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, 
      France.
LA  - eng
PT  - Journal Article
DEP - 20230127
PL  - Germany
TA  - Knee Surg Sports Traumatol Arthrosc
JT  - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
JID - 9314730
SB  - IM
MH  - Humans
MH  - Tibia/surgery
MH  - Retrospective Studies
MH  - *Osteoarthritis, Knee/surgery
MH  - Knee Joint/surgery
MH  - Femur/surgery
MH  - Lower Extremity/surgery
MH  - Osteotomy/methods
MH  - *Femoral Fractures
OTO - NOTNLM
OT  - Closed-wedge osteotomy
OT  - Double-level osteotomy
OT  - Joint line orientation
OT  - Patient-specific cutting guides
EDAT- 2023/01/28 06:00
MHDA- 2023/06/19 13:09
CRDT- 2023/01/27 11:13
PHST- 2022/12/02 00:00 [received]
PHST- 2023/01/16 00:00 [accepted]
PHST- 2023/06/19 13:09 [medline]
PHST- 2023/01/28 06:00 [pubmed]
PHST- 2023/01/27 11:13 [entrez]
AID - 10.1007/s00167-023-07325-y [pii]
AID - 10.1007/s00167-023-07325-y [doi]
PST - ppublish
SO  - Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):3007-3014. doi: 
      10.1007/s00167-023-07325-y. Epub 2023 Jan 27.