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PubMed2006

Management of the severe varus and valgus knee using the low contact stress rotating platform.

Many surgeons feel the use of an unconstrained mobile-bearing knee is contraindicated in cases of severe varus and valgus deformity. In the author's opinion the Sigma LCS rotating-platform knee system can be used in virtually every primary knee irrespective of deformity. The key is to maintain flexion stability by not releasing the lateral collateral ligament in a valgus knee or the superficial medial collateral ligament in the varus knee.

Humans↗

PubMedDate not supplied

Prophylactic ankle braces and knee varus-valgus and internal-external rotation torque.

CONTEXT: Although prophylactic ankle bracing has been shown to be effective in reducing the incidence of ankle sprains,how these ankle braces might affect the other joints of the lower extremity is not clearly understood. OBJECTIVE: To determine the effects of a prophylactic ankle brace on knee joint varus-valgus and internal-external rotation torque during a drop landing onto a slanted surface. DESIGN: A repeated-measures design. SETTING: Biomechanics research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-four physically active college students. INTERVENTION(S): Participants were tested in a brace and no brace condition. MAIN OUTCOME MEASURE(S): We measured 3 dependent variables:(1) peak ankle inversion-eversion torque, (2) peak knee varus-valgus torque, and (3) peak knee internal-external rotation torque. A force plate was used to collect ground reaction force data, and 6 motion analysis cameras collected kinematic data during the unilateral drop landing. An adjustable bar was hung from the ceiling, and a slant board was positioned over the center of the force plate, so that the ankle of the participant's dominant leg would invert upon landing. Peak torque was measure din both the brace and no-brace conditions. The average of the peak values in 3 trials for both conditions was used for the statistical analysis. RESULTS: Ankle eversion torque was significantly greater in the brace condition (F1,23 19.75, P < .01). Knee external rotation torque was significantly greater in the brace condition(F1,23 4.33, P <.05). Valgus knee torque was smaller in the brace condition, but the difference was not statistically significant(F1,23 3.45, P .08). CONCLUSIONS: This study provides an important first step in understanding the effects of prophylactic ankle bracing on other joints of the lower extremity. We found that prophylactic ankle bracing did have an effect on knee torque when the subject was landing on a slanted surface. Specifically, knee external rotation torque increased when the ankle was braced.

Journal Article↗

PubMed1991

[Appraisal of outcomes of the treatment of equinus-cavus-varus deformities of the foot in adults].

There is presented the experience of treatment of 81 patients with equinus-cavus-varus deformation of 102 feet of different etiology by means of closed application of Volkov-Oganesyan-Povarov's hinged-distraction apparatus to restore the form and function of foot and talocrural articulation. For impartial assessment of the outcomes of treatment there has been developed and applied the scheme of multimark grading system of clinico-functional state of feet. The grade of the foot form and function restoration is appraised by 15 indices in comparison with the same in normal state. The sum of marks equals to 100 in case of optimum outcome. In accordance with the developed scheme there have been appraised 54 feet with the sum of marks obtained from 45 to 91 and their statistic reliability. The proposed scheme allows to make an impartial assessment of the outcomes of treatment of the equinus-cavus-varus deformation of feet and can be applied in practical institutions.

Adult↗

PubMed1991

[Early signs of poor prognosis in Legg-Perthes-Calve disease treated by femoral varus osteotomy].

A total of 126 Perthes diseases (112 patients) were studied. The treatment comprised intertrochanteric femoral varus osteotomy in every patient. In 20 patients (25 hips), the course of the disease was more severe than expected. The early radiological criteria for this severe course were: 1. Lateral calcification extending far laterally towards the greater trochanter, 2. Deformation and widening of the femoral head before the fragmentation phase, 3. The Saturn phenomenon; a sclerotic epiphysis surrounded by a ring of looser bony tissue, 4. Deformation and widening of the femoral neck at the initial phase of the disease, 5. Early wide sclerotic changes in the metaphysis. The overall results were poor. Two hips obtained a fair and 23 poor results. These described radiological changes are readily recognized at early phase of Perthes disease and indicate poor prognosis. In these cases varus osteotomy gave unsatisfactory results which means that other type of treatment in these patients should be considered.

Adolescent↗

PubMedDate not supplied

A new three-dimensional osteotomy for cubitus varus deformity after supracondylar fracture of the humerus in children.

In the past, supracondylar osteotomy for the correction of cubitus varus deformity has been associated with a high failure rate and significant complications, even in simple lateral closing wedge osteotomy. This is because the supracondylar area is thin and fixation is difficult to maintain. In cubitus varus deformity, not only medial, but posterior, tilt and internal rotation of the distal fragment also frequently occurs. To correct all these deformities and to achieve a wide bony contact and more rigid fixation than simple lateral closing wedge osteotomy, we propose a new three-dimensional osteotomy. Among 12 patients who received this osteotomy, 11 had an excellent result and one had a good result.

Adolescent↗

PubMedDate not supplied

[Which knee ligaments must be reconstructed in anterior and posterior valgus and varus instability? An experimental study].

This study aims to localize the ligamentous lesions in distinct knee joint instabilities. For that reason 41 human cadaver knee joint specimens were tested in a three-dimensional determined apparatus. Ligaments were successively dissected and forces and torques were introduced. Both cruciates are the dominant structures in preventing straight anterior und posterior movement of the tibia. As a supporting element the postero-medial capsule prevents anterior dislocation in ACL-deficient knees. Therefore extraarticular procedures in cruciate instabilities will not be successful. In contrast varus- and valgus instabilities resulted after transsection of a couple of ligaments. Valgus stability decreased after cutting the medial collateral, posterior oblique and both cruciate ligaments. The most important element in preventing straight varus instability was the lateral collateral followed by the posterior cruciate ligament, while the popliteus tendon had only little influence. Therefore in medial and lateral instabilities all supporting structures should be exposed and reconstructed.

Anterior Cruciate Ligament↗

PubMedDate not supplied

Surgical reconstruction of a congenital foot deformity: hallux varus with brachymetatarsia of the first metatarsal.

A literature review of the etiologies and treatments of both hallux varus and brachymetatarsia is presented. An unusual case report of a young girl with bilateral congenital hallux varus and brachymetatarsia of the first metatarsal is then discussed. A detailed account of the surgical correction consisting of autogenous bone grafts from adjacent metatarsals proved to demonstrate excellent biomechanical and cosmetic results.

Child↗

PubMedDate not supplied

V-Y plasty for correction of varus fifth toe.

V-Y plasty has been used for greater than 35 years for correction of the varus fifth toe. During this time, there has been no study of the results of this operation on children with long-term follow-up. We report the results of 20 operations in 16 children. The short-term results were good in 70%. However, postoperative review at a mean time of 2 years 1 month showed marked deterioration, with only 30% good results. V-Y plasty is not recommended for correction of the varus fifth toe.

Arthroplasty↗

PubMed1990

Post-traumatic cubitus varus. Long-term follow-up of corrective supracondylar humeral osteotomy in children.

The results in twenty-four patients who had had a supracondylar osteotomy of the humerus to correct post-traumatic cubitus varus were reviewed after the patients had completed skeletal growth. The average age of the patients was 7.9 years at operation and thirty-one years at the time of follow-up. The average duration of follow-up was twenty-three years. According to our grading system, seven patients had a good; six, a fair; and eleven, a poor result. All but two of the nineteen patients in whom the humero-ulnar angle had been measured preoperatively lost correction that had been obtained at operation. No correlation was found between the quality of the result and either the age of the patient at operation or the amount of correction that had been obtained at operation. The correction that was obtained at operation was maintained in the two patients in whom the cubitus varus deformity had been caused by malunion of a supracondylar fracture. However, when the deformity followed either physeal injury or supracondylar fracture with damage to the physis secondary to the initial trauma, the correction was not maintained. At the most recent follow-up, three patients were symptomatic, and fourteen were dissatisfied with the cosmetic result because of the residual deformity of the elbow or the postoperative scar, or both. In spite of the partial recurrence of the deformity, which was sometimes severe, all but the three symptomatic patients had a very good functional result. Many of these patients worked at heavy manual labor.

Adolescent↗

PubMed1989

[Congenital metatarsus varus].

The authors report on "congenital primitive metatarsus varus". After discussing the incidence, etiology, pathogenesis and classification, the clinical features and associated malformations are evaluated. Then they go into treatment details affirming, according to the literature, that this malformation is susceptible to complete regression if treated bloodlessly during the early months of life, and in any case, before the onset of loss of ambulation, by manipulations followed by a series of plaster casts and finally by corrective braces and shoes. If this treatment is fruitless or in cases seen at an advanced age and with a high degree of varus, there are several surgical operations that achieve satisfying results operating on tendons or on articular capsules.

Child↗

PubMed1988

A new osteotomy for cubitus varus.

From 1974 to 1986, a step-cut technique of distal humerus valgus osteotomy using one cortical screw for fixation was used to correct cubitus varus deformity in 11 patients. The results were graded as excellent, eight patients, good, two, and poor, one. The poor result was secondary to persistent varus. The average humeral-elbow-wrist angle in the ten patients with valgus correction roentgenographically measured 9.3 degrees. The average amount of correction was 28.4 degrees. All patients retained their preoperative level of elbow motion. There were no radial or ulnar nerve injuries, nonunions, infections, or hypertrophic scars. The osteotomy requires careful preoperative planning and special attention to surgical detail. Large amounts of deformity may be corrected safely with a low complication rate.

Adolescent↗

PubMed1988

Distal femoral varus osteotomy.

The results of twenty-three distal femoral varus osteotomies (in twenty-one patients) that were performed between 1977 and 1984 were evaluated. Fifteen osteotomies were done for osteoarthritis; three, for post-traumatic arthritis or deformity; three, for rheumatoid arthritis; and two, for renal osteodystrophy. The median age of the patients was fifty-six years (range, nineteen to seventy years). The length of follow-up averaged four years (range, two to nine years). The average tibiofemoral angle preoperatively was 18 degrees of valgus, which was corrected postoperatively to an average of 2 degrees of valgus. At follow-up, nineteen (83 per cent) of the twenty-three knees were rated as good or excellent according to The Hospital for Special Surgery knee score, which had improved from an average of 65 points preoperatively to 86 points post-operatively. Of the fifteen patients who had osteoarthritis (93 per cent), all but one had a good or excellent result. Most patients had no substantial improvement in the range of motion of the knee as a result of the operation. Eighty-six per cent of the patients expressed satisfaction with the outcome. We concluded that varus osteotomy of the distal part of the femur is a reliable and effective surgical procedure for the treatment of gonarthrosis associated with valgus deformity due to osteoarthritis or trauma. We do not recommend its use in patients who have rheumatoid arthritis or in those who have inadequate motion of the knee before the operation.

Adult↗

PubMed1987

Contrast arthrography in symptomatic varus knees.

The authors carried out a study of contrast arthrography in 48 cases of primary genu varum, i.e. not secondary to trauma or to pathological conditions of the hip or foot. The patients all had symptoms and were classified according to the commonly used Trillat-Dejour method into four groups or stages depending on the degree of varus and the radiographic and arthrographic findings. Associated lesions secondary to the basic pathology were observed in all cases. These ranged from hypertrophic synovitis to torn medial or lateral menisci up to total compromise of the joint typical of stage 4 arthritic varus knee. In these patients, contrast arthrography is useful in planning surgery, particularly high tibial osteotomy. It also enables the surgeon to decide whether complementary intra-articular measures are indicated without having to resort to arthroscopy. This is always a more invasive method, necessitating general anaesthesia, as these knees are quite painful and the arthroscopic access is difficult.

Aged↗

PubMed1986

The change of the venous circulation of the proximal part of the femur after varus osteotomy in Perthes' disease.

In order to assess the influence of varus osteotomy on the venous circulation through the proximal part of the femur in Perthes' disease, intraosseous venography was performed immediately before osteotomy and also several months later. In intraosseous venography of the epiphysis examined on 53 hips, changes between first and second venographies were seen in the superior retinacular vein (SRV), the inferior retinacular vein (IRV) and the femoral capital vein (FCV) in both the shape of veins and the frequency of appearance. It remains undecided, however, whether or not these changes are influenced by varus osteotomy. On the other hand, the frequency of the FCV increased after osteotomy, suggesting the effect of the osteotomy. Intraosseous venography of the metaphysis was studied on 53 hips. The inflow of the opaque medium into diaphysis, indicating venous congestion of the bone, disappeared in about 40% after the osteotomy. This revealed the positive effect of osteotomy on the normalization of venous circulation.

Child↗

PubMedDate not supplied

Biplane cuneiform osteotomy for juvenile metatarsus primus varus.

An operation combining the procedures of Cotton and Fowler on the medial cuneiform has been used for the correction of juvenile metatarsus primus varus and is presented in this manuscript. The procedure consists of a biplanar opening wedge osteotomy of the medial cuneiform with insertion of a bone graft and internal fixation. This surgical approach evolves from the procedures of Cotton (a sagittal plane correction of the depressed distal medial column in pes planus), and Fowler (a transverse plane correction of the medial column for metatarsus adductus). The operation has been utilized at St. Anne's Hospitals and provides excellent reduction of the intermetatarsal angle, with realignment of an oblique metatarsal-cuneiform joint. The operation is done with the Hohmann osteotomy/bunionectomy for realignment of the metatarsophalageal joint to correct hallux valgus that exists with juvenile metatarsus primus varus.

Foot↗

PubMed1987

Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.

The results in ninety-three knees that had been treated by proximal tibial opening-wedge osteotomy for varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of 11.5 years (range, ten to thirteen years). After ten years, only forty-two (45 per cent) of the ninety-three knees had an excellent or good result, and in fifty-one knees there was recurrent pain for which seventeen had another operation. At five years, on the other hand, 90 per cent of the knees had a good result. Deterioration occurred at an average of seven years after the osteotomy and was always associated with recurrence of pain. Although the results deteriorated with time, time was not the only determinant of the result. Alignment, measured as the hip-knee-ankle angle on radiographs of the whole limb that were made with the patient bearing weight, was also a determinant of long-term results. The best results were obtained in the twenty knees that had a hip-knee-ankle angle of 183 to 186 degrees. In these knees, there was no pain and no progression of the arthrosis in either the medial or the lateral tibiofemoral compartment. Of the five knees that had an angle of more than 186 degrees, all five had progressive degenerative changes in the lateral compartment. In the sixty-eight undercorrected knees (an angle of less than 183 degrees), the results were less satisfactory, and there was a tendency toward recurrence of the varus deformity and progression of the arthritis of the medial compartment. However, when the correction was insufficient the deterioration was slow (average, seven years), and it was not associated with lateral laxity and deterioration of the lateral compartment, which are the changes that characterize the natural course of gonarthrosis as described by Hernborg and Nilsson. Therefore, proximal tibial osteotomy is a very suitable operation for patients who have gonarthrosis of the medial compartment, but a rigidly standardized and precise operative technique is required as well as accurate radiographic measurements of the mechanical axis of the limb, because exact postoperative alignment is the prerequisite for the longest possible period of relief of symptoms after osteotomy.

Activities of Daily Living↗

PubMedDate not supplied

Derotation varus osteotomy in Perthes disease.

Two groups of patients with severe forms of Perthes disease were studied. Containment was obtained by performing a derotation varus osteotomy in 32 hips, and by casts and splints in 12 hips. The clinical results were better in the operated group than in the nonoperated group. Seventy-five percent of the hips in the operated group had good to fair radiological results, compared with 41% fair results only in the nonoperated group. The various radiological methods of assessment are outlined. It is concluded that derotation varus osteotomy has advantages over nonoperative treatment in severe Perthes disease, especially in Catterall grade 4 hips.

Casts, Surgical↗

PubMed1985

Femoral varus-derotation osteotomy in spastic cerebral palsy.

Twenty children (twenty hips) with spastic cerebral palsy underwent femoral varus-derotation osteotomy for which the principal indication was inadequate coverage of the femoral head. Other infrequent indications included pain, valgus angulation of the femoral neck, and dislocation of the hip. The age at surgery ranged from four to fifteen years. Each child had muscle releases before the osteotomy was done. At follow-up, at least seven years later, the femoral head in twenty hips was well centered. Four hips remained subluxated but were less subluxated than before the osteotomy. One hip remained dislocated. The center-edge angle averaged -8 degrees preoperatively and +17 degrees at follow-up. The neck-shaft angle averaged 155 degrees preoperatively, 114 degrees immediately post-operatively, and 125 degrees at follow-up. Femoral varus-derotation osteotomy, when combined with muscle releases, can allow children with spastic cerebral palsy to maintain their ambulatory status and may decrease pain about the hip.

Adolescent↗