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Background Pes cavus can be defined as an abnormal elevation of the longitudinal arches, which is often secondary to a muscle imbalance. This deformity affects the foot’s three dimensions (3D) and our osteotomies are usually planned on a lateral (two-dimension) X-ray. Are we really considering all the spatial components of the deformity? The aim of this study is to present a technique tip to identify the apical plane of the pes cavus deformity and perform a midfoot dorsal-based wedge resection osteotomy by using customized 3D printed surgical guides. Methods Three patients underwent the presented technique, all for the indication of symptomatic neuromuscular pes cavus with both anterior and posterior deformity. Results 3D-printed patient-specific guides help the surgeon to minimize human error, improving intraoperative accuracy, while reducing surgical time and intraoperative X-ray exposure. Conclusions Closing wedge midfoot osteotomy to correct anterior pes cavus may be an interesting indication to use customized 3D printed surgical guides.

Anterior cruciate ligament reconstruction (ACLR) failure is multifactorial, but it is known that increased posterior tibial slope (PTS) leads to a greater likelihood of ACLR failure. This technical note describes the senior author’s technique for performing an anterior closing wedge proximal tibial osteotomy, in which the osteotomy is made proximal to the tibial tubercle. This procedure is the first part of a staged surgery for patients with multiple failed ACLRs and increased sagittal plane PTS. Debridement of osteolytic reconstruction tunnels with bone grafting is also undertaken in preparation for a second-stage revision ACLR., Technique Video Video 1 Proximal tibial closing wedge osteotomy with tibial tubercle sparing and bone grafting. In a patient with multiple failed anterior cruciate ligament (ACL) reconstructions and increased posterior tibial slope (PTS) in the right knee, a proximal tibial closing wedge osteotomy is performed with bone grafting as a first stage to maximize the chances of success of a subsequent second stage ACL reconstruction. Examination under anesthesia reveals 3+ positive pivot-shift and Lachman tests. An anterior midline incision is made, and subcutaneous skin flaps develop medially and laterally. A scalpel and Cobb elevator are used to develop subperiosteal flaps laterally to the proximal tibiofibular joint and medially to the posteromedial aspect of the tibia. The patellar tendon is carefully outlined and protected, as the tibial tubercle will be preserved. Arthroscopy is then performed to address any intraarticular pathology and debride osteolytic bone tunnels from previous ACL reconstructions. Two guide pins are then placed parallel to the joint line at the inferior extent of the desired osteotomy. After confirming their position extending to the posterior tibial cortex fluoroscopically, two additional pins are drilled, parallel to the joint line, at the anterior extent of the planned osteotomy. These are angled such that they will meet the first two pins at the posterior tibial cortex, and fluoroscopy is used for verification of position. An ACL saw is then used to cut the anterior tibial cortex colinear with the inferior and superior guide pins, the desired wedge of bone is removed with curettes and rongeurs, and the guide pins are removed. To verify enough bone has been removed, a curette is inserted into the posterior extent of the wedge, and a lateral fluoroscopic image is taken. The wedge is then gently closed and a bump placed under the heel. The closed osteotomy is secured with several large staples, and anteroposterior and lateral radiographs confirm position of hardware. Bone grafting of the tibial and femoral tunnels is accomplished with autologous bones from the osteotomy and allograft bone matrix.

Surgical treatment of insertional Achilles tendinopathy is indicated in case of failure of conservative therapy. A choice is then made within a large spectrum of procedures from minimally invasive techniques such as endoscopic calcaneoplasty to more invasive procedures, such as dorsal closing wedge calcaneal osteotomy. Isolated calcaneoplasties can lead to poor results in cases of pre-existing Achilles tendon lesions; in these cases the tendon disinsertion is justified. In this context, we describe an endoscopic treatment of insertional Achilles tendinopathy., Technique Video Video 1 This video presents an endoscopic speed bridge technique for the treatment of insertional achilles tendinopathy: the “snake technique.”

Introduction: Distal femoral varus osteotomy (DVO) allows for the surgical management of uni-compartmental femoral-tibial gonarthrosis on knee valgum after failure of medical treatment. The aim of this study was to evaluate the functional results of this therapeutic approach at the Saint Jean de Dieu Hospital in Afagnan. Patients and Method: This is a retrospective, single-center study conducted from January 2006 to December 2018 on patients who presented with gonarthrosis with disabling knee valgum. Osteosynthesis was performed using AO blade-plates bent at 90°. The patients were reviewed and the evolution and complications were recorded. Results: Forty-seven patients had been treated surgically by the medial closure varus femoral osteotomy technique. They were 32 women and 14 men with an average age of 55.45 years (25-72 years). Twenty-six patients had AHLBACK stage III femorotibial gonarthrosis and 5 patients had stage IV. Twenty-six patients also had associated patellofemoral osteoarthritis. All patients consolidated with a mean time of 95 days (90-125). No pseudarthrosis or postoperative infection was observed. We recorded one case of osteosynthesis failure (material rupture) resumed by a dynamic DCS compression screw. Conclusion: Femoral varus osteotomy by medial closure remains today an alternative of choice in the management of gonarthrosis with associated knee valgum in our context.

Introduction: Proximal tibial injury leading to tibia valga which, in turn, leading to genu valgum is well described deformity. Management options vary between growth modulation and corrective osteotomy. Osteotomy which is used for skeletally mature patients can either be done in single stage or in multiple stages or in gradual manner. Case Report: We describe here a method to obtain single-stage correction with two-level osteotomy in a 20-year-old patient. It includes medial closing wedge osteotomy at distal femur and translational osteotomy at tibial shaft. Conclusion: This method of two-level osteotomy recognizes and treats two deformities (i.e., genu valgum and tibia valga) separately and achieves correction in one stage with perfect restoration of mechanical axis of lower limb and joint line obliquity of knee. Keywords: Genu valgum, tibia valga, double-level osteotomy, closing wedge osteotomy, translational osteotomy.

Valgus malalignment can be corrected with a biplanar lateral opening wedge distal femoral osteotomy (bLOWDFO) in patients with symptomatic lateral compartment disease. Advantages of a lateral opening wedge technique over the medial closing wedge technique include avoidance of vascular structures and theoretically better control of the amount of correction. The advantages of a bLOWDFO over a uniplanar osteotomy are that it creates a larger surface area for healing, and provides inherent stability to control the osteotomy intraoperatively. The purpose of this article is to present a reproducible technique for bLOWDFO and review the indications, preoperative planning, rationale, and clinical outcomes.

Objective To describe outcomes of dogs with excessive tibial plateau angle (eTPA) and cranial cruciate ligament (CrCL) disease treated with center of rotation of angulation-based leveling osteotomy (CBLO) and cranial closing wedge ostectomy (CCWO). Study design Retrospective study. Animals Twenty-one dogs. Methods Medical records of dogs with CrCL disease and eTPA (>34°) treated with CBLO/CCWO were reviewed. Signalment, body weight, intra-articular structure appearance, TPA (preoperatively, postoperatively, and at osteotomy healing), postoperative function, and complications were recorded. Results Twenty-one dogs (28 stifles) with CrCL disease/eTPA underwent CBLO/CCWO. Twenty stifles had complete CrCL tears and eight tears were partial. Mean age and weight of dogs were 4 years (range, 1-9) and 27 kg (range, 4-65), respectively. Medial menisci were normal in 20 stifles, torn in 5, and degenerative in 3. All lateral menisci were normal. The caudal cruciate ligament was normal in 26 stifles and partially torn in 2. Mean TPA was 43° preoperatively, 10° postoperatively, and 10° at final recheck. Grade 4 healing occurred in all osteotomies by 8 weeks postoperatively. Complications included one pin migration, breakage of two proximal screws (1 case), one late-onset caudolateral band CrCL tear, two late-onset meniscal tears, and one surgical site infection. Eighteen dogs returned to full function, and three dogs achieved acceptable function, at a mean of 27 months. Conclusion Center of rotation of angulation-based leveling osteotomy/CCWO resulted in grade 4 osteotomy healing by 8 weeks, minimal complications, and acceptable to full return to function. Clinical significance Center of rotation of angulation-based leveling osteotomy/CCWO should be considered to treat canine CrCL disease/eTPA.

Objective To report midterm to long-term outcomes of dogs with cranial cruciate ligament (CCL) rupture and excessive tibial plateau angles (TPA) treated with a modified cranial closing wedge osteotomy (m-CCWO). Study design Retrospective case series. Study population Dogs (n = 21) with CCL rupture and excessive TPA treated with m-CCWO (n = 28). Methods Medical records, midterm and long-term follow-up radiographic examination records, Canine Orthopedic Index data, and owner surveys were reviewed to determine functional outcomes, owner satisfaction, and complications associated with the technique. Results Tibial plateau angle decreased from 42.3° ± 4.8° preoperatively to 4.8° ± 3.3° after m-CCWO. No catastrophic complications occurred, while major and minor complications occurred in three of 28 and six of 28 stifles, respectively. Canine Orthopedic Index scores and owner surveys were available in 16 of 21 dogs at a median of 608 days postoperatively (range 279-1225). Functional midterm or long-term outcomes for these dogs treated with m-CCWO were excellent in eight dogs, acceptable in seven dogs, and unacceptable in one dog. Progression of osteoarthritis was noted on all midterm and long-term follow-up radiographs. All owners but one were satisfied. Conclusion Modified cranial closing wedge osteotomy was associated with an acceptable morbidity and resulted in satisfactory functional outcomes in most dogs of this series. Clinical significance Modified cranial closing wedge osteotomy should be considered as an alternative to treat CCL rupture in dogs with excessive TPA.

Objective The aim of this study was to describe a new surgical method of segmental femoral ostectomy for the reconstruction of the femoropatellar joint (FPJ) in dogs with medial patellar luxation (MPL) grade IV. Study Design The medical records of six dogs that underwent segmental femoral ostectomy to reconstruct the FPJ for MPL grade IV were retrospectively reviewed. The data included breed, age, body weight, comorbidities, history of orthopaedic abnormalities, pre- and postoperative radiographic findings, morphological indicators measured on three-dimensional computed tomographic multiplanar reconstruction images, surgical methods and postoperative complications. Outcomes Eleven hindlimbs with MPL grade IV in six dogs underwent segmental femoral ostectomy to reconstruct the FPJ with the four basic surgical procedures. Six stifle joints with femoral varus deformity were treated by closing wedge ostectomy and segmental ostectomy, while five stifle joints were treated by segmental ostectomy alone. The mean resected femoral length was 11.7 mm. The mean resected femoral length relative to the preoperative femoral length was 14.3%. The stability and congruity of the FPJ was markedly improved, with an increased range of motion in all dogs compared with their preoperative status. Conclusion Segmental femoral ostectomy was a useful treatment method for MPL grade IV with shortened quadriceps muscle length relative to the femoral length. Reconstruction of the FPJ is important for recovery of limb function.

Ulnar abutment (ulnocarpal impaction) syndrome may be a source of ulnar-sided wrist pain in the athlete. This condition results from excessive load transfer across the triangular fibrocartilage complex and ulnocarpal joints with characteristic degenerative changes. It frequently occurs in patients with either static or dynamic ulnar positive variance. Treatment is tailored to the athlete and their sporting demands. Surgical treatment focuses on addressing ulnar variance to unload the ulnocarpal joint, with multiple surgical options, including the metaphyseal closing wedge osteotomy achieving this goal. This review focuses on the presentation, biomechanics, and treatment options for ulnar abutment syndrome in the athlete.

Background The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) > 30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed 2 months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after 2 months. Results Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05–0.8); CCWO 0.22 (0.05–0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P = 0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76–6.98°); CCWO 100% cranial to the AA and 0° (− 1.34–0.65°); control group 5% caudal to the AA and 0.99° (0–3.39°)). At 8 weeks, PLT grade differed significantly in the two operated groups (P = 0.000) (TPLO 40% 0–2, 20% 2–4, 40% > 4; CCWO 98.8% 0). Conclusions TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results 2 months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA > 30°.

Valgus malalignment is an important risk factor in recurrent patella instability. This article explores the role of corrective osteotomy and discusses the various described methods both on the femoral and tibial sides of the joint. A detailed operative technique of medial closing wedge distal femoral osteotomy is included.

Background: Anterior closing wedge osteotomy of the proximal tibia may be considered in revision anterior cruciate ligament (ACL) reconstruction surgery for patients with excessive posterior tibial slope (PTS). Purpose: (1) To determine the ratio of wedge thickness to degrees of correction for supratubercle (ST) versus transtubercle (TT) osteotomies for anterior closing wedge osteotomies and (2) to evaluate the accuracy of ST and TT osteotomies in achieving slope correction. Study Design: Controlled laboratory study. Methods: The computed tomography (CT) scans of 38 knees in 37 patients undergoing revision ACL reconstruction were used to simulate both ST and TT osteotomies. A 10° wedge was simulated in all CT models. The height of the wedge along the anterior tibia was recorded for each of the 2 techniques. The ratio of wedge height to achieved degree of correction was calculated. ST and TT osteotomies were performed on 3-dimensional (3D)–printed tibias of the 12 patients from the study group with the greatest PTS, after the desired degree of correction was determined. Pre- and postosteotomy slopes were measured for each tibia, and the actual change in slope was compared with the intended slope correction. Results: According to CT measurements, the ratio of wedge height to degree of correction was 0.99 ± 0.07 mm/deg for the ST osteotomy and 0.83 ± 0.06 mm/deg for the TT osteotomy ( P < .001). When these ratios were used to perform simulated osteotomies on the twelve 3D-printed tibias, the mean slope correction was within 1° to 2° of the intended slope correction, regardless of osteotomy location (ST or TT) or whether slope was measured on the medial or lateral plateau. The ST technique tended to undercorrect and the TT technique tended to overcorrect. Conclusion: When anterior tibial closing wedge osteotomies were removed to correct excessive PTS, removing a wedge with a ratio of 1 mm of wedge height for every 1° of intended correction for an ST technique and a ratio of 0.8 mm to 1° for a TT technique resulted in overall average slope correction within 1° to 2° of the target. Clinical Relevance: The calculated ratios will allow clinicians to more accurately correct PTS when performing anterior closing wedge tibial osteotomy.

A middle-aged woman who was previously a long-distance trail runner presented with chronic right forefoot pain and was diagnosed with Freiberg's disease. She suffered from nonunion after undergoing a dorsal closing wedge osteotomy. The nonunion achieved full osseous union after treatment with abaloparatide. Patient reported outcome measures taken at 19 months postoperatively indicated good to excellent clinical outcomes and satisfaction. The aim of this case is to report on the effectiveness of abaloparatide to treat nonunion and support fracture healing., Highlights • Use of abaloparatide to treat nonunion in Freiberg's disease • Successful treatment of nonunion following dorsal closing wedge osteotomy • Role of osteoanabolic medications in fracture healing

Background: Limited evidence exists in the literature regarding the detection rates of lateral hinge fracture (LHF) on computed tomography (CT) after medial closing wedge distal femoral osteotomy (MCDFO). Moreover, the effect of LHF on bone healing after MCDFO remains unclear. Hypothesis: The detection rates of LHF after MCDFO would be higher on CT than on plain radiography. The incidence of problematic bone healing would be higher in the knees with LHF than in those without LHF. Study Design: Cohort study (diagnosis), Level of evidence, 3. Methods: Patients who underwent MCDFO between May 2009 and July 2019 were retrospectively evaluated. The presence of LHF was evaluated using immediate postoperative plain radiography and CT. The detection rates of LHF on plain radiography and CT were compared. The incidence of problematic bone healing (nonunion, delayed union, and loss of correction) was also compared between the knees with LHF and those without LHF. Results: A total of 55 knees of 43 patients (mean age, 37.7 ± 16.7 years) were included in the study. Although 33 LHFs were detected on CT, only 19 LHFs were detected on plain radiography. The detection rate of LHF was significantly higher on CT than on plain radiography (60% vs 34.5%; P = .008). At 1-year follow-up, 10 cases of problematic bone healing (1 nonunion, 4 delayed unions, and 5 losses of correction) were identified. The incidence of problematic bone healing was significantly higher in the knees with LHF than in those without LHF as shown on plain radiography (36.8% vs 8.3%; P = .001) and CT (30.3% vs 0%; P = .004). Conclusion: LHF can be detected better on CT than on plain radiography and has a negative effect on bone healing after MCDFO. For patients with LHF detected on either plain radiography or CT, careful rehabilitation with close follow-up is recommended.

Ray resections have been a viable treatment option for patients with tumors, trauma, infection, vascular insufficiency, or other abnormalities of the hand since the procedure was described in the 1920s. The creation of a functional hand after central ray resection presents unique technical challenges: insufficient closure of the gap between the metacarpals bordering the resected ray can produce an enlarged space between remaining digits and potentially cause digital malrotation, both of which negatively affect hand function. The goal is to make the space between resulting fingers as close to normal as possible. A number of procedures were described to address this issue, but unfortunately, they can be technically onerous and may require prolonged immobilization, the use of internal hardware, or the use of temporary hardware requiring removal.We describe a technique for amputation of the affected ray at the proximal metacarpal metadiaphyseal flare and a concomitant closing wedge osteotomy to allow superior gap closure between the residual fingers while maintaining the structure of the carpus and alignment of the hand. This improves functional and aesthetic outcomes after central ray resection of the hand. Key words: Metacarpal ray resection, Middle ray amputation, Ray amputation hand

Purpose When performing lateral closing wedge high tibial osteotomy (LCWHTO), fibular untethering can be performed with either fibular shaft osteotomy (FSO) or proximal tibiofibular division (TFD). The aim of this study was to compare the degree of varus instability between the two methods after LCWHTO and to analyze the determinants of varus instability. Methods This study retrospectively analyzed 108 consecutive patients with medial compartment osteoarthritis who underwent LCWHTO and had > 2 years of follow-up. Patients who underwent unilateral LCWHTO without a previous history of ligament injury were included. Forty-five patients who received LCWHTO with TFD and 51 patients who received LCWHTO with FSO were finally analyzed. The mean follow-up duration was 5.3 years in LCWHTO with TFD and 4.1 years in LCWHTO with FSO. The shortest distance between the lateral tibial plateaus and the corresponding most distal subchondral bone surface of the lateral femoral condyle was measured on varus stress radiographs and compared with that on the unaffected contralateral knee. Multivariable logistic regression analyses were conducted to identify predictors of varus instability. Results Lateral joint space width showed no significant between-group difference. Multivariable logistic regression analysis revealed that the pre-operative hip-knee-ankle angle was positively correlated with the lateral joint space width. The type of fibular untethering procedure was not associated with postoperative varus instability. Conclusion The degree of pre-operative varus malalignment is associated with postoperative varus instability after LCWHTO. Proximal tibiofibular division is not a variable for postoperative varus instability after LCWHTO. Level of evidence Level III, Retrospective comparative study.

Patellar instability in skeletally immature patients must be approached with concern of potential damage to physes. In this article, we present a case of combined knee deformity consisting of genu recurvatum, genu valgum and patella baja which arose subsequent to a pediatric tibial tubercle ventromedialization. Patient was a female who was 22 years old upon first admission. After confirming cartilage to be in good health, the deformity was corrected with a single supratubercular posteriorly and medially based proximal tibial closing wedge osteotomy. At the seventh year follow-up, patient was pain free, functionally satisfied and radiographic evaluation showed correct alignment. This case illustrates the consequent difficulties faced if physeal damage occurs during treatment of patellar instability as well as effectiveness of a single well-planned supratubercular proximal tibial osteotomy treating combined genu recurvatum, genu valgum and patella baja deformities; although anatomic and clinical studies are required to generalize its use.

Background:Although an appropriate hinge position to prevent unstable lateral hinge fractures is well established in medial opening wedge high tibial osteotomy, the position during medial closing wedge distal femoral osteotomy has not been elucidated.Purpose/Hypothesis:The purpose was to evaluate the ideal hinge position that would prevent an unstable lateral hinge fracture during biplanar medial closing wedge distal femoral osteotomy based on soft tissue coverage and bone density around the hinge area. The hypothesis was that the ideal hinge position could be clarified by analyzing soft tissue coverage and bone density around the lateral hinge area.Study Design:Controlled laboratory study.Methods:In 20 cadaveric knees (mean age, 70.3 ± 19.2 years), the femoral attachment of the gastrocnemius lateral head was quantitatively analyzed as a soft tissue stabilizer using digital photography and fluoroscopy. Then, medial closing wedge distal femoral osteotomy was performed, locating the lateral hinge either inside (group 1) or outside (group 2) the femoral attachment of the gastrocnemius lateral head, and the incidence of unstable lateral hinge fractures was compared between the 2 groups. Cortical bone density around the lateral hinge was measured using Hounsfield units on 30 computed tomography scans and reconstructed as a 3-dimensional mapping model. The transitional zone with low bone density was regarded as the safe hinge position with an increased capacity for bone deformation.Results:The upper and lower margins of the femoral attachment of the gastrocnemius lateral head were 9.1 ± 0.9 mm above and 8.0 ± 1.4 mm below the upper border of the lateral femoral condyle, respectively, and the femoral attachment of the gastrocnemius lateral head was widest in the anteroposterior dimension 0.4 ± 1.7 mm above the upper border of the lateral femoral condyle. The incidence of unstable lateral hinge fractures during osteotomy was significantly decreased in group 1 compared with group 2 (group 1: 0/10; group 2: 5/10; P = .01). An isolated transitional zone with low bone density was observed in all 30 knees and located 1.3 ± 0.8 mm above the upper border of the lateral femoral condyle. Bone density of the transitional zone with low bone density was significantly lower than surrounding femoral cortices ( P < .001).Conclusion:Only the upper border of the lateral femoral condyle can be recommended as an ideal hinge position to prevent unstable lateral hinge fractures during biplanar medial closing wedge distal femoral osteotomy based on soft tissue coverage and bone density.Clinical Relevance:When the hinge is positioned at the upper border of the lateral femoral condyle during biplanar medial closing wedge distal femoral osteotomy, the risk of unstable hinge fractures can be minimized.

Lateral closing wedge osteotomies are still actual treatments of unicompartmental arthrosis and deformities. This article focuses on surgical timing, indications, and technique to achieve a pain-free knee joint and a normal weight forces distribution.

Cubitus varus deformity is a common complication of malunited supracondylar fractures of humerus. 5 cases were treated in our institute from Jun. 3 2016 to June 2018. They Cubitus were treated with lateral closing wedge osteotomy and fixation with plating. Mean operating time was 98 minutes. Lateral closing wedge osteotomy and fixation with plate is effective and safe technique in treatment of cubitus varus deformity in young adults. Keywords: Cubitus Varus, Deformity, Adults, Lateral, Closing Wedge, Osteotomy

Background: Anterior cruciate ligament (ACL) ruptures are among the most common injuries in young athletes and active adults. Reconstruction of the ACL most often leads to good functional outcomes and return to full activities. However, a number of patients experience ACL graft failures requiring revision surgery. The reasons for ACL graft failure are often multifactorial, though recent attention has been given to elevated posterior tibial slope (PTS) as a risk factor for recurrent ACL injuries. Indications: In patients with 2 or more ACL reconstruction failures with a PTS ≥12 degrees, anterior closing wedge proximal tibia osteotomy (ACWPTO) may be indicated to reduce the risk of recurrent ACL graft failure and allow return to full activities. Technique Description: This surgical technique video demonstrates the ACWPTO using a case example in a young athlete. Preoperative templating on lateral radiograph is used to determine the amount of correction for the closing wedge. The osteotomy is completed using K-wires and a free hand biplanar cutting technique with the tibial tubercle left in place. This is performed with a concomitant revision ACL reconstruction using quadriceps tendon autograft. Results: There are 2 small cases series published with good clinical outcomes and return to sport activities. No ACL graft failures were reported in either study with short-term follow-up. Discussion: In this surgical technique video, we review the literature indicating elevated PTS as a risk factor in ACL injuries and recurrent ACL graft failures. We highlight important technique pearls and pitfalls to avoid complications during the surgical demonstration. Finally, we review postoperative rehabilitation guidelines and clinical outcomes within the existing literature. In patients with recurrent ACL graft failures, ACWPTO provides a safe and reliable technique to correct an elevated PTS and return patients back to full activities with reduced risk of ACL graft re-tear.

The purpose of this study was to compare the planning methods of Dugdale and Miniaci for high tibial osteotomies (HTO) and to assess how their use could influence on the degree of correction and thus the postoperative weight bearing line (WBL). Pre- and postoperative standing hip-knee-ankle (HKA) radiographs were obtained from 70 patients that underwent HTO. The correction angles were determined using Dugdale’s and Miniaci’s methods, and for the latter, both for an opening wedge as well for a closing wedge osteotomy. In a subset of 50 patients, the calculations were performed twice by two observers to calculate inter- and intra-rater reliability. Regression analysis and Bland–Altman plots were used to compare the methods. Whereas the Dugdale method had been used in the planning of the real operations, a regression model was used to predict how the obtained correction would have been if the Miniaci method had been used instead. Intra- and inter-rater reliability was excellent for the correction angle for both Dugdale’s (0.992 and 0.991) and Miniaci’s methods (0.988 and 0.987). When planning for an opening wedge osteotomy (OW) and a closing wedge osteotomy (CW), using the Miniaci method and comparing the correction angle with the angle obtained by the Dugdale method, the Miniaci OW and CW angles were larger by a factor of 1.07 (95% CI 1.06–1.08) and 1.10 (95% CI 1.09–1.11). Postoperatively, a mean undercorrection of 2.9° (SD = 2.3) was found. Predicting the correction with use of the calculated Miniaci angles resulted in an undercorrection of 2.5°, indicating that use of the Dugdale method accounted for 14% of the undercorrection. It is more likely to underestimate the correction angle when using the Dugdale method compared to the Miniaci method. This could lead to poorer correction accuracy. As the inter-rater reliability is excellent for both methods, choosing to use the Dugdale method on basis of simplicity is not justified. III, Diagnostic study.

Background and purpose: The medial closing-wedge distal femoral varus osteotomy (MCW-DFVO) was an excellent operation for painful valgus lateral unicompartmental osteoarthritic (OA) knee, especially in the young patient. Originally, it requires a medial approach that has more precarious. On top of that, releasing of the iliotibial band (ITB) that is the deforming force needs added incision. Therefore, this study aims to describe the new surgical technique of MCW-DFVO that uses a lateral approach and lateral plating to treat the valgus OA knee. Additionally, we also reveal the outcomes of our technique as the case series.Materials and method: Ten patients (12 knees) who underwent MCW-DFVO via a lateral approach were retrospectively reviewed. The inclusion criteria were age > 18 years, isolated lateral compartmental OA knee, no significant patellofemoral pain, and ROM > 90 degrees. We excluded the inflammatory joint disease, unstable knee (femorotibial joint subluxation > 1 cm), and prior surgical procedure. Demographic data, pre- and postoperative ROM, radiographic outcomes, complications, and survivorship were recorded.Results: The mean age, body mass index, and preoperative ROM were 55.3 ± 4.0 years, 25.4 ± 3.7 kg/m2and 113.3 ± 11.5 degrees, respectively. The preoperative valgus deformity was 162.3 ± 4.8 degrees, and the Final post-operative alignment was 182.3 ± 2.6 degrees. Overall mean operative time of this technique was 92.5 ± 26.7 minutes. During the follow-up period, post-operative ROM was decreased to 108.8 ± 11.7 degrees. One knee required plate removal due to hardware irritation, and another knee required subsequent total knee arthroplasty (TKA) at 1 and 8.5 years after DFVO, respectively. The survivorship of this technique was 91.7% at the mean survival time of 13.8 years (95% confidence interval, 11.9 – 15.7 years).Conclusion: This study proposed the new surgical technique of MCW-DFVO via a lateral approach. This technique provided a satisfactory outcome and excellent survivorship. However, further research with a larger sample size was required.

Small breed dogs (

Radial closing-wedge osteotomy is a widely accepted treatment for Kienbock’s disease. However, despite favorable long-term clinical outcomes, its impact on lunate perfusion has not been documented. The purpose of this study was to determine whether radial closing wedge osteotomy improved lunate perfusion on gadolinium (Gd)-enhanced magnetic resonance imaging (MRI). We conducted a retrospective review of 12 patients with Kienbock’s disease who received radial closing wedge osteotomy. Mean age at surgery was 25 years. Preoperative Gd-enhanced MRI was performed in 7 patients. After bone union, implants were removed and MRI was repeated. Two patients were classified as Lichtman stage IIIA, and 5 as stage IIIB. Percentage pre- to post-operative perfused lunate volume was compared on MRI. At last follow-up, mean QuickDASH score improved from 43.7 to 6.2. Pre- to post-operative lunate fragmentation, collapse and perfusion were compared qualitatively on MRI. On quantitative analysis, perfusion increased from 24% to 54% (p = 0.018) using our method of measuring percentage perfused lunate volume. The method showed satisfactory reproducibility. Investigation using Gd-enhanced MRI suggested that radial closing wedge osteotomy increases lunate perfusion.