PROXIMAL FIBULAR OSTEOTOMY COMBINED WITH ARTHROSCOPIC DEBRIDEMENT FOR TREATING MEDIAL KNEE OSTEOARTHRITIS WITH VARUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 HAOLiang ¹ , JIANWeihong ² , YANGFeng ³ , LIUChunlong ¹ , TANGQiang ¹

1. Department of Orthopedics, Second Affiliated Hospital, Nanchang University, Nanchang Jiangxi, 330006, P.R.China;
2. Department of Orthopedics, Third Affiliated Hospital, Nanchang University;
3. Department of Orthopedics, Jiujiang Sixth People's Hospital;

Corresponding?author：

HAOLiang, Email: haoliang201@163.com

Keywords：

Knee; Osteoarthritis; Varus; Arthroscopic debirdment; Proximal fibular osteotomy

DOI：

10.7507/1002-1892.20160279

Video：

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Objective To evaluate the effectiveness of proximal fibular osteotomy combined with arthroscopic debridement in the treatment of medial knee osteoarthritis with varus. Methods Between December 2013 and June 2015, 61 patients with medial knee osteoarthritis with varus were treated by arthroscopic debridment in 32 cases (group A) and by proximal fibular osteotomy combined with arthroscopic debridement in 29 cases (group B). No significant difference was found in gender, age, side, disease duration, OA stage, visual analogue scale (VAS) score, and knee society score (KSS) between 2 groups (P > 0.05). The clinical outcome was evaluated by VAS score and KSS score at 1 week, 3 months, and 12 months after operation. Results The patients in 2 groups were followed up 12 months. All incisions healed by first intention. There was no significant difference in complication incidence between groups A and B (0 vs. 3.4%; χ²=0.723, P=0.432). The VAS scores were significantly decreased at 1 week, 3 months, and 12 months after operation when compared with preoperative score in 2 groups (P < 0.05). The VAS score of group A was significantly lower than that of group B at 1 week after operation (P < 0.05), but the VAS score of group A was significantly higher than that of group B at 3 months, and 12 months after operation (P < 0.05). The knee function was obviously improved in 2 groups, and the KSS scores at 1 week, 3 months and 12 months after operation were significantly better than preoperative score (P < 0.05). The KSS score of group A was significantly lower than that of group B at 3 months, and 12 months after operation (P < 0.05). Conclusion Proximal fibular osteotomy combined with arthroscopic debridement can treat knee malalignment and disease in knee, it is an effective and safe method to treat the medial knee osteoarthritis with varus.

Citation： HAOLiang, JIANWeihong, YANGFeng, LIUChunlong, TANGQiang. PROXIMAL FIBULAR OSTEOTOMY COMBINED WITH ARTHROSCOPIC DEBRIDEMENT FOR TREATING MEDIAL KNEE OSTEOARTHRITIS WITH VARUS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1366-1369. doi: 10.7507/1002-1892.20160279 Copy

1.	Reginster JY, Beaudart C, Neuprez A, et al. Strontium ranelate in the treatment of knee osteoarthritis: new insights and emerging clinical evidence. Ther Adv Musculoskelet Dis, 2013, 5(5): 268-276.
2.	Fahlman L, Sangeorzan E, Chheda N, et al. Older adults without radiographic knee osteoarthritis: knee alignment and knee range of motion. Clin Med Insights Arthritis Musculoskelet Disord, 2014, 7: 1-11.
3.	Hardcastle SA, Dieppe P, Gregson CL, et al. Individuals with high bone mass have an increased prevalence of radiographic knee osteoarthritis. Bone, 2015, 71: 171-179.
4.	Crawford DC, Miller LE, Block JE. Conservative management of symptomatic knee osteoarthritis: a flawed strategy. Orthop Rev (Pavia), 2013, 5(1): e2.
5.	Kittelson AJ, George SZ, Maluf KS, et al. Future directions in painful knee osteoarthritis: harnessing complexity in a heterogeneous population. Phys Ther, 2014, 94(3): 422-432.
6.	張英澤, 李存祥, 李冀東, 等.不均勻沉降在膝關節退變及內翻過程中機制的研究.河北醫科大學學報, 2014, 35(2): 218-219.
7.	陳偉, 秦迪, 吳濤, 等.應用腓骨截骨術治療膝關節骨性關節炎效果優良的機制分析.河北醫科大學學報, 2015, 36(6): 727.
8.	Jones G. What's new in osteoarthritis pathogenesis? Intern Med J, 2016, 46(2): 229-236.
9.	Pitta M, Davis W 3rd, Argintar EH. Arthroscopic management of osteoarthritis. J Am Acad Orthop Surg, 2016, 24(2): 74-82.
10.	Kornilov N, Kulyaba T, Petukhov A, et al. Computer navigation helps achieving appropriate gap balancing and restoration of alignment in totalkneearthroplasty for fixed valgus knee osteoarthritis irrespective of the surgical approach. Acta Orthop Belg, 2015, 81(4): 673-681.
11.	Sihvonen R, Englund M, Turkiewicz A, et al. Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear: a prospective cohort study. Osteoarthritis Cartilage, 2016, 24(8): 1367-1375.
12.	Loia MC, Vanni S, Rosso F, et al. High tibial osteotomy in varus knees: indications and limits. Joints, 2016, 4(2): 98-110.
13.	Strecker W, Müller M, Urschel C. High tibial closed wedge valgus osteotomy. Oper Orthop Traumatol, 2014, 26(2): 196-205.
14.	Diffo Kaze A, Maas S, Waldmann D, et al. Biomechanical properties of five different currently used implants for open-wedge high tibial osteotomy. J Exp Orthop, 2015, 2(1): 14.
15.	Yang ZY, Chen W, Li CX, et al. Medial compartment decompression by fibular osteotomy to treat medial compartment knee osteoarthritis: a pilot study. Orthopedics, 2015, 38(12): e1110-1114.
16.	Ekhtiari S, Haldane CE, de Sa D, et al. Return to work and sport following high tibial osteotomy: A systematic review. J Bone Joint Surg (Am), 2016, 98(18): 1568-1577.
17.	Kim CW, Lee CR, Seo SS, et al. Clinical efficacy of an arthroscopic surgery in open wedge high tibial osteotomy. J Knee Surg, 2016. [Epub ahead of print].
18.	Naouar N, Kaziz H, Mouelhi T, et al. Evaluation at long term follow up of medial unicompartmental knee arthroplasty in young patients. Tunis Med, 2016, 94(1): 66-71.

1. Reginster JY, Beaudart C, Neuprez A, et al. Strontium ranelate in the treatment of knee osteoarthritis: new insights and emerging clinical evidence. Ther Adv Musculoskelet Dis, 2013, 5(5): 268-276.
2. Fahlman L, Sangeorzan E, Chheda N, et al. Older adults without radiographic knee osteoarthritis: knee alignment and knee range of motion. Clin Med Insights Arthritis Musculoskelet Disord, 2014, 7: 1-11.
3. Hardcastle SA, Dieppe P, Gregson CL, et al. Individuals with high bone mass have an increased prevalence of radiographic knee osteoarthritis. Bone, 2015, 71: 171-179.
4. Crawford DC, Miller LE, Block JE. Conservative management of symptomatic knee osteoarthritis: a flawed strategy. Orthop Rev (Pavia), 2013, 5(1): e2.
5. Kittelson AJ, George SZ, Maluf KS, et al. Future directions in painful knee osteoarthritis: harnessing complexity in a heterogeneous population. Phys Ther, 2014, 94(3): 422-432.
6. 張英澤, 李存祥, 李冀東, 等.不均勻沉降在膝關節退變及內翻過程中機制的研究.河北醫科大學學報, 2014, 35(2): 218-219.
7. 陳偉, 秦迪, 吳濤, 等.應用腓骨截骨術治療膝關節骨性關節炎效果優良的機制分析.河北醫科大學學報, 2015, 36(6): 727.
8. Jones G. What's new in osteoarthritis pathogenesis? Intern Med J, 2016, 46(2): 229-236.
9. Pitta M, Davis W 3rd, Argintar EH. Arthroscopic management of osteoarthritis. J Am Acad Orthop Surg, 2016, 24(2): 74-82.
10. Kornilov N, Kulyaba T, Petukhov A, et al. Computer navigation helps achieving appropriate gap balancing and restoration of alignment in totalkneearthroplasty for fixed valgus knee osteoarthritis irrespective of the surgical approach. Acta Orthop Belg, 2015, 81(4): 673-681.
11. Sihvonen R, Englund M, Turkiewicz A, et al. Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear: a prospective cohort study. Osteoarthritis Cartilage, 2016, 24(8): 1367-1375.
12. Loia MC, Vanni S, Rosso F, et al. High tibial osteotomy in varus knees: indications and limits. Joints, 2016, 4(2): 98-110.
13. Strecker W, Müller M, Urschel C. High tibial closed wedge valgus osteotomy. Oper Orthop Traumatol, 2014, 26(2): 196-205.
14. Diffo Kaze A, Maas S, Waldmann D, et al. Biomechanical properties of five different currently used implants for open-wedge high tibial osteotomy. J Exp Orthop, 2015, 2(1): 14.
15. Yang ZY, Chen W, Li CX, et al. Medial compartment decompression by fibular osteotomy to treat medial compartment knee osteoarthritis: a pilot study. Orthopedics, 2015, 38(12): e1110-1114.
16. Ekhtiari S, Haldane CE, de Sa D, et al. Return to work and sport following high tibial osteotomy: A systematic review. J Bone Joint Surg (Am), 2016, 98(18): 1568-1577.
17. Kim CW, Lee CR, Seo SS, et al. Clinical efficacy of an arthroscopic surgery in open wedge high tibial osteotomy. J Knee Surg, 2016. [Epub ahead of print].
18. Naouar N, Kaziz H, Mouelhi T, et al. Evaluation at long term follow up of medial unicompartmental knee arthroplasty in young patients. Tunis Med, 2016, 94(1): 66-71.

Chinese Journal of Reparative and Reconstructive Surgery

PROXIMAL FIBULAR OSTEOTOMY COMBINED WITH ARTHROSCOPIC DEBRIDEMENT FOR TREATING MEDIAL KNEE OSTEOARTHRITIS WITH VARUS

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