IC 304-2022: Technical Tips and Tricks for Knee Osteotomy-Technical Tips and Tricks for Knee Osteotomy (4/5)

Video Transcription

Per me, I think there are different indications and I choose the techniques I want to do according to the type of patient, with the defects they have.  e for me, really, you should have it in your portfolio  Thus, the choice of osteotomy type depends on the need for correction, the stage of arthritis, ligamentous instability, preparative leg length, weight, activity level, age, tibial femoral torsion and, finally, surgery preference.  So, you have to consider that, also, there is a study that has shown that, if you do an IT osteotomy with the leg open,  you're going for maybe 7 millimeters of length, whereas if you do a closed leg IT osteotomy, you typically reduce the length of the leg by about 4 millimeters  So, too, you should take this into consideration, if you're talking about different leg lengths.  So clinical examination, for me, is the key. You have to assess alignment on all three plans, look at the gate for virus stress, assess roman contractor and flexion, because this is another important factor, examine the patellofemoral joint,  check for stability and obtain an MRI to see the quality of the cartilage and meniscae.  My preference is, if I have less than 15 degrees of virus, I do a closed leg IT osteotomy. If we have to treat a very high defect, I go for an open leg.  So with the closed leg, the benefit of using the closed leg is that you have problems related to hardware reduction, you don't have the use of bone grafting, you have bone-on-bone autochthonous treatment, you have faster recovery, and, For me, it's easier to combine with additional procedures that I do quite often.  This is the survival rate of closed leg IT osteotomy and up to 10 years we have very good results, about 80-90% good results, and even at 15 years we still have very good results and we are declining, only after 20 years, which I think is normal.  Closed leg control is peronical nerve injury and that is why most doctors escape this kind of fate and there are other proximal tibiofemoral disruptions without desmosis, subsequent difficult TKA which can be, bone loss and fracture of the cortical medial line is also important, as is the case with the closed leg on the lateral side.  This is the adverse event and the sensory step is really the biggest complication of this type of luck. I will show you my technique and it will be a short video.  This is a combination, when I did the work on the cartilage and the incisions are visible, I go to look for the nerve and this is one of the lucky points.  It should release the nerve, close the tibialis anterior in the closed leg, because in this case, when you close the line, you can have a cut of the nerve and this is what gives you the pulse of the nerve.  So you release the anterior tibialis anterior and you go to protect your posterior and you do that with the periosteal elevator and then you're ready to select your cut.

Video Summary

In the video, the speaker discusses different factors to consider when choosing the appropriate osteotomy technique for patients with defects. Factors such as correction need, arthritis stage, ligamentous instability, leg length, weight, activity level, age, tibial femoral torsion, and surgery preference all play a role in the decision-making process. The speaker mentions a study showing that an IT osteotomy with the leg open results in a 7mm length increase, while a closed leg IT osteotomy reduces leg length by about 4mm. Additionally, the speaker emphasizes the importance of clinical examination, alignment assessment, gait observation, examination of the patellofemoral joint, stability check, and obtaining an MRI to assess cartilage and meniscus quality. The speaker shares their preference for closed leg IT osteotomy for angles less than 15 degrees of varus and open leg for treating high defects. They highlight the benefits of closed leg IT osteotomy, such as faster recovery and easier combination with additional procedures. The survival rate of closed leg IT osteotomy is reported to be good, with 80-90% positive results at 10 years and still good results at 15 years. Adverse events associated with closed leg IT osteotomy include peroneal nerve injury, proximal tibiofemoral disruptions, bone loss, and fracture of the cortical medial line. The speaker demonstrates their technique and emphasizes the importance of releasing the nerve and protecting the posterior tibialis anterior during the procedure.

Asset Caption

Stefano Zaffagnini, MD

Keywords

osteotomy technique

leg length

closed leg IT osteotomy

clinical examination

peroneal nerve injury