Axis Correction in Cartilage Repair

Abstract

Angular deformity of the lower limb, either physiological or after incorrect healing of lower limb fractures may cause severe degenerative changes and thus functional impairment of both hip, knee and ankle joints. Therefore, early correction of the axis is strictly indicated. This article focuses on the correction of axial deformities especially when using “bioresurfacing techniques” in cartilage disorders like microfracturing, autologous osteochondral transplantation and autologous chondrocyte transplantation which is reported to bring about marked advantages for the regeneration of the articular surface. Anatomic considerations and principles of correction osteotomy are discussed, three rules of osteotomy in general and in osteotomies around the knee are postulated.

Cartilage repair - angular deformity of the lower limb - posttraumatic malalignment - axis correction - principles of correction osteotomy

References

• 1 Akizuki S, Yasukawa Y, Takizawa T. Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone.  Arthroscopy. 1997;  13 9-17
• 2 Franco V, Cipolla M, Gerullo G, Gianni E, Puddu G. Öffnende Keilosteotomie des distalen Femurs beim Valgusknie.  Orthopäde. 2004;  33 85-192
• 3 Gautier E, Thomann B W, Brantschen R, Jakob R P. Fixation of high tibial osteotomy with the AO cannulated knee plate.  Acta Orthop Scand. 1999;  70 397-399
• 4 Gross A E. Repair of cartilage defects in the knee.  J Knee Surg - Orthopäde. 2004;  15 167-169
• 5 Hierleder G, Müller K H. Korrekturosteotomien nach Traumen an der unteren Extremität. Springer, Heidelberg, Berlin 1984
• 6 Hsu R W, Himeno S, Conventry M B, Chao E Y. Normal axial alignment of the lower extremities and load bearing distribution at the knee.  Clin Orthop Relat Res. 1990;  225 215-227
• 7 Jakob R P, Jacobi M. Die zuklappende Tibiakopfosteotomie in der Behandlung der unikompartimentären Arthrose.  Orthopäde. 2004;  33 143-151
• 8 Lobenhoffer P, Agneskirchner J, Zoch W. Die öffnende valgisierende Osteotomie der proximalen Tibia mit Fixation durch einen medialen Plattenfixateur.  Orthopädie. 2004;  33 153-160
• 9 Marti R K, Scroder J, Witteveen A. The closed varus supracondylar osteotomy. In: Drez Jr D, DeLee JC (eds). Operative Techniques in Sports Medicine. Osteotomies about the Athletic Knee. Saunders, Orlando, FL 2000; Vol. 8, no. 1
• 10 Müller M E, Allgower M, Schneider R, Willenegger H. Manual of Internal Fixation. 2nd edn. Springer, New York 1979; 376-377
• 11 Paley D, Pfeil J. Prinzipien der kniegelenknahen Deformitätenkorrektur.  Orthopädie. 2000;  29 18-38
• 12 Paley D, Tetsworth K T. Percutaneous osteotomies. Osteotomy and Gigli saw techniques.  Orthop Clin North Am. 1991;  22 613-624
• 13 Paley D, Tetsworth K T. Preoperative planning of uniapical angular deformities.  Clin Orthop. 1992;  280 48-64
• 14 Paley D, Tetsworth K D. Deformity correction by the Ilizarov technique. In: Chapman MW (ed). Operative Orthopaedics. Lippincott, Philadelphia 1993; 61: 883
• 15 Puddu G, Fowler P J, Amendola A. Opening wedge osteotomy system by Arthrex. Surgical technique. Arthrex Inc., Naples/FL 1998
• 16 Puddu G, Franco V. Femoral antivalgus opening wedge osteotomy. In: Fez Jr D, DeLee JC (eds). Operative techniques in sports medicine. Osteotomies about the athletic knee. Saunders, Orlando/FL 2000; Vol. 8, no. 1
• 17 Wakabayashi S, Akizuku S, Takizawa T, Yasukawa Y. A comparison of the healing potential of fibrillated cartilage versus eburnated bone in osteoarthritic knees after high tibial osteotomy: An arthroscopic study with 1-year follow-up.  Orthopäde. 2004;  18 272-278
• 18 Wakitani S, Imoto K, Yamamoto T. et al . Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees.  Orthopäde. 2004;  10 199-206