Massimo Cipolla

Open wedge high tibial osteotomy

Osteotomy is a classic operation in the treatment of unicompartmental osteoarthrosis of the knee. It has often been presented as a possible alternative to prosthetic joint replacement, but the indications depend on the stage and articular diffusion of the degenerative changes and on the patient’s profile and are very different in most cases from the indications for unicompartmental or total knee replacement. A relatively new technique of high tibial osteotomy will be illustrated in this article with careful step-by-step presentation of all the details of the operation. Compared to the Coventry lateral closing wedge osteotomy, this technique turns upside down the method of correction of the varus deformity and adds a wedge medially. It is based on a special dedicated system of instruments and plates developed by Puddu et al in the early 1990s.

Which osteotomy for a valgus knee

A valgus knee is a disabling condition that can affect patients of all ages. Antivalgus osteotomy of the knee is the treatment of choice to correct the valgus, to eliminate pain in the young or middle age patient, and to avoid or delay a total knee replacement. A distal femoral lateral opening wedge procedure appears to be one of the choices for medium or large corrections and is particularly easy and precise if compared to the medial femoral closing wedge osteotomy. However, if the deformity is minimal, a tibial medial closing wedge osteotomy can be done with a faster healing and a short recovery time.

Osteotomies: the surgical treatment of the valgus knee.

Lateral compartment arthrosis from congenital valgus or the result of previous lateral meniscectomy can be a disabling condition. Realignment osteotomy, which may avoid or delay the need for a total knee replacement, is appropriate for young or middle-aged patients suffering from a painful valgus knee. Medium or large corrections can be managed with distal femoral lateral opening wedge osteotomy while minimal deformities are best treated with medial closing wedge tibial osteotomy.

Microvasculature of the human medial meniscus: Operative findings

The purpose of our study was to weigh the probability of a successful meniscus repair on the basis of the microvasculature of the human medial meniscus. In a series of 105 patients who underwent an anterior cruciate ligament reconstruction between January 1985 and December 1986, we chose the 40 patients who had a subtotal medial meniscectomy (38%) to study the microvasculature of the human medial meniscus adequately; the other patients had either an intact meniscus (23%), a meniscus repair (29%), or an already removed meniscus (10%). Forty medial menisci, from 40 male patients with an average age of 27 years, having an anterolateral and/or anteromedial chronic knee laxity and an associated meniscal pathology, were subdivided into two groups: (a) 20 tears restricted to the posterior horn, and (b) 20 bucket-handle tears observed under light microscopy. Meaningful capillary plexuses penetrating into the meniscal stroma were found in 18 of 40 menisci (45%). They were easier to identify in posterior horn tears (55%) than in bucket-handle tears (35%), and were found especially in younger patients (22 years on the average). Therefore, we encourage meniscus repairs even in chronic tears, particularly in younger patients and in posterior-horn tears.

Tendinopathies of the ankle joint

Tendons around the ankle joint may undergo overuse pathology. The anatomy of the ankle must be thoroughly studied in order to understand the causes of the overuse pathology, and their clinical presentation. Changes in tendon functioning may arise following biomechanical alterations of the foot and ankle. Anatomic repair of the tendon tear-and-wear injuries is mandatory, as well as reconstruction of completely disrupted tendons. Restoration of the biomechanics of the foot and the ankle contributes to improved repair procedures and greatly helps in preventing recurrences of tendon disease.