ABSTRACT
INTRODUCTION: Center of the intercondylar eminence at the proximal tibia had been widely used as a reference point for tibial bone cut in the Total Knee Arthroplasty (TKA) procedure. However, in the presence of preexisting tibia vara, the center of intercondylar eminence as tibial bone cut reference point often leads to varus malalignment after TKA procedure. CASE REPORT: 75 years old male patient complained of worsening pain on the left knee. The patient has had a history of knee osteoarthritis for the past seven years. The radiograph on the right knee revealed osteoarthritis grade 3 and left knee osteoarthritis grade 4, both with tibia vara. We planned to perform total knee arthroplasty surgery on his left knee with a preoperative planning tibial reference point of 10 mm lateral to the center. Six months after the knee replacement, there was minimal pain on activity, and full ROM was achieved on his left knee. On the radiographic X-ray evaluation, the alignment between the tibial implant surface and mechanical axis is 0.43 degrees valgus. CLINICAL DISCUSSION: In a varus knee malignment, the mechanical axis passes through one-third of the medial side of the knee, which makes the medial side of the implant wear off faster, resulting in the collapse of the medial tibia, thus decreasing implant survival and increasing the need for revision for TKA. CONCLUSION: In patients with preexisting tibia vara, tibial bone cut reference point planning before TKA procedure is important to provide longevity of implant survival and better quality of life.
ABSTRACT
PURPOSE: We aimed to evaluate surgical outcomes of high-grade bursal rotator cuff-tear repairs. METHODS: This systematic review was performed in May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed. Inclusion criteria were English-language studies reporting the results of pain improvement, functional outcome scores, and radiographic examinations after repair of bursal side partial rotator-cuff tears at any time point in patients of any age and with all levels of evidence. Exclusion criteria were articles not in English, in vitro or animal studies, epidemiological studies, and such article types as technical notes or narrative reviews. RESULTS: Of 58 articles, five were included in this study, of which three and two had level III and IV evidence, respectively, four were comparative studies, and one was a case series. Visual analogue scales were used in four of the five studies, all showing improvement in pain assessment from 5.87 preoperatively to 1.02 postoperatively. All five studies showed significant improvement on each functional outcome score at the final follow-up. The retear rate for all studies was 10.97% (27 of 246). CONCLUSION: High-grade bursal side partial-thickness rotator cuff-tear repair gave satisfactory results in terms of pain scores, range of motion, and functional outcomes. The retear rate was still considerably high (10.9%), necessitating better understanding of the basic science, such as molecular mechanisms during adaptation, to improve the surgical technique.
