Evaluation of Carpal Arch Widening and Outcomes After Carpal Tunnel Release.

PURPOSE: The purpose of this study was to compare the carpal arch widths between baseline and 6 months after open carpal tunnel release, and to determine whether any increase in the carpal arch width was associated with clinical outcomes of surgery. METHODS: We measured carpal arch widths in standardized carpal tunnel radiographs before, and 6 months after, open carpal tunnel release in 76 patients with carpal tunnel syndrome. Clinical outcomes were assessed for grip strength change and perceived disability using the Disabilities of the Arm, Shoulder, and Hand questionnaire at 6-month follow-up. We correlated the clinical outcomes with carpal arch width changes. RESULTS: The mean change of the carpal arch width was 1.8 mm (standard deviation, 1.4 mm; range, -0.3 to 5.2 mm). There was no significant correlation between the amount of carpal arch width widening and the clinical outcomes in terms of grip strength change and the Disabilities of the Arm, Shoulder, and Hand scores. CONCLUSIONS: This study found that the change of carpal arch width was minimal at 6 months after open carpal tunnel release, and that the increase, if any, was not associated with clinical outcomes such as grip strength change or the Disabilities of the Arm, Shoulder, and Hand scores. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Changes in patellofemoral alignment do not cause clinical impact after open-wedge high tibial osteotomy.

PURPOSE: The objectives of this study were (1) to evaluate the clinical and radiologic outcomes of open-wedge high tibial osteotomy focusing on patellofemoral alignment and (2) to search for correlation between variables and patellofemoral malalignment. METHODS: A total of 46 knees (46 patients) from 32 females and 14 males who underwent open-wedge high tibial osteotomy were included in this retrospective case series. Outcomes were evaluated using clinical scales and radiologic parameters at the last follow-up. Pre-operative and final follow-up values were compared for the outcome analysis. For the focused analysis of the patellofemoral joint, correlation analyses between patellofemoral variables and pre- and post-operative weight-bearing line (WBL), clinical score, posterior slope, Blackburn Peel ratio, lateral patellar tilt, lateral patellar shift, and congruence angle were performed. RESULTS: The minimum follow-up period was 2 years and median follow-up period was 44 months (range 24-88 months). The percentage of weight-bearing line was shifted from 17.2 ± 11.1 to 56.7 ± 12.7%, and it was statistically significant (p < 0.01). Regarding the clinical results, statistical significance was observed using all scores (p < 0.01). In the radiologic evaluation, patellar descent was observed with statistical significance (p < 0.01). Last follow-up lateral patellar tilt was decreased with statistical significance (p < 0.01). In correlation analysis between variables of patellofemoral malalignment, the pre-operative weight-bearing line showed an association with the change in lateral patellar tilt and lateral patellar shift (correlation coefficient: 0.3). CONCLUSION: After open-wedge high tibial osteotomy, clinical results showed improvement, compared to pre-operative values. The patellar tilt and lateral patellar shift were not changed; however, descent of the patella was observed. Therefore, mild patellofemoral problems should not be a contraindication of the open-wedge high tibial osteotomy. LEVEL OF EVIDENCE: Case series, Level IV.