PMC9941361_01
Case 1: A 69-year-old woman who played competitive Naginata (long-handled sword).. A. Anteroposterior standing radiograph showing medial slip of the femur (white lines), B. Coronal view on T2-weighted fat suppression magnetic resonance imaging showing the complete exclusion of the lateral meniscus (triangle formed by the yellow dashed line). Mild medial meniscal extrusion is also seen (green lines). Bone marrow edema extends from the top of the lateral tibial eminence to the lateral edge of the lateral tibial plateau (yellow triangles), C. The preoperative hip-knee-ankle (HKA) angle, joint line obliquity (JLO; white dashed arrow), mechanical distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were 2 , 7 , 84 , and 83 , respectively, D. At the 6-month follow-up, despite the lack of change in the HKA angle compared with the preoperative angle, JLO (white dashed arrow), mLDFA, and mMPTA were corrected to 0 , 91  and 90 , respectively. Owing to a displaced hinge fracture (white arrow), the osteotomy site did not fuse, E. All corrected angles and the horizontalized joint line (white dashed line) were well preserved at the 5-year follow-up. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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X-rays revealed CPAK type II-aligned lateral osteoarthritis (Fig. 2A-C). She was eager to compete in Naginata again, and FVTVO was chosen based on the deformity analysis (Fig. 2D). The patient was satisfied with the 5-year results (Fig. 2E; Tegner scale/JOA score/flexion range = 6/90/135 , respectively).
Case 2: A 46-year-old woman who frequently climbed mountains higher than 3000 m above sea level.. A. Coronal view on T2-weighted fat suppression magnetic resonance imaging showing lateral meniscal extrusion from the lateral femoral condyle (yellow lines) in addition to medial meniscal extrusion (green lines). A large cartilage defect is visible on the medial femoral condyle (white arrow), B. The cartilage defect was confirmed on arthroscopy during osteotomy, C. Posteroanterior three-dimensional computed tomography (3D-CT) view of the whole leg showing the medial and lateral condyles. Although there are multiple possible 3D-CT views, the true posteroanterior view should be chosen. The true view shows the medial and lateral condyles with no obliquity. Using this view, the accurate value of each angle can be measured. The preoperative hip-knee-ankle angle (HKA), joint line obliquity (JLO; white dashed arrow), mechanical distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were 3 , 7 , 83 , and 84 , respectively, D. At the 6-month follow-up, JLO (white dashed arrow), mLDFA, and mMPTA were corrected to -3 , 90 , and 93 , respectively. The HKA was unchanged (3 ), and bone union was complete, E. All corrected angles and the JLO (white dashed line) were well-preserved at the 2-year follow-up. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Knee valgus was mild (CPAK type II; HKA angle = 3 ; Fig. 3C); however, there was a large cartilage defect on the medial femoral condyle (Fig. 3A and FVTVO was performed without changing the coronal varus/valgus alignment (Fig. 3D). Fourteen months after surgery, she successfully returned to mountain climbing at the same level as before being affected by the cartilage defect. The Tegner scale and JOA scores, and flexion range at the 2-year follow-up were 5, 100, and 150 , respectively (Fig. 3E).
Case 3: A 57-year-old man who participated in competitive alpine skiing at the national level. A. Magnetic resonance (MR) image, sagittal view, showing the complete absorption of the previously reconstructed anterior cruciate ligament with tibial bone tunnel expansion (black triangles). The tibia is anteriorly translated, B. Lateral meniscal extrusion from the lateral femoral condyle (triangle formed by the yellow dashed line) and medial meniscal extrusion (green lines) are visible on the coronal view of the T2-weighted fat suppression MR image. The lateral cartilage surfaces are irregular from the top of the lateral eminence to the lateral edge of the lateral tibial plateau (yellow triangles), C. The preoperative hip-knee-ankle angle (HKA), joint line obliquity (JLO; white dashed arrow), mechanical distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were 2 , 6 , 86 , and 85 , respectively, D. Preoperative lateral radiograph showing 12  of posterior tibial slope (PTS). PTS (yellow circle) was defined as the angle between the medial joint line (yellow arrow) and a perpendicular line (yellow line) to the posterior cortex (yellow dashed line), E. PTS (yellow circle) decreased to 2  after osteotomy, F. At the 6-month follow-up, HKA, JLO (white dashed arrow), mLDFA, and mMPTA were corrected to -1 , 0 , 90 , and 90 , respectively. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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The reconstructed ACL had been absorbed (Fig. 4A) at presentation, with lateral osteoarthritis accompanied by a concave lateral tibial plateau (Fig. 4B). Whole-leg X-rays demonstrated CPAK type II-aligned lateral knee osteoarthritis (Fig. 4C), and FVTVO was planned to return the patient to skiing at a competitive level. Owing to the slope-decreasing HCWHTO, the 10  of preoperative flexion contracture was also eliminated, and full extension was obtained (Fig. 4, Fig. 5). Terumo Biomaterials, Tokyo, Japan) was performed for the femur (Fig. 4, Fig. 5). The patient fully returned to skiing 12 months after FVTVO, before plate removal. The Tegner scale and JOA scores and the knee flexion range at the final follow-up (1.5 years) were 7, 90, and 120 , respectively.