The Journal of Bone and Joint Surgery, Vol 64, Issue 1 47-58, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-grafting or drilling of the lesion
T Koshino
High tibial osteotomy to correct a varus or valgus deformity was performed
on thirty-seven knees (thirty-six patients) with spontaneous osteonecrosis
of the femoral condyle (thirty-five medial and two lateral). Drilling or
bone-grafting of the necrotic lesion was done concomitantly with the
osteotomy in twenty-three knees. Follow-up periods ranged from two years to
eight years and six months. Preoperative pain was relieved and walking
ability was improved in thirty-five knees. The clinical results, as rated
by a knee score, were better in those knees with osteonecrosis of the
medial femoral condyle and a postoperative femorotibial angle (as measured
on a standing roentgenogram) ranging from 164 to 173 degrees (7 to 16
degrees of valgus angulation). Postoperatively in seventeen knees.
Roentgenographic improvement was greater in those knees in which tibial
osteotomy was performed concomitantly with bone-grafting or drilling.
Postoperative arthrotomy in eight knees showed that the necrotic lesion was
covered with a white layer of fibrocartilage in three of the four knees
that had had osteotomy more than one and one-half years previously.
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