Managing coronal plane deformities around the knee by Using percutaneous osteotomy

Abstract

Coronal plane deformities around the knee, encompassing genu varum and genu valgum, present significant challenges in pediatric and adult orthopedics. While various surgical techniques exist, percutaneous osteotomy offers a minimally invasive approach with potential advantages in reducing morbidity and improving functional outcomes. These abstract reviews the current literature on percutaneous osteotomy for managing these deformities, highlighting its techniques, indications, and limitations. Percutaneous osteotomy utilizes small incisions and specialized instruments to perform osteotomies, minimizing soft tissue trauma compared to open techniques. Several techniques exist, including closing wedge, opening wedge, and oblique osteotomies, each tailored to the specific deformity and patient characteristics. The choice of osteotomy type depends on the desired correction, bone morphology, and the presence of concomitant deformities. Precise preoperative planning, often employing three-dimensional imaging and computer-assisted surgical navigation, is crucial to achieve accurate correction. The indications for percutaneous osteotomy in managing coronal plane deformities vary based on factors such as patient age, skeletal maturity, deformity severity, and associated comorbidities. It is particularly attractive in skeletally immature patients where growth modulation techniques may be insufficient or contraindicated. In adults, percutaneous osteotomy can effectively address mild-to-moderate deformities, improving joint mechanics and reducing pain. However, severe deformities or those with significant bone loss or malunion may require more extensive open surgical approaches. Postoperative management typically involves immobilization with a cast or brace, followed by a gradual return to weight-bearing activities. Regular radiographic follow-up is essential to monitor healing and assess the stability of the osteotomy. While percutaneous osteotomy offers a minimally invasive advantage, potential complications include non-union, malunion, infection, and neurovascular injury. However, the risk of these complications is generally lower compared to open techniques. Studies comparing percutaneous osteotomy to open techniques have shown comparable rates of correction and functional outcomes in select patient populations. Minimally invasive techniques lead to reduced blood loss, shorter hospital stays, faster rehabilitation, and improved cosmetic results. However, the learning curve for percutaneous osteotomy is steeper, requiring specialized training and experience. Further research is needed to optimize surgical techniques, refine patient selection criteria, and further evaluate the long-term outcomes of percutaneous osteotomy in managing coronal plane deformities around the knee. In conclusion, percutaneous osteotomy presents a viable and increasingly popular alternative for the management of select coronal plane deformities around the knee, offering a balance between minimally invasive surgery and effective deformity correction.