Mylène Jansen

Return to sport and work after KJD and HTO 89 5 Figure 1 : Inclusion flowchart. HTO: high tibial osteotomy; KJD: knee joint distraction; MS: multiple sclerosis. Surgical techniques and postoperative rehabilitation A detailed description of surgical techniques can be found in previous publications. 24,27,28 All HTO patients underwent a bi-planar, medial opening-wedge osteotomy 29 by 1 of 3 experienced surgeons. Preoperatively, the desired correction was determined on full leg standing radiographs using the Miniaci method. 30 For fixation, the TomoFix plate and screws (DePuy Synthes, Switzerland) or Synthes locking compression plate (LCP) (DePuy Synthes, Switzerland) were used (Figure 2a). Postoperatively, patients were allowed partial weight-bearing (up to 20 kg) for 6 weeks, followed by gradual full weight-bearing. Plate removal was routinely performed in all patients within 2 years. For KJD, an external distraction device was used: 2 dynamic monotubes (Triax, Stryker, 45 kg spring with 2.5 mm displacement) were fixated to 8 bone pins (Figure 2b). The tubes were distracted 2 mm intra-operatively, followed by 1 mm of distraction per day up to a total of 5 mm of joint distraction. Weight-bearing radiographs were taken on day 4 to check the amount of distraction. When adequate distraction was obtained, patients were discharged and allowed full weight-bearing with crutches. Radiographic evaluation and pin tract inspection were performed after 3 weeks. The frame and pins were surgically removed after 6 weeks, followed by gradual increase to full weight-bearing in 6 weeks. Both HTO and KJD patients were prescribed subcutaneous low molecular weight heparin, for 6 and 9 weeks respectively. All patients were referred to regular outpatient physical therapy.