Thirty knees of twenty-two patients have been operated on in the
past four years (1960-1964) to correct the varus or valgus deformity
resulting from degenerative changes. Six knees in four other patients
suffering from rheumatoid arthritis had similar procedures. An upper
tibial wedge osteotomy was used in the general region of the closed epiphysis.
The thrust of weight-bearing and other stresses was thus lessened
on the degenerated tibial condyle and transferred to the more normal
condyle. The results at from one to four years after operation have
been encouraging. It is hoped that by this procedure the pain of
degenerative arthritis of the knee can be relieved or reduced and
the usefulness of the knee prolonged.
Why was this article selected as a classic
orthopaedic reference?
Coventry beautifully describes the problem of arthritis of the knee,
which in 1965 had no effective treatment. Indeed, in the last sentence
of his introductory paragraph, he states, "Arthrodesis
and arthroplasty are seldom carried out." He introduces
into the English-language literature the concept of above-the-tibial
tubercle proximal osteotomy and gives credit to Gariépy,
who had described it in French, and to Jackson and Waugh, who described
a below-the-tibial tubercle osteotomy of the knee in the British
JBJS in 1961.
How has the information in the article withstood
the "test of time"?
The rationale, technique, and definition of satisfactory and unsatisfactory
results are very clear, and very little has been added in thirty-six
years to change the fundamentals of this message. The procedure
is still performed today, and it is always included among alternative
surgical interventions being considered for degenerative arthritis
of the knee.
How has our thinking changed with regard to
this subject since the publication of this landmark work?
While arthroplasty is king today, the influence of this article
continues in two realms: first, as an option for younger patients
who have unicompartmental arthritis of the knee, and second, for patients
who may benefit from biologic advances such as autologous chondrocyte
transplantation. So now, in the emerging age of biologic arthroplasty,
it is just as essential to remember the principles of restoring
the mechanical alignment of the knee so that cartilage can function
within the limits of a normal mechanical loading environment.
R.P.
Many classic, landmark articles have been published in The
Journal in the past. Monthly, we will be publishing summaries of selected
articles, along with a contemporary commentary by a knowledgeable
member of the editorial board identifying the article’s
significance in orthopaedics and its continuing relevance to our
practices. Please let us know of a classic journal article that
you believe should be summarized and commented upon in the future.J.D.H.
Many classic, landmark articles have been published in The
Journal in the past. Monthly, we will be publishing summaries of selected
articles, along with a contemporary commentary by a knowledgeable
member of the editorial board identifying the article’s
significance in orthopaedics and its continuing relevance to our
practices. Please let us know of a classic journal article that
you believe should be summarized and commented upon in the future.
J.D.H.