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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : RC06 - RC09 Full Version

Evaluation of Medial Compartment Decompression by Fibular Osteotomy to Treat Medial Compartment Knee Osteoarthritis: A Retrospective Study


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51884.16220
Pallav Gupta, Manish Singh, Gagandeep Singh

1. Resident Doctor, Department of Orthopaedics, Government Medical College, Jammu, India. 2. Consultant, Department of Orthopaedics, Government Medical College, Jammu, India. 3. Resident Doctor, Department of Orthopaedics, Government Medical College, Jammu, India.

Correspondence Address :
Dr. Manish Singh,
Consultant, Department of Orthopaedics, Government Medical College, Jammu, India.
E-mail: drmanish_singh@yahoo.co.in

Abstract

Introduction: Osteoarthritis (OA) of the knee is a debilitating old age disease causing pain and restriction in movement. Proximal Fibular Osteotomy (PFO) can be a novel surgical technique which may provide an increase in the joint space and balance the load bearing of the knee joint. The present study was conducted to determine the outcomes of this surgical technique in patients with OA of the knee. The findings may motivate many practicing orthopaedicians to undertake this surgical technique and thereby, impart better quality of life to such patients.

Aim: To assess the outcome in terms of medial joint space, lateral joint space, tibiofemoral angle and range of movement of medial compartment decompression by fibular osteotomy in medial compartment knee OA.

Materials and Methods: This retrospective study was conducted in the Postgraduate Department of Orthopaedics, Government Medical College, Jammu, India, from November 2018 to October 2019, on 30 adult patients (both genders) aged 40-60 years who had moderate to severe symptomatic medial compartment knee OA. Patients who had rheumatoid arthritis, post-traumatic arthritis, congenital lower extremities defects, infections in joints, presence of ligament/meniscus injury, and those with abnormality in the lateral compartment were excluded. Preoperatively and postoperatively, medial joint space, lateral joint space, tibiofemoral angle and range of movement were assessed and compared. The p-value <0.05 was taken as statistically significant.

Results: A total of 30 patients were enrolled in the study, 18 (60%) were males, and 12 (40%) were females. Compared to preoperative values, postoperatively there was a significant increase in medial joint space (1.3±0.7 vs 5.2±0.9 mm, p-value <0.01), significant decrease in lateral joint space (6.9±0.3 mm vs 5.7±0.2 mm, p-value <0.01), significant decrease in tibiofemoral angle (180.7±1.02 vs 178.13±0.97, p-value <0.01) and significant increase in range of movement (135.36±1.06 degrees vs 137.6±1.02 degrees postoperatively, p-value <0.01). The median duration of follow-up for the patients were six months.

Conclusion: Proximal fibular osteotomy can be suitably applied in the clinical practice for OA of the knee joint and it can give prolonged beneficial outcomes for the patients.

Keywords

Chronic degenerative disease, Knee joint, Pain, Range of movement

The Osteoarthritis (OA) of the knee joint is a chronic, progressive degenerative disease often related to pain, stiffness as well as deformity (1). Knee OA is a common joint disease. It affects nearly 30% of the population more than 60 years of age (2). Knee OA is categorised into primary or secondary. Mechanical, structural, genetic, and environmental factors are involved in its development and advancement. (3).

Knee varus deformities are commonly found in patients having knee OA, 74% of patients with idiopathic OA are affected by this. In these deformities, mechanical femorotibial axis of <180° as well as narrow medial joint space are present on full-leg standing AP radiographs (4).

The medial compartment of normal knees bears 60-80% of total load, but the reason behind uneven distribution of load is still not clear (5).

Management options are {pain-relieving medications, physiotherapy exercises, steroid injections, Platelet-Rich Plasma (PRP) injections in the affected joints} (6). Surgical options, which are the main treatment options, consist of high tibial osteotomy and total knee arthroplasty (7).

High tibial osteotomy, a surgical option, is a technically demanding procedure leading to complications comprising iatrogenic fracture, non union, and neurovascular injury. Total knee arthroplasty can result in correction of alignment of the lower extremity, provides pain relief, and improve function significantly. But, it may not be choice for treatment in case of young age, active patients or patients with moderate OA (8).

As reported in the previous researches, the fibula-soft tissue complex gives lateral support to the osteoporotic tibia, which may cause non uniform settlement as well as plateau degeneration bilaterally (9),(10). Thus, there is a medial shift in the load towards medial plateau from normal distribution. This subsequently causes knee varus, exaggerating the medial compartment knee OA advancement (11).

Proximal Fibular Osteotomy (PFO) results in improvement of joint space by removing the support of fibula and rebalancing the load on both (medial and lateral) sides of the tibial plateau. It is a safe, easy, fast, and affordable surgery, in which insertion of additional implants is not required (11). The aim of the present retrospective study was to assess the outcome of medial compartment decompression by fibular osteotomy which was used to treat medial compartment knee OA.

Material and Methods

This retrospective study was conducted in the Postgraduate Department of Orthopaedics, Government Medical College, Jammu, India, from November 2018 to October 2019. The study included of 30 adult patients (both genders) aged 40 to 60 years with medial compartment OA, satisfying the inclusion criteria.

After obtaining an approval from the Hospital Ethics Committee (IEC/GMC/2019/807), a written, informed consent was taken from the patients for their inclusion in the present study. All the patients were explained in detail the available methods of treatment, with the final treatment decision left for the patient to decide. The complications of surgery and anaesthesia were also explained to the patient.

Inclusion and Exclusion criteria: Any patient who had symptomatic osteoarthritis of the medial compartment of the knee (of moderate or severe nature) with surgical indication and providing written consent for undergoing surgery were included in the study. Patients with rheumatoid arthritis, post-traumatic arthritis, congenital lower extremities defects, infections in joints, presence of ligament/meniscus injury, and those with abnormality in the lateral compartment were excluded from the study.

The severity of the patients were graded as per the International Knee Documentation Committee (IKDC) score (12) which classified OA into four categories:

• Minimal (Grade A): no reduction in joint space;
• Mild (Grade B): reduced joint space but still more than 4 mm; presence of small osteophytes, femoral condyle flattening or slight sclerosis;
• Moderate (Grade C): 2 to 4 mm joint space;
• Severe (Grade D): <2 mm joint space.

Clinical evaluation of the patients was done and details regarding gender, age, knee involved, and grading system (12) were noted. The latter included two patients operated for bilateral PFO were regarded as two independent participation.

Study Procedure

Preoperative planning: All the patients were admitted on Outpatient Department (OPD) basis. A detailed history, especially with reference to pain, loss of function and crepitation was taken. Detailed examination was done. The examination included findings on inspection and palpation, intermalleolar distance with ankles touching, testing for lateral ligaments with varus or valgus stress, testing for menisci and cruciate ligaments and patellofemoral joint examination by patellofemoral compression test (Zohlen test). Complete neurovascular status assessment was done (10),(11),(12),(13).

Radiographic imaging was performed on patients, which included: (1) weight bearing AP and lateral radiographs; (2) axial views of patellofemoral joint; (3) whole standing radiograph to assess the alignment; and (4) measurement of mechanical tibiofemoral angle.

Operative procedure: All the patients were given intravenous injection of Cefuroxime 1.5 g + sulbactam 750 mg 1 hour before surgery. Patients were explained about surgical risks including vessel and nerve injuries, wound healing complications, thrombosis or embolism, and early/late infections.

Anaesthesia: The spinal anaesthesia was given to all patients before surgery.

Position and draping: The patient was placed supine on table for surgery. The knee was flexed and laid across the opposite limb, to make fibular head prominent during surgery. A standard orthopaedic draping set was deployed, and if both knees were being operated at the same time, we prepared and draped them together beforehand and then performed the surgery one after the another.

Incision: The fibular head was marked. A 3-5 cm lateral incision was made in the proximal one-third part of fibula-thereby preventing the common fibular nerve injury.

Steps of procedure: The incision to fascia was given along the septum between two muscles (soleus and peroneus), then separation of the muscle was done, and two Hohmann retractors for exposing the fibula. The periosteum was split and 2 cm section of the fibula is removed 6-10 cm below the fibular head by using an oscillating/fret saw. Following resection, for sealing the fibula, bone wax was utilised. The normal saline was used in large amount for irrigation of incision. Thereafter, suturing of muscles, fascia, and skin was done separately with nylon.

Postoperatively: The patient was allowed to ambulate as soon as the effect of spinal anaesthesia weared-off or pain was tolerated. Orals were allowed after 4 hours of surgery. The patient was discharged after 24 hours. The pressure bandage was removed on 4th day and sutures in 12-14 days.

The patients were advised physiotherapy which comprised of 30 minutes of Quadriceps stretch, Quadriceps tense and Hamstring stretch as part of early rehabilitation for one month. The later rehabilitation comprised of Quadriceps strengthening, Quadriceps strengthening step down exercise and Quadriceps strengthening minisquat exercise for 30 minutes for three months.

Follow-up: Patients were followed-up at one, three, and six months postoperatively and annually after that. At each follow-up, weight-bearing AP as well as lateral radiographs of the affected knee were taken. The representative preoperative and postoperative case images are shown in (Table/Fig 1),(Table/Fig 2).

Criteria of evaluation of result: Functional relief was measured by IKDC score. For radiological assessment, both the joint spaces (lateral and medial) and the tibiofemoral angle were measured. Clinical improvement was assessed by range of movement.

Statistical Analysis

Data was compiled and represented as mean, standard deviation (for continuous parameters); absolute numbers and relative frequency (percentage) for categorical parameters. By using paired t-test, quantitative variables were compared between preoperative and postoperative. The p-value <0.05 was considered statistically significant. The data was entered in MS Excel spreadsheet; Statistical Package for Social Sciences (SPSS) version 21.0 was used for analysis.

Results

Right and left knee were involved in 53% and 47% of the patients, respectively. Grade 2 OA was present in 77% patients and Grade 3 in 23% patients (Table/Fig 4).

As compared to preoperatively, postoperatively, patients had more range of movement (137.6±1.02 vs 135.36±1.06, p-value <0.01), lesser tibiofemoral angle (178.13±0.97 vs 180.7±1.02, p-value <0.01), greater medial joint space (5.2±0.9 vs 1.3±0.7, p-value <0.01), lesser Lateral joint space (5.7±0.2 vs 6.9±0.3, p-value <0.01) and more IKDC score (73.5±5.2 vs 45.7±6.6, p-value <0.01) (Table/Fig 5). The median duration of follow-up for the patients was six months (4-7 months).

No significant complications were seen after the procedure with only one patient having foot drop and another patient having Extensor Hallucis Longus (EHL) weakness i.e., peroneal nerve injury which got recovered spontaneously.

Discussion

The present study holds strength in showing a significant improvement in the joint space after fibular osteotomy with clear cut improvement in the range of motion. The present study results can inspire other practicing orthopaediacians to undertake this surgical procedure for providing better outcomes to patients with OA. However, future studies need to be conducted on a larger sample size and wider regional variation population groups to see if the outcomes vary. Also, one needs to compare the experience of the operating surgeon in association with the final outcomes for the patients.

Recently, PFO has come out as a novel procedure for providing pain relief and improving joint function. PFO results in weakening of the lateral fibular support and corrects varus deformity; this can shift the loading force from the medial compartment more laterally, resulting in reduced pain as well as satisfactory functional recovery (7).

In the present study, total 30 knee joints were evaluated. Twelve patients were females, while 18 were males. The mean age was 52.7±4.6 years. The right knee and left knee were operated in 16 and 14 patients, respectively. Out of this, one patient was operated bilaterally. In a similar study by Yang ZY et al., including total 110 patients, 76 were females; right and left knees were operated in 62 and 48 patients, respectively; the mean age was 59.2 years (11). In study by Ahmed M et al., including 60 patients, 73.3% were females; mean age was 51.8±4.1 years (13).

In the present study, there was significant difference in preoperative and postoperative functional status of patients. This study is in accordance with study done by Yang ZY et al., (2015) that included 150 patients who had medial compartment arthritis; follow-up was done for more than two years (11). The preoperative and postoperative Knee Society Score (KSS) was 45±21.3 and 92.3±31.7, respectively; while the preoperative and postoperative IKDC score was 45.7±6.6 and 73.5±5.2 respectively. It reported that PFO can result in significant improvement in radiographic appearance as well as knee joint function and provide pain relief for long term (11).

The findings of the present study were supported by previous stuides like Ahmed M et al., where the Oxford Knee Score (OSS) was used to assess the functional outcome where they found that OSS improved from preoperative levels of 20.82±1.97 to postoperative levels of 35.92±3.50 (p<0.00000001) (13). Similarly, Liu B et al., showed the efficacy of PFO procedure with significant improvements in the clinical and functional KSS scores from preoperative levels of 49.14±10.95 and 44.97±17.1 to postoperative levels of p 67.77±11.08 and 64.66±13.12 respectively (p<0.05) (14). The findings are also supported indirectly in the studies by Wang X et al.,(15) and Subash Y et al., (16).

Though other studies being compared did not use IKDC score as was used in the present study, but they used some other functional score. It must be stressed here that even IKDC score is a valid functional score that can be used in children, adolescents and adult population (17). IKDC score assesses both the knee symptoms and the functional activity as a single scoring system and any increase in the IKDC represents the improvement in the patient condition of the knee (17), as was seen in the present study after PFO.

Similar results were reported by Ahmed M et al., including 60 patients where preoperative and postoperative mean medial joint space on standard AP radiograph were 1.45±0.28 mm and 4.63±0.668 mm, respectively; thus medial joint space was improved. The mean preoperative and postoperative lateral joint space was 8.86±1.27 mm and 4.72±0.79 mm respectively; thus lateral joint space was improved. The mean preoperative Visual Analog Scale (VAS) for pain measurement was 7.90±0.79, which improved to 2.32±0.792, postoperatively. The mean postoperative Oxford knee score was 35.92±3.509 that was improved significantly compared to preoperative score (20.82±1.97) (13).

Liu B et al., included 84 patients who had medial compartment knee OA (n=111 knees). The mean preoperative VAS score was 7.08±1.41. The average preoperative KSS and functional scores were 49.14±10.95 and 44.97±17.1 while postoperatively it was 67.77±11.08 and 64.66±13.12, respectively. Significant improvement was present in 77 knees and satisfactory clinical outcome in 51 knees (14).

Similar study was done by Wang X et al., significant reduction in mean VAS scores was noted from preoperatively to postoperatively (8.02±1.50 vs 2.74±2.34). The mean knee sub-score (69.02±11.12 vs 44.41±8.90) and function subscores of the American KSS (67.63±13.65 vs 41.24±13.48) showed improvement postoperatively than preoperative levels (15).

In another study by Subash Y et al., a significant difference was present in VAS score with the mean preoperative VAS score decreasing from 6.9 to a value of 2.1 in the postoperatively (16). The modified oxford score postoperatively showed significant increased from preoperative score (79 vs 52.2).

The present study is also consistent with another study including similar study population by Wang X et al., who concluded that an increase in the proximal curve of the fibula was observed among patients who had medial compartment knee OA; this change was positively correlated with age and settlement of the medial tibial plateau (15). This anatomical adaptation of the fibula with higher fibular axial load and the pulling from the peroneus longus was noted.

In terms of safety, in the present study, PFO showed minimal complications. Among other studies, in study by Yang ZY et al., peroneal nerve injury was observed in 4 patients (3.6%) (11). Ahmed M et al., reported that loss of dorsiflexion of the great toe and superficial wound infection were present in 3 (5.0%) patients each (13). Because of this, posterolateral approach is recommended through the space between the soleus and peroneus muscles (brevis and longus) for decreasing the relative risk of iatrogenic nerve injury.

Limitation(s)

The study had a small sample size. Also, proximal fibular osteotomy was not compared to any other approach in the study.

Conclusion

Authors assessed functional scoring using IKDC score which increased significantly postoperatively. Range of movement also increased postoperatively. Postoperatively, tibiofemoral angle and lateral joint space decreased and medial joint space increased. Thus, with the present study we can conclude that for early medial compartment OA of the knee, PFO is an easy and simple procedure and causes significant reduction in pain, improves the radiographic appearance, and results in restoration of function.

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DOI and Others

DOI: 10.7860/JCDR/2022/51884.16220

Date of Submission: Aug 12, 2021
Date of Peer Review: Oct 29, 2021
Date of Acceptance: Jan 15, 2022
Date of Publishing: Apr 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 17, 2021
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• iThenticate Software: Feb 25, 2022 (18%)

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