30-year-old Partiban from Malaysia was an avid futsal player until he started noticing pain in his left knee throughout one year. The pain worsened until he had difficulties squatting and running; it eventually caused him to stop playing futsal. The patient was referred to Prof. Dr. Azhar M. Merican, who deduced that the underlying cause for the pain was a deformity of the patient’s left upper tibia. The deformity was due to the malunion of a fracture sustained in a motor vehicle accident when the patient was 14 years old. At the time, the fracture had been treated with a plaster cast.
For 11-year-old Amarachi Austin-Okoh, running, jumping and even walking was a struggle. She suffered from a condition called Blount’s Disease, where the tibia, or shin bone, doesn’t grow properly, causing the legs to develop a bow shape. The disease had progressed so far in Amarachi’s case that even walking caused her great pain, and she explained that “It was very painful and hard, and, then, if people were walking a distance or something, I would start walking slower and slower, because it got harder and harder.”
For patients with early stages of osteoarthritis, high tibial osteotomy (HTO) can be a useful treatment option. In the closing-wedge version of this operation, a wedge of bone is cut out of the lateral side of the tibia, whereas with the opening-wedge osteotomy, a bone graft is inserted in a cut made on the medial side. Both realign the knee and relieve pressure from the joint. The closing-wedge technique is more common, but recently, the opening-wedge osteotomy has become more popular since it is less invasive and possibly results in less deformity of the proximal tibia.