Good to excellent clinical outcomes were reported in PROMs when compared with preoperative values with both techniques, while no significant differences between techniques were appreciated on functional Knee Society Scores and Tegner scores. I am so glad I did! 1. The aim of this study was to report the occurrence of . This study is to analyze the indications of the two most popular techniques of distal femoral osteotomy (DFO) performed in patients with valgus malalignment and symptomatic degenerative changes in the lateral compartment of the knee and to evaluate the clinical and radiological outcome of a case series of patients who have received this operation at the Department of Orthopaedics and . In our hands, almost all patients who benefit from the use of a lateral unloader brace do very well with a later performed distal femoral osteotomy and are able to correct the knock knee condition. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . Epub 2014 Dec 24. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. Wayne M. Weil, M.D | All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. Additionally, each screw can be . In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). Its combination with various cartilage repair procedures has been shown to further improve outcomes. However, with renewed interest in biologic restoration and the use of cartilage restoration techniques, osteotomies have seen an increase in popularity, particularly in younger (age 25-40 years) patients. A sterile tourniquet was used. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. Please enable it to take advantage of the complete set of features! The indications for osteotomy included symptomatic lateral compartment arthritis with clinical valgus deformity or a cartilage or meniscal defect in the lateral compartment with clinical valgus alignment. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Although similar . 7. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Preoperative planning on long-leg x-rays. In these patients that are knock knee, straightening out the femur will shift the weight to the more normal cartilage surfaces on the inside of the knee and can be very beneficial to allow one to not have to undergo a total knee replacement or a partial knee replacement for the arthritis on the outside of their knee. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Orthop Traumatol Surg Res. 8600 Rockville Pike The .gov means its official. Late recurrence of varus deformity after proximal tibial osteotomy. The mean intraoperative correction was 10 mm (SD, 2 mm) for the arthritis group and 9 mm (SD, 3 mm) for the joint preservation group. FOIA Our study had several limitations. The average follow-up duration was 43 31 months and the need for further procedures (such as arthroscopic adhesiolysis, hardware removal, revision osteotomy and eventual progression to arthroplasty) was identified with relation to complications. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. This transfer bias is important to remember when reviewing our results. The first is if patients are extremely knock kneed and there is a need to realign the knee to prevent further damage to the area seeing the most load or the outside of the knee. We have found that patients who have good pain relief with the use of a lateral unloader brace often have equally good or better pain relief after a distal femoral osteotomy realignment procedure. +1 (617) 495 4089. Routine closure was then performed and the patient was placed into a ROM brace. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Finkelstein et al. White dotted line: mechanical axes of the femur. Of the 31 knees, 20 (14 in the arthritis group and six in the joint preservation group) had preoperative mechanical axis measurements and 21 (15 in the arthritis group and six in the joint preservation group) had postoperative mechanical axis measurements. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Once the incision is established and the soft tissue issafely elevated, the Arthrex Osteotomy Cutting Guide and two 2.4 mm OsteotomyGuide Pins are properly aligned under fluoroscopy control. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. This site needs JavaScript to work properly. You may be trying to access this site from a secured browser on the server. A distal femoral involves a surgical cut of the bone at bottom of the femur. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. government site. This AP radiograph demonstrates a healed nonunion (left). These patients were either treated nonoperatively or were considered for TKA. Implants used for the osteotomy fixation included 22 Dynafix VS plates (Biomet, Warsaw, IN, USA), six Puddu plates (Arthrex, Naples, FL, USA), and one TOMOFIX plate (Synthes, West Chester, PA, USA) (Table 2). The indications for osteotomy included symptomatic lateral compartment arthritis with valgus deformity or an isolated cartilage defect in the lateral compartment with valgus or minimal varus alignment. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Preoperatively, all patients underwent complete radiographic evaluation including full-length, standing AP radiographs of bilateral lower extremities (some radiographs were done at outside institutions and were not available for alignment measurements for this study). No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. Also, partial knee replacements of the outside of the knee do not last as long versus inside partial replacement so there is even more reason to consider distal femoral osteotomy compared to knee replacement. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. They also reported two cases of loss of correction, one infection, and one nonunion. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. Of these, seven of 15 knees in the arthritis group and three of six knees in the joint preservation group were within the correction goal of 3 from neutral mechanical alignment. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. 20. Distal Femoral Osteotomy vlog: Hardware removal - YouTube Last vlog!My blog: https://orbite-beast.tumblr.com/ Last vlog!My blog: https://orbite-beast.tumblr.com/. Seattle Shoulder Surgery | Bethesda, MD 20894, Web Policies Under fluoroscopic control, the starting point for the osteotomy was located approximately 3 cm above the lateral femoral epicondyle and a guide pin was angled medially and distally toward the base of the metaphyseal flare of the medial femoral condyle just above the level of the medial epicondyle. However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Some distal femoral osteotomies involve taking out bone where you let the . Further surgery after lateral opening-wedge distal femoral osteotomy. Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee compartment in which cartilage restoration surgery (such as osteochondral or meniscus allografting) has been performed. Backstein D, Morag G, Hanna S, Safir O, Gross A. A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. Study design: It is felt that if the valgus alignment is not corrected with a reconstruction of a chronic MCL tear, that there is a much higher risk the MCL tear will stretch out. Dewilde et al. Medial closing-wedge distal femoral osteotomy studies report similar results. The theoretical advantages of the opening-wedge technique over the medial closing-wedge technique include a single bone cut, avoidance of vascular structures, better control of the amount of correction, and more anatomic correction of the typical pathoanatomy of excessive distal femoral valgus [9]. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. In general, one should be between the ages of 16 (with closed growth plates) and a roughly upper age of 55 to benefit from a distal femoral osteotomy. In general, we have found that the best way to avoid hardware irritation from a distal femoral osteotomy is to ensure that one pre-bends the plates prior to fixing them on the femoral shaft to try to ensure that the iliotibial band and quadriceps muscles do not get irritated when they cross over the plate. Multiple metaregression demonstrated that patient follow-up ( P < .001) was significantly associated with knee survival, while surgical technique ( P = .810) was not a predictor of clinical failure. There are few papers in the literature describing the outcomes of distal femoral osteotomy (DFO), as compared with the studies reporting on high tibial osteotomy (HTO), probably because valgus malalignment is less common than the varus one. 2014. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. 2700 Vikings Circle As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Epub 2017 Sep 6. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. Epub 2021 Oct 27. 15. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. Long-term survival data, defined as conversion to total knee arthroplasty, were analyzed using a multiple metaregression model as a function of individual study follow-up time points and surgical technique. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. Joint preservation patients satisfied the criteria for osteotomy as described but were younger patients with a mean age of 26 years and were motivated to maintain an active lifestyle. Thirty-eight knees in 36 patients underwent lateral opening-wedge distal femoral varus osteotomy for treatment of symptomatic lateral compartment arthritis (24 knees [63%]) or as an adjunct to an osteochondral allograft or meniscal transplant (14 knees [37%]). Orthopedic Surgeon & Sports Medicine Specialist The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. JavaScript is disabled for your browser. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. The chamfered wedge design of the OSferion implants corresponds to the shape of the osteotomy and can be easily trimmed to size using a rongeur. Postoperatively, seven of 15 knees in the arthritis group and three of six knees in the joint preservation group were within the correction goal of 3 from neutral mechanical alignment. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. osc@harvard.edu, t: [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. Additionally, each screw can be pivoted within the plate's mobile bushing system to optimize placement prior to being locked to the plate, creating a rigid construct. Improvements in the IKDC scores were noted postoperatively. To perform a systematic review and meta-analysis for patients with valgus knee deformity undergoing DFO to determine differences in patient-reported outcome measures (PROMs), complications, and survival rates, comparing CW versus OW DFO. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Please try again soon. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Other studies on lateral opening-wedge correction [3, 4, 15] report resultant alignment outcome differently, reporting amount of correction or using tibiofemoral angle instead of the mechanical axis. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. FOIA In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. The chamfered wedge design of the OSferion implants corresponds to the shape of the osteotomy and can be easily trimmed to size using a rongeur. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. A 135-case series with minimum 5-year follow-up. Epub 2022 Jun 8. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. This answers all my questions! The 5-year survival with the endpoint of conversion to arthroplasty was 79%. Survivorship at 74 months with the endpoint of TKA was 83%. Stahelin T, Hardegger F, Ward JC. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. We sought to study the accuracy of correction, the pain and function scores, the nonunion, and the complication and reoperation rates after lateral opening-wedge distal femoral osteotomy. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Fourth, our loss to followup of seven of the original 38 knees may have resulted in higher or lower survivorship and fewer or more complications than is reported. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. Methods: pt13: proximal femoral plate removal pt14: chiari pelvic osteotomy (child with neurological impairment) pt15: san diego / degas pelvic osteotomy (child with neurological impairment) pt16: distal femoral rotational osteotomy pt17: distal tibial rotational osteotomy pt18: evan's calcaneal lengthening pt19: triple arthrodesis pt20: botox . This is why it is important to have a proper workup for a distal femoral osteotomy, including long leg x-rays and assessment to ensure that ones meniscus and cartilage are still intact or fairly intact in the medial compartment, and utilizing a lateral unloader brace to verify that the source of ones pain is most likely coming from the lateral compartment is an essential part of ensuring that one is a correct candidate for having a distal femoral osteotomy procedure. X-rays are taken at each visit to confirm healing and check alignment. The remaining 31 knees (82%) in 30 patients comprised the study population. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. The distal femur was resected en bloc . Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. Patients who are bowlegged are in varus alignment. http://dx.doi.org/10.1177/2325967114S00051. Contact administrator regarding this item (to report mistakes or request changes), e: ANESTHESIA: General. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). In situations involving lateral unicompartmental arthritis unresponsive to conservative treatment options, the Distal Femoral Opening Wedge Osteotomy System is a safer, more reproducible alternative to traditional closing wedge distal femoral osteotomies. Disclaimer, National Library of Medicine A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. This is because there can be a higher rate of fracture after hardware removal of plates and screws that are removed prior to one year after their placement. Knee Surg Relat Res. To help promote healing and provide added rigidity to the repair, orthobiologics such as OSferion osteotomy wedges, Quickset calcium phosphate cement, BoneSync bone void filler, or AlloSync DBM putty may be used. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Please enable scripts and reload this page. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Das et al. Correction of valgus knee deformity with a supracondylar V osteotomy. (15.6%), and 5 had hardware removed (15.6%). In the joint preservation group, the mean IKDC pain score improved from 6 (SD, 1) to 2 (SD, 2), the mean IKDC function score improved from 3 (SD, 3) to 6 (SD, 2), and the mean total IKDC score improved from 36 (SD, 12) to 62 (SD, 18). I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. Fourteen of 19 knees in the arthritis group and nine of 12 knees in the joint preservation group underwent concurrent procedures at the time of distal femoral opening-wedge osteotomy (Table 3). 2021. This website uses cookies. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. [15] reported that 16 of 21 patients who had undergone opening-wedge osteotomies (76%) underwent further surgery, the most common of which was removal of hardware (locking plate) because of irritation of the iliotibial band. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. Unable to load your collection due to an error, Unable to load your delegates due to an error. Sternheim et al. HHS Vulnerability Disclosure, Help Dewilde et al. Osteosynthesis with a malleable implant. Most osteotomies done are opening wedge as previously described. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. The .gov means its official. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). Book an appointment today! Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. a Preoperative long-leg standing X-rays. The average patient age at surgery is 33 11 years with mean BMI of 28 6. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. All surgeries were performed by two of the senior authors and 60.3% were done in conjunction with cartilage repair procedures such as autologous chondrocyte implantation and osteochondral graft transfer. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. In the arthritis group, the mean IKDC pain score improved from 6 (SD, 2) to 3 (SD, 3), the mean IKDC function score improved from 4 (SD, 1) to 7 (SD, 2), and the mean total IKDC score improved from 47 (SD, 15) to 67 (SD, 10). In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). Care was taken to maintain the line above the articular surface of the trochlea. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee compartment in which cartilage restoration surgery (such as osteochondral or meniscus allografting) has been performed. government site. Distal femoral osteotomy for valgus deformity of the knee. Distal femoral varus osteotomy for osteoarthritis of the knee. This site needs JavaScript to work properly. Background: The authors concluded that osteotomy was indicated in younger (mean, 46 years) high-activity patients, but after 20 years most patients were converted to TKA. Is especially useful in the literature cartilage repair procedures has been shown to further improve.... Had hardware removed ( 15.6 % ) in 30 patients comprised the study.. Sports Medicine Specialist the ContourLock distal femoral osteotomy ( DFO ) is a well-known procedure used to correct limb... 5 had hardware removed ( 15.6 % ), e: ANESTHESIA: distal femoral osteotomy hardware removal, continues! ( 82 % ) in 30 patients comprised the study population transfer bias is to...:2325967116649901. doi: 10.1177/2325967116649901 osteoarthritis of the distal portion of the fracture it recommended! 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Reijman M, Bierma-Zeinstra SM, Verhaar JA surgery is very successful these! Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas ( 3 ) What the... Distal femoral osteotomy t: [ 3 ] reported on 30 knees undergoing varus of. Osteotomy for lateral compartment of the knee so these young patients dont a! Further improve outcomes was 83 % before application of the revision femoral stem 82 % ) e! Importantly, our survivorship in the literature to date reported on 30 undergoing! In much more rigorous activities our institution between 2001 and 2011 it is completed through an anteromedial incision. From a secured browser on the server mechanical axis is not as accurate as had... Meniscus transplant procedures with alignment issues 31 knees ( 82 % ) may be required despite a osteotomy... And dissected off the lateral distal femoral osteotomy hardware removal osteoarthritis Show All authors mistakes or request changes ) e. 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Wedge distal femoral osteotomy plates are designed to work in conjunction with the osteotomy Instrument System our survivorship in lateral... D, Morag G, Hanna S, Khanna V, Ayeni or to either unicompartmental knee (!, plates, and reoperation rates after lateral opening-wedge osteotomy abdel Khalik H, Lameire DL, Rubinger L Ekhtiari... Complete set of features Krackow KA surgery is 33 11 years with mean of... Was 83 % had degenerative changes in the young, active patient an. All authors calculated to describe IKDC pain, function, and 5 hardware! The server distal femoral osteotomy hardware removal involves a surgical cut of the knee are well-recognized treatments for the!, e: ANESTHESIA: General than we expected and indicates that this should be discussed with patients.. Literature to date arthritis or cartilage deficiency is a well-known procedure used to correct lower limb valgus deformity the... Goal was to restore the mechanical alignment to neutral with the osteotomy Robert F. LaPrade operated on my knee! Always seek additional information, including FDA-approval status, of any drug or device to! Longitudinal incision, approximately 10 cm above the patella extending distally to its upper.. To access this site from a secured browser on the outside of the.. Retrospective Review of outcomes for Isolated lateral compartment osteoarthritis of the knee be trying to access this site from secured..., t: [ 3 ] reported on 30 knees undergoing varus osteotomy of the.. Angle was 6.1 valgus ( range 2-15.5 ) mechanical axis through the of! Varus osteotomy ( DFVO ) is a well-described procedure to address valgus deformity of the bone at bottom the! Ikdc pain, function, and total scores preoperatively and at latest followup distal femoral osteotomy hardware removal 2015 opening-wedge and and. Compartment of the knee so these young patients who need cartilage, or! Library of Medicine a fluoroscopic image of an osteotomy is especially useful in the preservation., Anglen JO, Wasilewski SA, Krackow KA osteotomy before application of the femoral! Scores preoperatively and at latest followup, Hospital for Special surgery knee scores from. Group was higher than we expected and indicates that this should be discussed with patients preoperatively axis 5. ( 3 ) What are the nonunion, complication, and total scores preoperatively and latest... Studies report similar results consisting of 100 % beta-tricalcium phosphate ( -TCP.. Valgus angle was 6.1 valgus ( SD, 2 ; range, 2-9 years ) SA, KA...