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Anterior Closing-Wedge Osteotomy for Posterior Slope Correction With Tibial Tubercle Preservation.

ABSTRACT: An excessive posterior tibial slope has been identified as a potential risk factor for anterior cruciate ligament tears. Anterior closing-wedge osteotomy decreases the posterior slope and can eliminate this risk factor in patients with recurrent instability and greater than 12° posterior slope. We will describe an anterior closing-wedge osteotomy technique performed at the tibial tubercle (TT), in which the TT is not detached to preserve the extensor mechanism attachment. A vertical cut is performed in the sagittal plane just posterior to the TT, leaving a distal cortical hinge. Two proximal parallel K-wires and 2 distal parallel K-wires convergent to the proximal ones are inserted from the anterior cortex on both sides of the tubercle toward the tibial posterior cortex at the posterior cruciate ligament's tibial insertion. Proximal and distal cuts are performed to remove the bone wedge. Reduction is achieved by gentle knee extension. Fixation is completed with 2 staples placed medially and laterally to the TT.

SUBMITTER: Queiros CM

PROVIDER: S-EPMC6948133 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Anterior Closing-Wedge Osteotomy for Posterior Slope Correction.

Project description:Increased tibial slope can be a cause of recurrent instability after anterior cruciate ligament reconstruction. This article presents a technique for an anterior closing-wedge osteotomy for slope correction. The indications for this procedure are patients with recurrent instability after anterior cruciate ligament reconstruction with a neutral leg axis or slightly varus deformity and a posterior slope of more than 12°. The exposure of the anterior aspect of the tibia is best made through an anterior approach approximately 1 to 2 cm medial to the tibial tuberosity. Hohmann retractors are placed from the medial and lateral sides behind the proximal tibia. The osteotomy lines are marked with 2 converging Kirschner wires with the use of an image intensifier. The entry point of the first Kirschner wire is just below the most inferior fibers of the patellar tendon. The hinge of the osteotomy should be just below the tibial insertion of the posterior cruciate ligament. The osteotomy is performed with an oscillating saw. The posterior cortex of the tibia should be left intact. After removal of the anterior base wedge, the osteotomy is closed by manual pressure. Osteosynthesis is performed with a lag screw from the tibial tuberosity to the distal tibia and an angular stable plate fixator.

| S-EPMC6261062 | biostudies-literature

Tibial Tubercle Preserving Anterior Closing Wedge Proximal Tibial Osteotomy and ACL Tunnel Bone Grafting for Increased Posterior Tibial Slope in Failed ACL Reconstructions.

Project description:Anterior cruciate ligament reconstruction (ACLR) failure is multifactorial, but it is known that increased posterior tibial slope (PTS) leads to a greater likelihood of ACLR failure. This technical note describes the senior author's technique for performing an anterior closing wedge proximal tibial osteotomy, in which the osteotomy is made proximal to the tibial tubercle. This procedure is the first part of a staged surgery for patients with multiple failed ACLRs and increased sagittal plane PTS. Debridement of osteolytic reconstruction tunnels with bone grafting is also undertaken in preparation for a second-stage revision ACLR.

| S-EPMC8556534 | biostudies-literature

Anterior Closing Wedge Proximal Tibial Osteotomy for Slope Correction in Failed ACL Reconstructions.

Project description:Increased sagittal plane posterior tibial slope has been identified as a risk factor for primary anterior cruciate ligament reconstruction (ACLR) failure. Although ACLR failure is multifactorial, correction of sagittal plane posterior tibial slope should be evaluated in patients with an ACLR graft rupture. There are limited technical descriptions of proposed decreasing tibial slope osteotomy procedures; therefore, the purpose of this Technical Note is to describe the current senior author's technique of performing an anterior closing wedge proximal tibial osteotomy to decrease sagittal plane tibial slope in patients requiring a revision ACLR.

| S-EPMC6554236 | biostudies-literature

Simultaneous Correction of Varus Deformity and Posterior Tibial Slope by Modified Hybrid Closed-Wedge High Tibial Osteotomy.

Project description:A large posterior tibial slope has been proven to be a risk factor for anterior cruciate ligament (ACL) injuries, ACL graft failure, and medial meniscus posterior root tear. In addition, such pathologies often are accompanied by varus alignment. Thus, simultaneous varus and slope-correction osteotomy is required in such cases. High tibial osteotomy (HTO) is a well-established treatment for medial compartment knee osteoarthritis. Several HTO surgical techniques have been proposed, and hybrid closed-wedge HTO has been found to correct both varus deformity and a large posterior tibial slope via modification of the transverse osteotomy procedure. This Technical Note describes a modified hybrid closed-wedge HTO for simultaneous varus and slope correction in patients with ACL deficiency and/or medial meniscus posterior root tear involving both varus deformity and a large posterior tibial slope. This technique may reduce the risk of failure of the ACL graft and/or repaired medial meniscus posterior root.

| S-EPMC9705931 | biostudies-literature

Proximal Tibial Opening Wedge Osteotomy for the Treatment of Posterior Knee Instability and Genu Recurvatum Secondary to Increased Anterior Tibial Slope.

Project description:Decreased posterior tibial slope has been associated with increased risk of graft failure and knee instability after posterior cruciate ligament (PCL) reconstruction. Premature physeal arrest at the tibial tubercle is a common cause of osseous genu recurvatum. Surgical management is recommended to correct the tibial slope and prolong the integrity of the PCL graft. This article discusses our preferred treatment using a proximal tibial opening wedge osteotomy for surgical management of posterior knee instability and genu recurvatum secondary to significant anterior tibial slope.

| S-EPMC8719226 | biostudies-literature

Posteromedial Opening-Wedge Tibial Osteotomy for Metaphyseal Varus and Abnormal Posterior Slope Correction in Failed Anterior Cruciate Ligament Reconstructions Using a Custom Cutting Guide.

Project description:Anterior cruciate ligament reconstruction after graft failure may need associated bone correction to ensure stability of the knee. This article presents a technique of posteromedial opening-wedge osteotomy using a custom cutting guide to correct increased tibial slope and metaphyseal varus deformity after recurrent graft failure. An autograft quadriceps tendon graft was selected for the revision anterior cruciate ligament graft. After exposure with an anteromedial incision a patient specific cutting guide was used to make the high tibial osteotomy. The final fixation of the posteromedial opening was achieved using a low-profile locking plate and a femoral head allograft bone wedge. The tibial tunnel was planned and included in the patient-specific cutting guide. The femoral tunnel was placed using an outside to in manner. Bioabsorbable screws were used as fixation devices.

| S-EPMC7451726 | biostudies-literature

Open Wedge High Tibial Osteotomy with Distal Tubercle Osteotomy Lessens Change in Patellar Position.

Project description:The purpose of this study was to investigate the change in patellar position after open wedge high tibial osteotomy (OWHTO) with distal tubercle osteotomy (DTO), comparing outcomes of conventional OWHTO in young adults with proximal tibia varus deformity but no arthritic manifestations. Thirty-three patients (mean age, 31.8 years) subjected to OWHTO/DTO were matched with 30 patients (mean age, 33.5 years) undergoing conventional OWHTO. Patellar position, as measured in pre- and postoperative standing lateral radiographs, was compared. Patellar height was assessed via Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel (BP) index, Caton-Deschamps (CD) index, and modified Miura-Kawamura index. Computed tomography was used to measure lateral patellar tilt and shift. In the OWHTO group, all patellar height indices decreased significantly following surgery. Although mean values of BP and CD indices decreased significantly in the OWHTO/DTO group, other determinants of patellar height showed no significant postoperative differences. Significant postoperative declines in average lateral patellar tilt were also evident in both groups, but pre- and postoperative lateral patellar shift did not differ significantly. OWHTO/DTO can be performed without significant changes in patellar height. The results obtained support that OWHTO/DTO is suitable for relatively young patients with proximal tibia vara but no arthritic change.

| S-EPMC5540386 | biostudies-other

Leg length change after opening wedge and closing wedge high tibial osteotomy: A meta-analysis.

Project description:BackgroundTheoretical considerations suggest that leg length increases after opening wedge high tibial osteotomy (HTO) and decreases after closing wedge HTO; however, in vivo studies have yielded conflicting results. This meta-analysis therefore assessed changes in leg length after opening wedge and closing wedge HTO.MethodsAll studies comparing pre- and postoperative leg length in patients who underwent opening and/or closing wedge HTO were included. Two reviewers independently recorded data from each study in terms of sample size as well as preoperative and postoperative leg length of open wedge and/or closed wedge HTO groups.ResultsFour studies were included in the meta-analysis. Although pooled results showed leg length changes from before to after surgery were -6.93 mm (95% confidence interval [CI]: -17.53 to 3.67 mm; P = 0.20) in opening wedge HTO and 1.97 mm (95% CI: -7.13 to 11.07 mm; P = 0.67) in closing wedge HTO, respectively, these values were statistically not significant. However, the difference in the pooled mean leg length change from before to after surgery between opening wedge and closing wedge HTO was 8 mm, a difference that was significant (95% CI: 6.53 to 9.46 mm; P<0.001).ConclusionThe change in leg length was not statistically significant for either opening or closing wedge HTO. However, leg length change from before to after surgery was 8 mm greater for opening wedge HTO than for closing wedge HTO.

| S-EPMC5509317 | biostudies-literature

Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis.

Project description:This meta-analysis was designed to compare the longevity of the survivorship of opening versus closing wedge high tibial osteotomy (HTO). All studies reporting survival rates in patients who underwent open or closed wedge HTO with more than 5-year follow-up duration were included in the meta-analysis. Survival time was considered as time to conversion to TKA. Twenty three studies were included in meta-analysis, 20 of which were of level IV evidence. The pooled 5-year survival rates were 95.1% (95% CI: 93.1 to 97.1%) in open wedge HTO and 93.9% (95% CI: 93.1 to 94.6%) in closed wedge HTO. Although there was 1.2% greater survival rate in open wedge HTO than in closed wedge HTO, this difference did not reach statistical significance (P?=?0.419). Pooled 10-year survival rates were 91.6% (95% CI: 88.5 to 94.8%) in open wedge HTO and 85.4% (95% CI: 84.0 to 86.7%) in closed wedge HTO, indicating that open wedge HTO had 6.2% greater survival rate 10 years after surgery than did closed wedge HTO (P?=?0.002). No difference in 5-year survivorship was found between open- and closed-wedge HTO. However, the survival rate was higher in open-wedge HTOs than in closed wedge HTO at 10 years.

| S-EPMC5544741 | biostudies-literature

Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate.

Project description:Distal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market. This report describes a medial, supracondylar, V-shaped, closing-wedge distal femoral osteotomy using a locked anterolateral proximal tibial locking plate that fits anatomically to the medial side of the distal femur. This is a great option as a stable implant for a medial closing-wedge distal femoral osteotomy.

| S-EPMC4738638 | biostudies-literature

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