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Biological Bone Plate and Iliac Bone Autograft for Proximal Tibial Slope Changing Osteotomy in Genu Recurvatum.

ABSTRACT: Genu recurvatum (GR) is defined as knee hyperextension greater than 5°, with the normal physiological accepted limits of up to 10 to 15° of extension. Physiological GR is commonly bilateral, symmetrical, and mostly asymptomatic. Pathologic GR is usually asymmetric, symptomatic, and can be congenital or acquired. Acquired GR can be classified according to the origin of the deformity into pure osseous, soft tissue, and combined types. Symptomatic GR can present with anterior knee pain and/or instability. Surgery is generally indicated in symptomatic (pain, instability), pathologic GR with an associated causative correctible deformity (bony, soft tissue, or a combination of both). Tibial slope-reversing osteotomy is indicated for the osseous or mixed types where there is inverted tibial slope. Varu-correcting osteotomy is indicated in the posttraumatic soft-tissue type (posterior and lateral soft-tissue injury as in knee dislocation), the aim of osteotomy is to protect the reconstructed ligaments. No role for osteotomy in the nontraumatic soft tissue type (gradual stretching of the posterior structures). In this article, we describe a technique to correct a unilateral genu recurvatum deformity with inverted tibial slope, mostly due to Osgood-Schlatter disease. Correction is done by performing an anterior open-wedge osteotomy of the proximal tibia and impaction of 2 wedges of autogenous iliac bone grafts within the osteotomy. The proximal portion of the tibia is cut in the coronal plan and is used as a biologic plate for fixation with no need for additional hardware (e.g., plate or staples) for fixation of the osteotomy.

SUBMITTER: Zein AMN

PROVIDER: S-EPMC9244464 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:In performing medial open-wedge high tibial osteotomy, it is recommended not to alter the posterior tibial slope. However, it remains unclear whether the osteotomy inclination angle affects the posterior tibial slope in the sagittal plane. This study aimed to verify how anterior or posterior osteotomy inclination angle affects the tendency of change in the posterior tibial slope and to conduct quantitative analysis of the extent to which the posterior tibial slope changes according to the degree of the osteotomy inclination angle change in MOWHTO. Computed tomography images of 30 patients who underwent MOWHTO were collected. Three-dimensional models of preoperative original tibia were reconstructed, and virtual osteotomies were performed. The sagittal osteotomy inclination angles formed by the osteotomy line and the medial tibial plateau line were classified as positive in case of anteriorly inclined osteotomy and negative in case of posteriorly inclined osteotomy. Thirteen osteotomies were performed for each tibial model at intervals of 5° from - 30° to 30°. The posterior tibial slope was assessed, and the proportional relationship between the sagittal osteotomy inclination angle and the posterior tibial slope change was analyzed. The posterior tibial slope changed significantly after osteotomy (p < 0.001), except for the cases where the sagittal osteotomy inclination angles were 5°, 0°, and - 5°. Anteriorly and posteriorly inclined osteotomy caused increase and decrease in the posterior tibial slope, respectively. As the inclination angle increased by 1°, the posterior tibial slope increased by 0.079° in anterior inclination osteotomy, while in posterior inclination osteotomy, as the inclination angle decreased by 1°, the posterior tibial slope decreased by 0.067°. The osteotomy inclination angle in the sagittal plane significantly affected the posterior tibial slope. When there was an inclination angle occurred between the osteotomy line and the medial tibial plateau line in the sagittal plane, the posterior tibial slope changed after MOWHTO. The posterior tibial slope tended to increase in anteriorly inclined osteotomy and decrease in posteriorly inclined osteotomy. The change in the posterior tibial slope was proportionally related to the absolute value of the osteotomy inclination angle.

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Biological Bone Plate and Iliac Bone Autograft for Proximal Tibial Slope Changing Osteotomy in Genu Recurvatum.

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