scholarly journals Tibial Tubercle–Sparing Anterior Closing Wedge Osteotomy With Cross-Screw Fixation to Correct Pathologic Posterior Tibial Slope

2021 ◽  
Vol 10 (3) ◽  
pp. e897-e902
Author(s):  
CPT Christian A. Cruz ◽  
CPT Mitchell C. Harris ◽  
CPT Jeffery L. Wake ◽  
CPT Gregory E. Lause ◽  
Brian J. Mannino ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Tubercle ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Posterior Tibial ◽  
Closing Wedge

Determining the Ratio of Wedge Height to Degree of Correction for Anterior Tibial Closing Wedge Osteotomies for Excessive Posterior Tibial Slope

2021 ◽  
pp. 036354652110441
Author(s):  
Courtney A. Quinn ◽  
Mark D. Miller ◽  
Robert D. Turk ◽  
Daniel C. Lewis ◽  
Christopher M. Gaskin ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Posterior Tibial ◽  
Closing Wedge ◽  
Anterior Tibial ◽  
Slope Correction ◽  
3D Printed

Background: Anterior closing wedge osteotomy of the proximal tibia may be considered in revision anterior cruciate ligament (ACL) reconstruction surgery for patients with excessive posterior tibial slope (PTS). Purpose: (1) To determine the ratio of wedge thickness to degrees of correction for supratubercle (ST) versus transtubercle (TT) osteotomies for anterior closing wedge osteotomies and (2) to evaluate the accuracy of ST and TT osteotomies in achieving slope correction. Study Design: Controlled laboratory study. Methods: The computed tomography (CT) scans of 38 knees in 37 patients undergoing revision ACL reconstruction were used to simulate both ST and TT osteotomies. A 10° wedge was simulated in all CT models. The height of the wedge along the anterior tibia was recorded for each of the 2 techniques. The ratio of wedge height to achieved degree of correction was calculated. ST and TT osteotomies were performed on 3-dimensional (3D)–printed tibias of the 12 patients from the study group with the greatest PTS, after the desired degree of correction was determined. Pre- and postosteotomy slopes were measured for each tibia, and the actual change in slope was compared with the intended slope correction. Results: According to CT measurements, the ratio of wedge height to degree of correction was 0.99 ± 0.07 mm/deg for the ST osteotomy and 0.83 ± 0.06 mm/deg for the TT osteotomy ( P < .001). When these ratios were used to perform simulated osteotomies on the twelve 3D-printed tibias, the mean slope correction was within 1° to 2° of the intended slope correction, regardless of osteotomy location (ST or TT) or whether slope was measured on the medial or lateral plateau. The ST technique tended to undercorrect and the TT technique tended to overcorrect. Conclusion: When anterior tibial closing wedge osteotomies were removed to correct excessive PTS, removing a wedge with a ratio of 1 mm of wedge height for every 1° of intended correction for an ST technique and a ratio of 0.8 mm to 1° for a TT technique resulted in overall average slope correction within 1° to 2° of the target. Clinical Relevance: The calculated ratios will allow clinicians to more accurately correct PTS when performing anterior closing wedge tibial osteotomy.

Posterior Tibial Slope is Increased in Patients With Tibial Tubercle Fractures and Osgood-Schlatter Disease

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Evan Drew Sheppard ◽  
Pradip Ramamurti ◽  
Seth Stake ◽  
Monica Stadecker ◽  
Md Sohel Rana ◽  
...  
Keyword(s):  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Tubercle ◽  
Posterior Tibial

scholarly journals ACL rupture and posterior tibial slope - how do we handle this?

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0028
Author(s):  
Jörg Dickschas
Keyword(s):  
Range Of Motion ◽  
Acl Reconstruction ◽  
Plate Osteosynthesis ◽  
Critical Role ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Tubercle ◽  
Tibial Osteotomy ◽  
Posterior Tibial ◽  
Closed Wedge

Aims and Objectives: In recent publications on acl-ruptures and especially on failure of acl reconstruction there comes a strong focus on posterior tibial slope (PTS). ACL reconstructions with a PTS of >12° have an 8 times higher risk of recurrent instability and reconstruction failure. But many questions stay unclear so far-When do we have to correct the tibial slope? How do we correct it? What about simultaneous frontal axis deviations? In this publication a new algorhythm is presented. Materials and Methods: The following aspects have to be evaluated Is the PTS the only dimension of the deformity or do we have to correct the frontal axis simultaneuosly? Performing a anterior closed wedge extension osteotomy: when do we go distal the tuberosity and when do we perform a tuberosity osteotomy and use it as “bio plating”? Osteosynthesis only screws or always plate? Are there indications for a contineous correction, f.e. with a hexapod? Whats the role of preoperative range of motion of the knee (especially extension)? Always tunnel filling in the same surgery? What about PCL insufficiency and low PTS? Results: An algorhythm is presented giving a treatment path for the different questions mentioned. The procedures are shown step by step in clinical examples and surgery documentation for every pathway. Conclusion: Posterior tibial slope plays an critical role in ACl recontruction. In primary ACl tear a slope correction is probably not indicated. In ACL reconstruction failure a analysis of the PTS needs to be done and correction needs to be discussed. Simultaneuous varus deormities need to be corrected by openwedge valgisation - extension high tibial osteotomy (HTO), while as isolated PTS elevation is subject to an anterior closed wedge extension HTO. Preoperative range of motion needs to be respected not to create hyperextension. Osteosynthesis can be perormed with only screws using the tibial tubercle as “bio-plating”. In cases of former bone-tendeon-bone (BTB) ACL reconstruction a tibial tubercle osteotomy should be avoided and a infratuberositeal osteotomy should be performed and stabilized with plate osteosynthesis. In severe postraumatic cases contineous correction of the slope with fixateur externe, f.e. hexapodes, needs to be performed.

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

2019 ◽  
Vol 8 (10) ◽  
pp. e1105-e1109 ◽  
Author(s):  
Carlos Mesquita Queiros ◽  
Felipe Galvao Abreu ◽  
Joao Luis Moura ◽  
Guilherme Venturi de Abreu ◽  
Thais Dutra Vieira ◽  
...  
Keyword(s):  
Tibial Tubercle ◽  
Wedge Osteotomy ◽  
Posterior Slope ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge ◽  
Slope Correction

Clinical Outcomes of Closing- and Opening-Wedge High Tibial Osteotomy for Treatment of Anteromedial Unicompartmental Knee Osteoarthritis

2018 ◽  
Vol 32 (08) ◽  
pp. 758-763 ◽  
Author(s):  
Jiangfeng Lu ◽  
Shiyu Tang ◽  
Yanru Wang ◽  
Yao Li ◽  
Chang Liu ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Functional Outcomes ◽  
Tibial Slope ◽  
Joint Space ◽  
Posterior Tibial Slope ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Posterior Tibial

AbstractThis article compares the long-term outcomes of closing-wedge osteotomy (CWO) and opening-wedge osteotomy (OWO) in the treatment of unicompartmental medial osteoarthritis with varus deformity. This study included 79 patients who underwent high tibial osteotomy (HTO) between 2002 and 2008. Pre- and postoperative radiography and computed tomography were used to evaluate the posterior tibial slope, the patellar height, the tibiofemoral angle, and the lateral and medial tibiofemoral joint space. Pre- and postoperative severity of arthritis was assessed with the Kellgren–Lawrence grading system. Pre- and postoperative American Knee Society (AKS) score and Lysholm Knee Score (LKS) were determined to evaluate functional outcomes. The duration of follow-up was 86.1 ± 6.2 months. Postoperatively, at the most recent follow-up, there was a slight increase in the size of the medial tibiofemoral joint space after CWO and OWO, which reflected a decrease in stress on the medial compartment and manifested as a significant improvement in the AKS knee and function scores and the LKS. OWO increased the posterior tibial slope as compared with the preoperative value, while CWO reduced the posterior tibial slope. CWO and OWO for HTO resulted in similar functional outcomes. OWO was associated with patella infera and more severe patellofemoral arthritis, while CWO was associated with a greater severity of lateral tibiofemoral arthritis.

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