Dataset Information

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

ABSTRACT: 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.

SUBMITTER: Rodriguez AN

PROVIDER: S-EPMC8719226 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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

Rodriguez Ariel N AN Schreier Foley F Carlson Gregory B GB LaPrade Robert F RF

Arthroscopy techniques 20211116 12

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 ...[more]

PMID: 35004153

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Project description:A decreased posterior tibial slope has been associated with an increased risk of posterior cruciate ligament failure, anterior knee pain, and premature knee osteoarthritis. Trauma is a common cause of osseous genu recurvatum. Surgical management is recommended to correct the tibial slope and prevent knee pain and osteoarthritis progression. This article discusses our preferred treatment using a proximal tibial opening-wedge osteotomy for surgical management of genu recurvatum secondary to significant anterior tibial slope. Technique Video Video 1 Once the arthroscopic evaluation of the knee has been done using the standard medial and lateral portals, a 15-cm longitudinal anteromedial skin incision is made in line with the medial border of the patellar tendon, raising full-thickness subcutaneous flaps. Medial dissection is performed, and the periosteum under the medial collateral ligament is elevated to the posteromedial corner of the tibia. Lateral dissection is accomplished carefully with the detachment of the tibialis anterior. Then, the patellar tendon is isolated, and the tibial tuberosity is exposed. An osteotomy of the tibial tubercle is performed (with a bone block of 6-8 cm long and should reach into the metaphyseal bone). Two guide pins are introduced anteriorly approximately 4 to 5 cm below the joint line directed posteriorly and aimed at the level of the insertion of the posterior cruciate ligament. These pins are used as guides for performing the osteotomy. After correct placement is confirmed by fluoroscopy, an osteotome is advanced. Great care is taken not to violate the posterior cortex while using the osteotome (up to 1 cm of the posterior cortex must be preserved to obtain a solid posterior hinge). Opening of the osteotomy is achieved by the sequential introduction of several osteotomes. The osteotomy is then widened using a spreader device until the desired tibial slope is achieved. The spreader device is left in place for a few minutes to allow for stress relaxation of the posterior cortex. The appropriate medial locking plate is fixed just medial to the tibial tuberosity osteotomy. The osteotomy is then packed with iliac crest autograft bone graft. The tibial tuberosity is proximally advanced by the same amount as the opening wedge osteotomy, to avoid a patella infera and to act as a biologic plate. Final fluoroscopic images are obtained to confirm osteotomy position, hardware position, and adequate bone grafting.

Dataset Information

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

Publications

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

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