Posteromedially placed plates with anterior staple reinforcement are not successful in decreasing tibial slope in opening-wedge proximal tibial osteotomy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-09-09

AUTHORS

Chase S. Dean, Jorge Chahla, Lauren M. Matheny, Tyler R. Cram, Samuel G. Moulton, Grant J. Dornan, Justin J. Mitchell, Robert F. LaPrade

ABSTRACT

Purpose To document the effectiveness of a novel technique to decrease tibial slope in patients who underwent a proximal opening-wedge osteotomy with an anteriorly sloped plate placed in a posteromedial position. The hypothesis was that posteromedial placement of an anteriorly sloped osteotomy plate with an adjunctive anterior bone staple on the tibia would decrease, and maintain, the tibial slope correction at a minimum of 6 months following the osteotomy.MethodsAll patients who underwent biplanar medial opening-wedge proximal tibial osteotomy with anterior staple augmentation to decrease sagittal plane tibial slope were included, and data were collected prospectively and reviewed retrospectively. Indications for decreasing tibial slope included medial compartment osteoarthritis with at least one of the following: ACL deficiency, posterior meniscus deficiency, or flexion contracture. Preoperative, immediate postoperative, and 6-month postoperative radiographs were reviewed.ResultsTwenty-one patients (14 males and 7 females) were included in the study with a mean age of 36.5 years. Intrarater and interrater reliability of slope measurements were excellent at all time points (ICC ≥ 0.94, ICC ≥ 0.85). The osteotomy resulted in an average tibial slope decrease of 0.8 from preoperative (n.s.). At 6-month postoperative, average slope was not significantly different from time-zero postoperative slope (mean = +0.2°).ConclusionsThe most important finding of this study was that posteromedial placement of an anteriorly angled osteotomy plate augmented with an anterior staple during a biplanar medial opening-wedge proximal tibial osteotomy did not decrease sagittal plane tibial slope. Whether a staple was effective in maintaining tibial slope from time zero to 6 months postoperatively was unable to be assessed due to no significant change in tibial slope from the preoperative postoperative states. The results of this study note that current osteotomy plate designs and surgical techniques are not effective in decreasing sagittal plane tibial slope.Level of evidenceIV. More... »

PAGES

3687-3694

References to SciGraph publications

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  • 2015-10-05. Osteotomy configuration of the proximal wedge and analysis of the affecting factors in the medial open-wedge high tibial osteotomy in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00167-016-4311-y

    DOI

    http://dx.doi.org/10.1007/s00167-016-4311-y

    DIMENSIONS

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    PUBMED

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    34 schema:description Purpose To document the effectiveness of a novel technique to decrease tibial slope in patients who underwent a proximal opening-wedge osteotomy with an anteriorly sloped plate placed in a posteromedial position. The hypothesis was that posteromedial placement of an anteriorly sloped osteotomy plate with an adjunctive anterior bone staple on the tibia would decrease, and maintain, the tibial slope correction at a minimum of 6 months following the osteotomy.MethodsAll patients who underwent biplanar medial opening-wedge proximal tibial osteotomy with anterior staple augmentation to decrease sagittal plane tibial slope were included, and data were collected prospectively and reviewed retrospectively. Indications for decreasing tibial slope included medial compartment osteoarthritis with at least one of the following: ACL deficiency, posterior meniscus deficiency, or flexion contracture. Preoperative, immediate postoperative, and 6-month postoperative radiographs were reviewed.ResultsTwenty-one patients (14 males and 7 females) were included in the study with a mean age of 36.5 years. Intrarater and interrater reliability of slope measurements were excellent at all time points (ICC ≥ 0.94, ICC ≥ 0.85). The osteotomy resulted in an average tibial slope decrease of 0.8 from preoperative (n.s.). At 6-month postoperative, average slope was not significantly different from time-zero postoperative slope (mean = +0.2°).ConclusionsThe most important finding of this study was that posteromedial placement of an anteriorly angled osteotomy plate augmented with an anterior staple during a biplanar medial opening-wedge proximal tibial osteotomy did not decrease sagittal plane tibial slope. Whether a staple was effective in maintaining tibial slope from time zero to 6 months postoperatively was unable to be assessed due to no significant change in tibial slope from the preoperative postoperative states. The results of this study note that current osteotomy plate designs and surgical techniques are not effective in decreasing sagittal plane tibial slope.Level of evidenceIV.
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    42 MethodsAll patients
    43 ResultsTwenty
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    45 age
    46 anterior bone staple
    47 anterior staple
    48 anterior staple augmentation
    49 anterior staple reinforcement
    50 augmentation
    51 average slope
    52 average tibial slope decrease
    53 biplanar medial opening-wedge proximal tibial osteotomy
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    73 mean age
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    78 minimum
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    84 osteoarthritis
    85 osteotomy
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    91 plate
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    93 point
    94 position
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    98 postoperative
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    101 postoperative state
    102 preoperative postoperative states
    103 proximal opening-wedge osteotomy
    104 proximal tibial osteotomy
    105 purpose
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    107 reinforcement
    108 reliability
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    110 sagittal plane tibial slope
    111 significant changes
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    114 slope decreases
    115 slope measurements
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