Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner View Full Text


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Article Info

DATE

2010-11-24

AUTHORS

Eugenio Savarese, Salvatore Bisicchia, Rocco Romeo, Annunziato Amendola

ABSTRACT

High tibial osteotomy (HTO) is a surgical procedure used to change the mechanical weight-bearing axis and alter the loads carried through the knee. Conventional indications for HTO are medial compartment osteoarthritis and varus malalignment of the knee causing pain and dysfunction. Traditionally, knee instability associated with varus thrust has been considered a contraindication. However, today the indications include patients with chronic ligament deficiencies and malalignment, because an HTO procedure can change not only the coronal but also the sagittal plane of the knee. The sagittal plane has generally been ignored in HTO literature, but its modification has a significant impact on biomechanics and joint stability. Indeed, decreased posterior tibial slope causes posterior tibia translation and helps the anterior cruciate ligament (ACL)-deficient knee. Vice versa, increased tibial slope causes anterior tibia translation and helps the posterior cruciate ligament (PCL)-deficient knee. A review of literature shows that soft tissue procedures alone are often unsatisfactory for chronic posterior instability if alignment is not corrected. Since limb alignment is the most important factor to consider in lower limb reconstructive surgery, diagnosis and treatment of limb malalignment should not be ignored in management of chronic ligamentous instabilities. This paper reviews the effects of chronic posterior instability and tibial slope alteration on knee and soft tissues, in addition to planning and surgical technique for chronic posterior and posterolateral instability with HTO. More... »

PAGES

1-17

References to SciGraph publications

  • 1996-03. High tibial osteotomy alone or combined with ligament reconstruction in anterior cruciate ligament-deficient knees in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 1990. Diagnostic Evaluation of the Knee in NONE
  • 2001-05. Open wedge tibial osteotomy by hemicallotasis for medial compartiment osteoarthritis in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 1999-09. Proprioception in the posterior cruciate ligament deficient knee in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2004-08-03. Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2005-11-16. The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2002-01-31. Posterolateral aspect and stability of the knee joint. II. Posterolateral instability and effect of isolated and combined posterolateral reconstruction on knee stability: a biomechanical study in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2006-06-24. Stress radiography to measure posterior cruciate ligament insufficiency: a comparison of five different techniques in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2006-03. The Role of Core Stability in Athletic Function in SPORTS MEDICINE
  • 2006-07-13. High tibial osteotomy for osteoarthritis of the knee with varus deformity utilizing the hemicallotasis method in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2006-09-01. Magnetic resonance imaging of posterior cruciate ligament injuries: a new classification of traumatic tears in LA RADIOLOGIA MEDICA
  • 1998-03. Proprioception of the Ankle and Knee in SPORTS MEDICINE
  • 2005-04-02. Assessment of posterior stability in total knee replacement by stress radiographs in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2001-10-16. High tibial osteotomy in knee instability: the rationale of treatment and early results in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2004-03-25. Tibial slope changes following dome-type high tibial osteotomy in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2003-09-11. Basic principles for surgical reconstruction of the PCL in chronic posterior knee instability in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 1984-11. Posterior Cruciate Ligament Insufficiency in SPORTS MEDICINE
  • 2005-10-14. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2010-03-13. Results of isolated posterolateral corner reconstruction in JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY
  • 2006-08-04. Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2008-03. Revision high tibial osteotomy with the Taylor spatial frame for failed opening-wedge high tibial osteotomy in JOURNAL OF ORTHOPAEDIC SCIENCE
  • 2000-09. Diagnostik und Therapie der frischen und chronischen hinteren Kreuzbandläsion in DER CHIRURG
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s10195-010-0120-0

    DOI

    http://dx.doi.org/10.1007/s10195-010-0120-0

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1051304234

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/21107635


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    36 schema:description High tibial osteotomy (HTO) is a surgical procedure used to change the mechanical weight-bearing axis and alter the loads carried through the knee. Conventional indications for HTO are medial compartment osteoarthritis and varus malalignment of the knee causing pain and dysfunction. Traditionally, knee instability associated with varus thrust has been considered a contraindication. However, today the indications include patients with chronic ligament deficiencies and malalignment, because an HTO procedure can change not only the coronal but also the sagittal plane of the knee. The sagittal plane has generally been ignored in HTO literature, but its modification has a significant impact on biomechanics and joint stability. Indeed, decreased posterior tibial slope causes posterior tibia translation and helps the anterior cruciate ligament (ACL)-deficient knee. Vice versa, increased tibial slope causes anterior tibia translation and helps the posterior cruciate ligament (PCL)-deficient knee. A review of literature shows that soft tissue procedures alone are often unsatisfactory for chronic posterior instability if alignment is not corrected. Since limb alignment is the most important factor to consider in lower limb reconstructive surgery, diagnosis and treatment of limb malalignment should not be ignored in management of chronic ligamentous instabilities. This paper reviews the effects of chronic posterior instability and tibial slope alteration on knee and soft tissues, in addition to planning and surgical technique for chronic posterior and posterolateral instability with HTO.
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