Anterior Closing-Wedge High Tibial Osteotomy Using Patient-Specific Cutting Guide in Chronic Anterior Cruciate Ligament–Deficient Knees

Guy, Sylvain; Khakha, Raghbir; Ollivier, Matthieu

doi:10.1016/j.eats.2022.05.006

Cited by 14 publications

(6 citation statements)

References 37 publications

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“…Patient-specific cutting guides could ease the learning curve, reduce operating time, and decrease the use of fluoroscopy. 11,24 It remains to be seen whether they can help to minimize changes in patellar height indices.…”

Section: Guy Et Almentioning

confidence: 99%

The Influence of Tibial Tubercle–Sparing Slope-Reducing Osteotomy on Patellar Height in Patients Undergoing Revision ACL Reconstruction

Guy,

Saithna,

Ferreira

et al. 2024

Am J Sports Med

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Background: A posterior tibial slope (PTS) >12° is an independent risk factor for anterior cruciate ligament (ACL) graft rupture, and a high tibial osteotomy (HTO) for slope correction can help avoid it. Management of patellar height is of major concern when performing HTO. Purpose: To evaluate the effect of tibial tubercle–sparing anterior closing-wedge osteotomy on patellar height in revision ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic revision ACLR combined with retro–tibial tubercle anterior closing-wedge HTO (ACW-HTO) between January 1, 2016, and March 31, 2021, were assessed for eligibility. Patellar height was measured on full weightbearing lateral radiographs according to the Insall-Salvati index (ISI) and Caton-Deschamps index (CDI) or frontal radiographs using the femoral patellar height index. The PTS was evaluated using the proximal anatomic axis of the tibia on standard short lateral radiographs. The delta (postoperative – preoperative) and the ratio (preoperative/postoperative) of the 3 patellar height indices and PTS were calculated. Preoperative and postoperative patellar heights were compared using independent t tests for each index. Also investigated was whether patients changed patellar height category (baja, normal, or alta) after slope osteotomy. Results: Among 475 revision ACLRs, 47 tibial tubercle–sparing ACW-HTOs were retained for analysis. No significant difference in patellar height was found between pre- and postoperative radiographs regardless of the index (preoperative – postoperative) (ISI: 1.0 ± 0.2 – 0.9 ± 0.2, P = .1729; CDI: 1.0 ± 0.2 – 1.0 ± 0.2, P = .4034; femoral patellar height index: 1.5 ± 0.2 – 1.5 ± 0.2; P = .5130). Fifteen patients (31.9%) exhibited a postoperative change in their patellar height category when measured by the ISI (6 moved up a category, 9 moved down one), and 18 patients (38.3%) changed category according to the CDI (10 moved up a category, 8 moved down one). No significant difference was found between pre- and postoperative patellar height among these patients (ISI: P = .2418; CDI: P = .3005). Conclusion: Changes in patellar height ratio are common after tibial tubercle–sparing ACW-HTO in patients undergoing revision ACLR. The clinical effect of these changes is unknown, and further study is needed to investigate whether they may result in patellofemoral symptoms.

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Section: Guy Et Almentioning

confidence: 99%

The Influence of Tibial Tubercle–Sparing Slope-Reducing Osteotomy on Patellar Height in Patients Undergoing Revision ACL Reconstruction

Guy,

Saithna,

Ferreira

et al. 2024

Am J Sports Med

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“…When elevated posterior tibial slope is identified in a patient who has previously undergone ACL reconstruction that has failed, it is important to consider an anterior closing-wedge high tibial osteotomy in order to decrease the slope and thereby reduce the risk of graft failure after revision ACL reconstruction (Fig. 3) 23,24 . In patients presenting with ACL insufficiency, elevated posterior tibial slope, and varus or valgus malalignment, a biplanar high tibial osteotomy should be considered.…”

Section: Joint Alignmentmentioning

confidence: 99%

The Principles of Knee Joint Preservation: Operative Treatment Strategies

Kraeutler,

McCulloch,

Sherman

et al. 2023

Journal of Bone and Joint Surgery

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➤ Joint alignment, meniscal status, and ligament stability are codependent factors involved in knee joint preservation, and any injury or imbalance can impact the knee articular cartilage status and can result in adverse clinical outcomes.➤ Cartilage preservation procedures in the knee will not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligamentous instability.➤ Lower-extremity varus or valgus malalignment is a risk factor for the failure of an anterior cruciate ligament (ACL) reconstruction. It represents an indication for a high tibial osteotomy or distal femoral osteotomy in the setting of failed ACL reconstruction, and may even be considered in patients who have an initial ACL injury and severe malalignment.➤ An elevated posterior tibial slope increases the risk of failure of ACL reconstruction, whereas a decreased posterior tibial slope increases the risk of failure of posterior cruciate ligament reconstruction.

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“…Weiler et al 37 reported 1 case (1.3%) of hardware infection at 5.5 months postoperatively, which was definitively treated with local debridement and removal of hardware. 1 15.3 (13-20) 8.9 (6-10) \ .01 Song (2020) 33 18.5 (17)(18)(19)(20) 8. 2020) 33 Yes Primary 18 (100) 0 (0)…”

Section: Adverse Events and Complicationsmentioning

confidence: 99%

Systematic Review of Clinical Outcomes After Proximal Tibia Anterior Closing-Wedge Osteotomy With ACL Reconstruction

Itthipanichpong,

Uppstrom,

V. Menta

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding indications and outcomes of proximal tibia anterior closing-wedge osteotomy (ACWO) with concomitant ACL reconstruction in patients with ACL tears. Purpose: To assess clinical outcomes after combined ACL reconstruction and proximal tibia ACWO. Study Design: Systematic review; Level of evidence, 4. Methods: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we performed a systematic review of the existing literature on ACWO and ACL reconstruction using PubMed (MEDLINE), Cochrane Library, Scopus, and Embase. The search phrases included “anterior closing wedge osteotomy,”“anterior closing wedge tibial osteotomy,”“anterior closing wedge proximal tibial osteotomy,”“anterior cruciate ligament,” and “revision anterior cruciate ligament.” Non-English publications and single-patient case reports were excluded. Extracted data included study details, patient demographics, patient-reported outcomes (PROs), clinical outcomes, radiographic outcomes, complications, and return-to-sport (RTS) rates. Results: A total of 6 studies with 110 patients (110 knees) were included. Two-stage ACWO and ACL reconstruction was reported in 2 studies of 78 patients (71%), while a single-stage technique was reported in 4 studies of 32 patients (29%). ACWO was performed in the setting of primary ACL tear in 23 patients (21%) and in recurrent ACL tear in 87 patients (79%). Patients demonstrated postoperative improvements in Lysholm, pivot-shift test, and side-to-side difference in anterior tibial translation. After ACWO, all studies reported mean postoperative PTS of <10° (range, 4.4°-9.2°). Of patients with available RTS data (n = 43), the same-level RTS rate ranged from 65% to 100%. A two-stage procedure reported in 1 study had a lower RTS rate (n = 13 of 20 [65%]) than that of 2 studies with single-stage procedure (n = 4 of 5 [80%] and n = 18 of 18 [100%]). The overall complication rate was 0.9% to 1.3%, and there were no reported ACL retears. Conclusion: The current evidence, which is constrained by the quantity and quality of studies, showed that ACWO with single- or two-stage ACL reconstruction in patients with ACL insufficiency and increased PTS was associated with significant improvements in PROs and high RTS rates.

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Anterior Closing-Wedge High Tibial Osteotomy Using Patient-Specific Cutting Guide in Chronic Anterior Cruciate Ligament–Deficient Knees

Cited by 14 publications

References 37 publications

The Influence of Tibial Tubercle–Sparing Slope-Reducing Osteotomy on Patellar Height in Patients Undergoing Revision ACL Reconstruction

The Influence of Tibial Tubercle–Sparing Slope-Reducing Osteotomy on Patellar Height in Patients Undergoing Revision ACL Reconstruction

The Principles of Knee Joint Preservation: Operative Treatment Strategies

Systematic Review of Clinical Outcomes After Proximal Tibia Anterior Closing-Wedge Osteotomy With ACL Reconstruction

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