Effect of Anterior Tibial Closing Wedge Osteotomy on Coronal Tibial Alignment in Relation to Preoperative Medial Proximal Tibial Angle and Wedge Height

Abstract

Background: The posterior tibial slope has been identified as an anatomic risk factor for anterior cruciate ligament insufficiency and reruptures after anterior cruciate ligament reconstruction. Anterior tibial closing wedge osteotomy for correction of sagittal plane deformities has the potential to cause an unintended change in coronal plane alignment. Purpose: To evaluate the effects of anterior tibial closing wedge osteotomies for correction of posterior tibial slope on coronal plane alignment using an infratuberosity surgical approach and to identify predictive factors for a change in medial proximal tibial angle (MPTA). Study Design: Case series; Level of evidence, 4. Methods: This study reports on retrospectively obtained data from radiographic measurements of 38 anterior tibial closing wedge osteotomies. All patients underwent revision anterior cruciate ligament reconstruction and had undergone ≥1 previous anterior cruciate ligament reconstruction. In all patients, an infratuberosity approach was used with angular stable plate fixation. Pre- and postoperative radiographs were examined retrospectively to detect changes in the sagittal and coronal plane alignment (posterior tibial slope and MPTA). A multivariate regression analysis was used to identify predictors for a change in MPTA. Results: The study group consisted of 14 women and 24 men whose mean ± SD age at the index procedure was 31.6 ± 8.7 years (range, 17-51 years). Posterior tibial slope decreased significantly (by 7.2° ± 2.3°; P < .001) from 14.6° ± 2.0° preoperatively to 7.4° ± 2.1° postoperatively. MPTA decreased significantly by 1.3° ± 1.5° ( P = .005) from pre- to postoperative measurement. Mean wedge height was 9.3 ± 1.1 mm. A lower preoperative MPTA (coefficient = 0.32; P = .017; 95% CI, 0.06-0.59) and larger wedge height (coefficient = 0.48; P = .029; 95% CI, 0.05-0.9) were significant predictive factors for a decrease in MPTA. Conclusion: Anterior tibial closing wedge osteotomy for posterior tibial slope reduction resulted in a slight but significant decrease of the MPTA in the coronal plane. These changes were dependent on the preoperative MPTA and the wedge height.

Osteotomy for treating knee osteoarthritis from 2012 to 2023: Bibliometric analysis and global trends

“…However, it is technically challenging and carries a risk of peroneal nerve injury, sometimes requiring multiple osteotomies and potentially causing limb shortening. [ 24 ] In contrast, MOWHTO corrects both coronal and sagittal force lines, reduces the risk of peroneal nerve injury, and offers intraoperative simplicity. However, it may necessitate bone grafting, which poses a risk of delayed or non-healing, a low patella, increased joint pressure, reduced postoperative joint stability, and a higher deformity recurrence rate.…”

Three-Dimensional Hinge Axis Orientation Contributes to Simultaneous Alignment Correction in All Three Anatomical Planes in Opening-Wedge High Tibial Osteotomy

“…While it is currently unknown whether such values of imprecision affect clinical outcomes significantly, the cumulative imprecision in all 3 dimensions might lead to the reported unintended corrections in nontargeted planes in the execution of uniplanar osteotomies. 12 , 40 Nonetheless, these observations might render 2D fluoroscopy insufficient if control of HA orientation in 3D space is pursued to prevent unintended corrections in nontargeted anatomical reference planes, or to simultaneously change alignment in all 3 anatomical reference planes of a clinically relevant coordinate system.…”