Sagittal Plane Corrections around the Knee

Abstract

Stability of the knee joint depends on soft tissues integrity and bony balance in the frontal and sagittal planes during gait. Although frontal plane imbalance is a well-known knee pathology, commonly treated by high tibial osteotomy, sagittal plane imbalance is less common, with fewer and more challenging surgical treatment options. The purpose of this review is to describe the biomechanical effects of sagittal knee imbalances and to outline the indications, techniques, and outcomes of sagittal knee osteotomies. The article details the reference axes and methods to measure posterior tibial slope (PTS), the principal indicator of sagittal imbalance, and its influence on anteroposterior tibial translations and rotational stability of the joint. The authors also outline the roles of the anterior and posterior cruciate ligaments in maintaining sagittal balance, with focus on the associations between PTS and ligament deficiencies, as well as posterolateral corner injuries. Different techniques and indications of tibial osteotomy in the sagittal plane, both above and below the anterior tibial tubercle, are compared in terms of technical difficulty, clinical benefits, and complication rates. The authors conclude on the importance of understanding sagittal knee imbalance, particularly in cases of ligament deficiencies, where the deformity can be the primary cause for lesions. Surgeons must identify the underlying deformities associated with sagittal imbalance, which can be recognized on weight-bearing X-rays and magnetic resonance imaging scans. Different techniques of sagittal osteotomies offer effective treatments for certain indications and should be considered in selected cases for unstable knees with ligament lesions.

Slope-Correction Osteotomy with Lateral Extra-articular Tenodesis and Revision Anterior Cruciate Ligament Reconstruction Is Highly Effective in Treating High-Grade Anterior Knee Laxity

“…There are some technical notes and case reports on slope-correction osteotomy and revision ACLR, but the only case series available were published by Dejour et al, 5 who studied 9 cases, and Sonnery-Cottet et al, 30 who studied 5 cases. 4,6,16,30,35 In line with the studies by Dejour et al and Sonnery-Cottet et al, our study showed very good clinical results and few complications.…”

“…Biomechanical studies have demonstrated that a high force on the ACL may contribute to ACLR failure. 17,38 There are a number of recommendations for surgically treating an elevated PTS in patients undergoing revision ACLR, 4,27,34 but a large case series has not been published to date.…”

Adding a modified Lemaire procedure to ACLR in knees with severe rotational knee instability does not compromise isokinetic muscle recovery at the time of return-to-play

“…Anteroposterior knee laxity was assessed using ‘static’ and ‘dynamic’ measurements of anterior tibial translation (ATT) on ‘true lateral view’ radiographs, superimposing the posterior femoral condyles. The ATT was defined as the distance between two lines parallel to the posterior tibial cortex: the first tangent to the posterior aspect of the medial tibial plateau, and the second tangent to the posterior femoral condyles [ 12 , 35 ], Static ATT was measured on monopodal weight bearing radiographs with the knee flexed at 20°. Dynamic ATT was measured using the Telos™ stress radiography device (Metax, Hungen, Germany) with a constant anterior force of 150 N, and the side-to-side difference between the injured knee and healthy knee was calculated.…”

Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results

“…Today, the most established technique was described by Lecuire et al in 1980. 45,47,49,51,52 In so doing, the tibial tuberosity is detached first and fixed back after wedging, acting like a "bioplate. "…”