Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

Abstract

Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL) associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn’t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

The Q angle analysis, during resistance training, on open kinematics chain and intermidiate closed kinematics chain, through photogrametry

“…It is important not to move to a zone of pathologic valgus, or not suffer a injuring deviation, as shows a possibility of working the femoral quadriceps without compromising the articulation of these individuals, reducing capsule stress and, consequently, the possibility of ligament injuries after sometime, making the work more efficient and less painful. (ALBUQUERQUE et al 2003).…”