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

Recently, the bony anatomy of the proximal tibia has gained strong interest, particularly in the cruciate ligament deficient knee. Regarding the anterior cruciate ligament (ACL), several studies outlined that a steep tibial slope (≥12 degrees) contributes to early failures after ACL reconstruction. As a consequence, the first clinical reports are available on slope reducing osteotomies in revision ACL surgery. Vice versa, biomechanical as well as clinical reports suggest that a flat slope increases the load on the posterior cruciate ligament (PCL) and might contribute to a poor result after PCL reconstruction. Since many decades, slope increasing anterior open wedge osteotomies are used to treat a symptomatic genu recurvatum. The aim of the current report is to describe different surgical techniques and report our first clinical experience of an anterior open wedge osteotomy as a sole procedure in chronic PCL deficient knees with a flat tibial slope. In six cases, a mean preoperative slope of 3.7 degrees (range = 2–5 degrees) was increased to a mean of 11.5 degrees (range = 9–13 degrees). There was one case with a delayed bone healing, which was successfully treated without loss of correction by revision internal fixation and bone grafting.

STUDY TO EVALUATE THE ROLE OF HIGH TIBIAL OSTEOTOMY (HTO) FIXED WITH ANGLE STABLE PLATE IN TREATMENT OF OSTEOARTHRITIS OF KNEE AT NMCH, ROHTAS, BIHAR

Background: Osteoarthritis is more common in females. It is because osteoarthritis in post-menopausal women is associated with higher body weight, higher subcutaneous fat, calcium deficiency and weaker muscles linked to hormonal changes. The purpose of this study was to evaluate the role of high tibial osteotomy fixed with angle stable plate in treatment of osteoarthritis of knee. Material and Methods: In our study 10 cases were operated by modified coventry technique, 10 cases were operated by open wedge osteotomy with non locking plates and bone graft and 104 cases were operated by medial open wedge osteotomy and iliac graft secured by locking plate. In these cases full weight bearing was allowed at 8 week, 6 week and 3rd post operative day respectively. Radiographical analysis include post operatively change in tibio-femoral angle. Mean follow up of these cases was 2 year. Results: In our study thee knee pain and function score were significantly improved (p value <0.001). The average pain score preoperatively was 1 8± 7(the maximum pain score for pain is 50) and post-operatively was 44±5. According to the grading used for functional assessment in knee scores there was definite improvement in the function of cases 122 (98.38%) at 2 yrs. The preoperatively mean functional knee score in of 110 cases (88.7%) cases was 28.86 (the maximum functional knee score is 100) and postoperatively was 70.45. There is correction in tibiofemoral angle (mean preoperative and postoperative tibiofemoral angle was 5.2±1.5 degrees varus and 5.8±1.3 degrees valgus respectively). Conclusion: There was definite improvement in the pain and function of the knee after the correction of the deformity (P value <0.001). The results of high tibial osteotomy in 88.23 percentage knees were rated as excellent. 104 out of these 124 cases were fix by locking plates. 2 cases had poor results due to excessive over correction and associated comorbidities. There is a definite correlation between the postoperative valgus obtained and relief in the pain.