Measurement of tibial slope angle after medial opening wedge high tibial osteotomy: case series

Abstract

CONTEXT AND OBJECTIVE: In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. DESIGN AND SETTING:Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, Brazil. METHODS:Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. RESULTS:There was an average increase in tibial slope angle after surgery of 2.38° (95% confidence interval: ± 0.73°). There was no correlation (r = -0.28) between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13).CONCLUSION: Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis. RESUMO CONTEXTO E OBJETIVO:No passado, alterações no ângulo de inclinação ântero-posterior do planalto tibial (AIAPPT), conhecido como "slope", não eram levadas em consideração no planejamento e avaliação das osteotomias, e o sucesso da osteotomia proximal tibial era relacionado ao grau de correção do ângulo femoro-tibial e ao alinhamento obtido. O objetivo foi mensurar a alteração no AIAPPT após a osteotomia proximal de abertura de cunha medial da tíbia e verificar o efeito da variação angular do AIAPPT sobre os resultados clínicos. TIPO DE ESTUDO E LOCAL: MÉTODOS:Foram incluídos 28 pacientes, e um total de 31 joelhos. Foi mensurado o AIAPPT baseado no eixo anatômico proximal tibial na radiografia lateral da tíbia no pré e no pós-operatório. A avaliação clínica foi realizada através do escore de Lysholm para joelho. RESULTADOS:Houve um aumento do AIAPPT após a cirurgia em média de 2,38° (± 0,73°; intervalo de confiança, IC 95%). Não houve correlação (r = -0,28) entre os resultados obtidos pelo escore de Lysholm pós-operatório e a diferença do AIAPPT pós e pré-operatório (P = 0,13).CONCLUSÃO: A osteotomia valgizante da tíbia proximal com cunha de abertura medial levou a um pequeno aumento no AIAPPT. Não houve correlação entre o aumento do slope tibial e os resultados clínicos a curto prazo após a osteotomia proximal da tíbia. Outros estudos clínicos são necessários para comprovar se uma osteotomia de extensão ou de flexão pode trazer benefício ao paciente com artrose unicompartimental do joelho.

Efficacy of Tibial Proximal Osteotomy in Correction of Lower Limb Alignment Indexes in Patients with Osteoarthritis in Medial Compartment of Knee

“…Most reports have shown about 80% satisfactory results existing within 5 years follow up (3). Similar to finding of previous studies, there were significant improvements in malalignment after surgery including: anatomical and mechanical limb angles, medial proximal tibial angle, joint line angle and location of weight bearing line toward the central point of the tibial plateau (24,25). We could obtain similar result because with accomplishment of surgery, knee was preserved; pain decreased, prevented early osteoarthritis and consequently life style improved.…”

Importance of the different posterolateral knee static stabilizers: biomechanical study

“…Before the performance of the tests, the soft parts around the knee were removed, preserving all the capsulo-ligamentary structures, the popliteus muscle with its tendon and the peripatellar portion of the quadriceps muscle with its tendon 10–14. The fibula was fastened to the tibia at a distance of 4 cm distal to the proximal extremity of the fibula, using a 4.5 mm diameter cortical screw13–15, and afterwards the fibula was sectioned 2 cm distal to the screw.…”

“…New surgical procedures can be developed based on this knowledge, making the treatments of these lesions more effective and reestablishing articular stability 10–11…”

Placement-induced effects on high tibial osteotomized construct - biomechanical tests and finite-element analyses

“…For the T-shaped plate, the anteromedial and medioposterior regions have been selected as the sites of plate placement [ 6 , 14 – 16 ]. The placement-induced effects of HTO plates have been investigated in terms of the tibiofemoral loads and the tibial slope [ 15 , 17 – 19 ]. Blecha et al proposed that the contact sites of the tibiofemoral joint occur at the more anterior region for up-right standing with a lower flexion angle [ 6 ].…”