Effects of Anterior Closing Wedge Tibial Osteotomy on Anterior Cruciate Ligament Force and Knee Kinematics

Yamaguchi, Kent T.; Cheung, E.; Markolf, Keith L.; Boguszewski, Daniel V.; Mathew, Justin; Lama, Christopher J; McAllister, David R.; Petrigliano, Frank A.

doi:10.1177/0363546517736767

Cited by 74 publications

(82 citation statements)

References 35 publications

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“…Micromotion at the posterior region in the wedge increased and led to increased posterior tibial slope. The ACL force increased when the posterior tibial slope increased and indicated good agreement with the results of the previous study in which PCL force decreased [50][51][52].…”

Section: Discussionsupporting

confidence: 89%

Biomechanical effect of a lateral hinge fracture for a medial opening wedge high tibial osteotomy: finite element study

et al. 2020

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Background: This study aimed to investigate the biomechanical effect on the Takeuchi classification of lateral hinge fracture (LHF) after an opening wedge high tibial osteotomy (HTO). Methods: We performed an FE simulation for type I, type II, and type III in accordance with the Takeuchi classification. The stresses on the bone and plate, wedge micromotion, and forces on ligaments were evaluated to investigate stress-shielding effect, plate stability, and biomechanical change, respectively, in three different types of LHF HTO and with the HTO without LHF model (non-LHF) models.Results: The greatest stress-shielding effect and wedge micromotion were observed in type II LHF (distal portion fracture). The type II and type III (lateral plateau fracture) models exhibited a reduction in PCL force and an increase in ACL force compared with the HTO without LHF model. However, the type I (osteotomy line fracture) and HTO without LHF models did not exhibit a significant biomechanical effect. This study demonstrates that Takeuchi type II and type III LHF models provide unstable structures compared with the type I and HTO without LHF models. Conclusions: HTO should be performed while considering a medial opening wedge HTO to avoid a type II and type III LHF as a potential complication.

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Section: Discussionsupporting

confidence: 89%

Biomechanical effect of a lateral hinge fracture for a medial opening wedge high tibial osteotomy: finite element study

et al. 2020

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“… 4 , 5 , 8 This is because it has been reported that increased tibial slope is directly correlated to increased anterior tibial translation, and has been shown to increase the forces experienced by the native ACL. 1 , 3 , 9 , 10 Clinical studies have supported these biomechanical findings, because an increased tibial slope has been reported to increase the risk of ACL graft failure, namely those ≥12°. 4 , 5 , 8 In our experience, we find intraoperatively that solely decreasing tibial slope before the second-stage ACL revision surgery can independently reduce anterior tibial translation.…”

Section: Discussionmentioning

confidence: 86%

Anterior Closing Wedge Proximal Tibial Osteotomy for Slope Correction in Failed ACL Reconstructions

DePhillipo

Kennedy

Dekker

et al. 2019

Arthroscopy Techniques

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Increased sagittal plane posterior tibial slope has been identified as a risk factor for primary anterior cruciate ligament reconstruction (ACLR) failure. Although ACLR failure is multifactorial, correction of sagittal plane posterior tibial slope should be evaluated in patients with an ACLR graft rupture. There are limited technical descriptions of proposed decreasing tibial slope osteotomy procedures; therefore, the purpose of this Technical Note is to describe the current senior author's technique of performing an anterior closing wedge proximal tibial osteotomy to decrease sagittal plane tibial slope in patients requiring a revision ACLR.

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“…The associated findings of primary PCL injury in > 100 patients with a decreased tibial slope appears to be a unique clinical finding that has yet to be fully investigated in the current literature. Although the association of sagittal plane tibial slope and ACL injury has been well studied 5,14,18,29 , literature regarding the impact of decreased posterior tibial slope and its associated risk for primary PCL injury is limited. After high tibial osteotomy, studies have highlighted the effect of increasing posterior tibial slope and the resultant increase in knee stability of PCL deficient knees.…”

Section: Discussionmentioning

confidence: 99%

“…11,18,21 Increased posterior tibial slope has been reported to alter the kinematics of the knee joint by anteriorly shifting the resting position of the tibia and subsequently increasingly the in situ forces on the anterior cruciate ligament (ACL). 4,8,28,29 Furthermore, increased posterior tibial slope has been directly correlated to higher anterior tibial translation (ATT), predisposing patients to ACL injury. 6,8 In contrast, increased posterior tibial slope counteracts PTT and reduces the stress placed on the native PCL.…”

Section: Introductionmentioning

confidence: 99%

Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury

et al. 2019

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Background: Recent biomechanical studies have identified sagittal plane posterior tibial slope as a potential risk factor for posterior cruciate ligament (PCL) injury because of its effects on the kinematics of the native and surgically treated knee. However, the literature lacks clinical correlation between primary PCL injuries and decreased posterior tibial slope. Purpose/Hypothesis: The purpose of this study was to retrospectively compare the amount of posterior tibial slope between PCL injured patients and an age/gender matched PCL intact controls. It was hypothesized that patients with PCL injuries would have a significantly decreased amount of posterior tibial slope compared to patients without PCL injuries. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent a primary PCL reconstruction without ACL injury between 2010 and 2017 by a single surgeon were retrospectively analyzed. Measurements of posterior tibial slope were performed using the lateral radiographs of both PCL injured patients and matched controls without clinical or MRI evidence of ligamentous injury. Mean values of posterior tibial slope were compared between the two groups. Interrater and intrarater agreement was assessed for the tibial slope measurement technique using a two-way randomeffects model to calculate the intraclass correlation coefficient (ICC). Results: One hundred four patients with PCL tears met the inclusion criteria and 104 control patients were matched to the PCL injured group according to age and gender. There were no significant differences in patient age (P=.166), gender (P=.345), or BMI (P=.424) between the PCL injured and control groups. Of the PCL tear cohort, 91 patients (87.5%) sustained a contact mechanism of injury, while 13 patients (12.5%) reported a noncontact mechanism of injury. The mean posterior tibial slope was 5.7  2.1 degrees (95% confidence interval [CI]: 5.3˚, 6.1˚) and 8.6  2.2 degrees (95% CI: 8.1˚, 9.0˚) for the PCL injured and matched control groups, respectively (P<.0001). Subgroup analysis of the PCL injured patients according to mechanism of injury demonstrated significant differences in posterior tibial slope between noncontact (4.6  1.8˚) and contact (6.2  2.2˚) injuries for all PCL tear patients (P=.013) and among patients with isolated PCL tears (P=.003). The tibial slope measurement technique was highly reliable, with an ICC of 0.852 for interrater and an ICC of 0.872 for intrarater reliability. Conclusion: A decreased posterior tibial slope was associated with PCL tear patients compared to age and gender-matched control patients with intact PCLs. Decreased tibial slope appears to be a risk factor for primary PCL injury. However, further clinical research is needed to assess if decreased posterior tibial slope affects posterior knee stability and outcomes following PCL reconstructions.

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Effects of Anterior Closing Wedge Tibial Osteotomy on Anterior Cruciate Ligament Force and Knee Kinematics

Abstract: PTS-reducing osteotomy significantly decreased ACL force and reduced ATT for knee loads that did not include IT.

Cited by 74 publications

References 35 publications

Biomechanical effect of a lateral hinge fracture for a medial opening wedge high tibial osteotomy: finite element study

Biomechanical effect of a lateral hinge fracture for a medial opening wedge high tibial osteotomy: finite element study

Anterior Closing Wedge Proximal Tibial Osteotomy for Slope Correction in Failed ACL Reconstructions

Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury

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