Patellar Height and Tibial Slope after Opening-Wedge Proximal Tibial Osteotomy

LaPrade, Robert F.; Oro, Fernando Barrera; Ziegler, Connor G.; Wijdicks, Coen A.; Walsh, Michael P.

doi:10.1177/0363546509342701

Cited by 133 publications

(147 citation statements)

References 41 publications

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“…8,12 The degree of slope change also depends on the positioning of the plate: anteriorly placed plates increase the sagittal plane slope, and posteriorly placed plates decrease the slope. 12 Regarding the material used to fill the gap created by the osteotomy, several compounds have been used such as autograft, allograft, synthetic bone substitutes (hydroxyapatite, b-tricalcium phosphate, a combination of both and bone cement) with or without platelet-rich plasma, growth factors, and bone marrow aspirate concentrate. 20,21 To date, bone graft is considered the gold standard bone filling material because of its osteoconductive, osteoinductive, and osteogenic properties.…”

Section: Discussionmentioning

confidence: 99%

“…12,16 Of note, patients that use nicotine-derived products should be discouraged from undergoing this procedure because of the high risk of nonunion. 15 …”

Section: Surgical Indicationsmentioning

confidence: 99%

“…It is essential to calculate the sagittal plane tibial slope preoperatively because medial opening wedge PTO has been reported to change the proximal tibial slope, and plate positioning can affect the degree of slope change (Fig 2). 12 Tibial slope is evaluated on the lateral radiograph by electronically drawing 2 circles in the tibial shaft that are each tangent to the anterior to posterior cortices, and drawing a straight line extending between the central point of the circles to find the anteroposterior Intraoperative photograph of a patient sterilely prepared and draped positioned supine on the operating table with the operative leg secured in a leg holder and the foot of the bed lowered to allow for full mobility of the lower extremity. A marking pen is used to outline the proposed incision medial opening wedge proximal tibial osteotomy on the anteromedial aspect left knee (purple marks).…”

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confidence: 99%

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Medial Opening Wedge Proximal Tibial Osteotomy

Chahla

Dean

Mitchell

et al. 2016

Arthroscopy Techniques

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Genu varus malalignment can lead to medial compartment overload and progression of ipsilateral compartment osteoarthritis. To slow this process, a medial opening wedge proximal tibial osteotomy (PTO) can be performed. This type of PTO is indicated in patients with genu varus malalignment and isolated medial compartment osteoarthritis of the knee, prior to or concurrent with medial compartment cartilage procedures or meniscal transplants, chronic posterolateral corner deficiency, or chronic anterior cruciate ligament deficiency. When treating ligamentous instability, a PTO can be performed in isolation, with simultaneous ligament reconstruction, or as a staged procedure with the osteotomy first, followed by ligament reconstruction if instability persists. Failure to address malalignment in cases of concurrent ligament reconstruction leads to increased stress on the graft and potential graft failure. One distinct advantage of this procedure is the ability to correct deformities in the sagittal and coronal planes. The purpose of this article was to describe our technique used to perform a medial opening wedge PTO.

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Section: Discussionmentioning

confidence: 99%

“…12,16 Of note, patients that use nicotine-derived products should be discouraged from undergoing this procedure because of the high risk of nonunion. 15 …”

Section: Surgical Indicationsmentioning

confidence: 99%

mentioning

confidence: 99%

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Medial Opening Wedge Proximal Tibial Osteotomy

Chahla

Dean

Mitchell

et al. 2016

Arthroscopy Techniques

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“…A prospective study on medial opening-wedge PTO by LaPrade et al 10 showed that greater increases in tibial slope occurred when using an anteromedial plate position compared with those with a posteromedial plate position. Theoretically, the same general principle should apply when performing an anterolateral opening-wedge PTO.…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, the same general principle should apply when performing an anterolateral opening-wedge PTO. 10 Moreover, another advantage of a tibial osteotomy is that it aids in both flexion and extension, whereas a distal femoral osteotomy is biomechanically effective only in extension. 11 The most commonly performed PTO is a valgusproducing proximal tibial medial opening-wedge osteotomy for genu varus limb malalignment.…”

Section: Discussionmentioning

confidence: 99%

Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy

Dean

Chahla

Moulton

et al. 2016

Arthroscopy Techniques

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Proximal tibial anterolateral opening-wedge osteotomies have been reported to achieve successful biplanar lower-extremity realignment. Indications for a proximal tibial anterolateral osteotomy include symptomatic genu recurvatum with genu valgus alignment, usually in patients with a flat sagittal-plane tibial slope. The biplanar approach is able to simultaneously address both components of a patient's malalignment with a single procedure. The correction amount is verified with spacers and intraoperative imaging, while correction of the patient's heel height is simultaneously measured. A plate is secured into the osteotomy site, and the site is filled with bone allograft. The anterolateral tibial osteotomy has been reported to be an effective surgical procedure for correcting concomitant genu recurvatum and genu valgus malalignment.

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Automated extraction of the femoral anatomical axis for determining the intramedullary rod parameters in total knee arthroplasty

Cauter

Beule

Haver

et al. 2011

Numer Methods Biomed Eng

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SUMMARYThe automated extraction of anatomical reference parameters may improve speed, precision and accuracy of surgical procedures. In this study, an automated method for extracting the femoral anatomical axis (FAA) from a 3D surface mesh, based on geometrical entity fitting, is presented. This was applied to conventional total knee arthroplasty, which uses an intramedullary rod (FIR) to orient the femoral prosthesis with respect to the FAA. The orientation and entry point of a FIR with a length of 200 mm are automatically determined from the FAA, as it has been shown that errors in these parameters may lead to malalignment of the mechanical axis. Moreover, the effect of partially scanning the leg was investigated by creating reduced femur models and comparing the results with the full models. Precise measurements are obtained for 50 models by using a central and two outer parts, with lengths of 20 and 120 mm, which correspond to 58% of the mean femoral length. The deviations were less than 2 mm for the FAA, 2.8 mm for the FAA endpoints and 0.7°and 1.3 mm for the FIR orientation and entry point. The computer-based techniques might eventually be used for preoperative planning of total knee arthroplasty.

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Patellar Height and Tibial Slope after Opening-Wedge Proximal Tibial Osteotomy

Cited by 133 publications

References 41 publications

Medial Opening Wedge Proximal Tibial Osteotomy

Medial Opening Wedge Proximal Tibial Osteotomy

Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy

Automated extraction of the femoral anatomical axis for determining the intramedullary rod parameters in total knee arthroplasty

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