Posteromedial Open-Wedge High Tibial Osteotomy to Avoid Posterior Tibial Slope Increase

Editorial Commentary: Anterolateral Hinge Position Decreases the Slope in Opening-Wedge High Tibial Osteotomy: A Key Point in Treating an Anterior Cruciate Ligament–Deficient, Varus Knee

“…Cadaveric studies have shown that a posterolateral hinge increases the tibial slope in comparison to a neutral lateral hinge position. 3 A recent clinical study from Kaya et al 4 showed similar findings. Osteotomies from the posteromedial tibia directed to an anterolateral hinge position showed a statistically significant mean decrease in tibial slope of 3 .…”

“…Osteotomies from the posteromedial tibia directed to an anterolateral hinge position showed a statistically significant mean decrease in tibial slope of 3 . 4 Moon et al, 5 in their retrospective clinical study, similarly found a mean increase of 3.19 in tibial slope in their patients, with a hinge axis that, on average, was externally rotated 4.92 toward a posterolateral position.…”

“…This would enrich the model and allow for extrapolations for opening wedges that are different from the 10-mm gap used in this study. However, in their study, Kaya et al 4 evaluated changes in the tibial slope in patients with an anterolateral hinge when the opening wedge was less than 10 compared with 10 or greater and found no statistically significant differences in the slope between these measures.…”

Editorial Commentary: Tibial Slope Should Be Naturally Maintained by Proper Posterior Cortical Osteotomy and Gap Distraction in Open-Wedge High Tibial Osteotomy

“…A part from the intended alignment change in the coronal plane, proximal tibial osteotomy (PTO) is also associated with untoward changes such as tibial slope change in the sagittal plane. 1 This can be used when the sagittal slope needs to be modified in the combined ligament reconstruction and PTO. However, it is generally expected that correction is made only on the coronal plane and not on the sagittal plane in most PTOs.…”

“…Various optimization methods have been proposed, including insertion of a structural grafting into the posterior part of the gap, hinge axis modification, mathematical formulations, computer simulations, posterior plating, intraoperative temporary additional fixation, or surgical details such as gap ratio adjustment. 1,3,4 In addition, the knee is sometimes forcefully extended and compressed at the anterior gap to maintain the proper ratio between the anterior and posterior gap (approximately two-thirds). 1,5,6 Some surgeons also keep the knee extended for the anterior and retrotubercular gap compression during biplanar…”