Sagittal realignment osteotomy for increased posterior tibial slope after opening-wedge high tibial osteotomy: a case report

Abstract

A 40 year old welder who underwent opening-wedge high tibial osteotomy for correction of alignment in a varus knee developed persistent pain with loss of knee extension. The posterior tibial slope increased from 9 degrees to 20 degrees after the osteotomy and caused the anteromedial knee pain and limited extension. The patient then underwent a revision osteotomy using a closing wedge technique to correct tibial slope. The osteotomy was performed, first from the medial cortex in the lateral direction, and second in the anteroposterior direction to remove the tibial bone in wedge shape and obtain full extension of the knee. The posterior tibial slope decreased to 8 degrees after the revision osteotomy and the patients returned to pain-free daily life. We reviewed this unique technique for correction of sagittal malalignment using a closing-wedge osteotomy for revision after opening-wedge osteotomy.

Anterior Closing Wedge Tibial Osteotomy for Failed Anterior Cruciate Ligament Reconstruction

“…Dejour et al 16 reported the results of 22 knees that underwent a similar osteotomy with good results using a technique described by Neyret et al 8 Others have also described sagittal realignment osteotomies of the proximal tibia. 17 There are several differences between our technique and those previously published. First, the slope-decreasing anterior closing wedge tibial osteotomy and revision ACL were performed in staged fashion rather than in the same setting, allowing healing of the osteotomy and incorporation of bone graft placed in previous ACL reconstruction tunnel sites.…”

Changes in posterior tibial slope angle in patients undergoing open-wedge high tibial osteotomy for varus gonarthrosis

“…Various correction techniques for a postoperatively increased PTSA have been described in the literature. Kimura et al [18] reported a good clinical outcome in a 40‐year‐old female patient who experienced postoperative anteromedial knee pain with loss of knee extension after opening‐wedge osteotomy. After revision with a closing‐wedge osteotomy, her complaints were resolved.…”