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Effects of sagittal tibial osteotomy on frontal alignment of the knee and patellar height

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Abstract

Aim of the study

The aim of this study was to evaluate the radiographic effect of sagittal tibial osteotomy (STO), flexion tibial osteotomy (FTO) and deflexion tibial osteotomy (DTO) around the knee. It has been hypothesized that proximal STO modifies patellar height and could cause varus/valgus changes of the anatomical tibial axis: The purpose of the study was to verify this and to analyse these modifications.

Method

Patients underwent proximal STO in our department between 2007 and 2018: overall 28 consecutive patients (19 males, 9 females; 28 knees). Twelve patients underwent DTO, and 16 patients underwent FTO. Two independent observers measured the pre-operative and post-operative radiological indexes: posterior tibial slope, Caton-Deschamps Index (CDI) and Modified Insall-Salvati Index (MISI) in the lateral views; medial Tibial Plateau-Tibial Shaft (mTPTS) and medial Femoral Shaft-Tibial Shaft (mFTA) anatomical angles were measured in the frontal plane.

Results

No complications were reported at the average follow-up of 1.6 ± 1.1 years. The mean mTPTS significantly increased from 0.6° ± 2.4° pre-operatively to 2.9° ± 2.6° of varus post-operatively (DTO (pre-operative 0.3 ± 3.1°, post-operative 2.4 ± 2.1°, ns); FTO (pre-operative 0.9 ± 1.9°, post-operative 3.2 ± 3.0°, P < 0.05)). The mean mFTA significantly reduced from 186.2° ± 4.9° pre-operatively to 182.7° ± 3.9° post-operatively (DTO (pre-operative 183.4 ± 3.3°, post-operative 180.6 ± 3.5°, ns); FTO (pre-operative 188.5 ± 4.9°, post-operative 184.4 ± 3.4°, P < 0.05)). The overall analysis reported no differences statistically significant in patellar height indexes.

Discussion

The main finding of this study is that STO slightly modifies tibial anatomical axes. This finding is more evident in FTOs. This surgical technique, due to its design, does not influence the patellar height. The tibial tuberosity osteotomy, performed in most of the cases to better expose tibial metaphysis and to avoid patellar tendon damages, provides another benefit that is the possibility to easily preserve the native patellar height.

Conclusion

Sagittal tibial osteotomies slightly modify tibial anatomical axes in frontal plan without influencing the patellar height. This surgical procedure resulted to be effective and reliable in correcting the sagittal knee alignment but reporting, particularly of FTO, varus changes of anatomical tibial axis.

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Authors and Affiliations

  1. Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France

    Francesco Luceri, Cécile Batailler, Elvire Servien & Sébastien Lustig

  2. IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy

    Francesco Luceri

  3. University of Milan, Via Mangiagalli 31, 20133, Milan, Italy

    Francesco Luceri

  4. Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy

    Mattia Basilico

  5. U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy

    Pietro Simone Randelli

  6. Dipartimento di Scienze Biomediche per la Salute, Laboratorio di Biomeccanica Applicata, University of Milan, Via Mangiagalli 31, 20133, Milan, Italy

    Pietro Simone Randelli

  7. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Giuseppe Maria Peretti

  8. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    Giuseppe Maria Peretti

  9. LIBM, EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

  10. LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, Lyon, France

    Sébastien Lustig

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  1. Francesco Luceri
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  2. Mattia Basilico
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  3. Cécile Batailler
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Correspondence to Francesco Luceri.

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Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Helsinki declaration and its later amendments, or comparable ethical standards. The University Hospital Centre Review Board approved the study protocol (CAL n° 2018-037).

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Luceri, F., Basilico, M., Batailler, C. et al. Effects of sagittal tibial osteotomy on frontal alignment of the knee and patellar height. International Orthopaedics (SICOT) 44, 2291–2298 (2020). https://doi.org/10.1007/s00264-020-04580-3

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