Posteromedially placed plates with anterior staple reinforcement are not successful in decreasing tibial slope in opening-wedge proximal tibial osteotomy
- 425 Downloads
To document the effectiveness of a novel technique to decrease tibial slope in patients who underwent a proximal opening-wedge osteotomy with an anteriorly sloped plate placed in a posteromedial position. The hypothesis was that posteromedial placement of an anteriorly sloped osteotomy plate with an adjunctive anterior bone staple on the tibia would decrease, and maintain, the tibial slope correction at a minimum of 6 months following the osteotomy.
All patients who underwent biplanar medial opening-wedge proximal tibial osteotomy with anterior staple augmentation to decrease sagittal plane tibial slope were included, and data were collected prospectively and reviewed retrospectively. Indications for decreasing tibial slope included medial compartment osteoarthritis with at least one of the following: ACL deficiency, posterior meniscus deficiency, or flexion contracture. Preoperative, immediate postoperative, and 6-month postoperative radiographs were reviewed.
Twenty-one patients (14 males and 7 females) were included in the study with a mean age of 36.5 years. Intrarater and interrater reliability of slope measurements were excellent at all time points (ICC ≥ 0.94, ICC ≥ 0.85). The osteotomy resulted in an average tibial slope decrease of 0.8 from preoperative (n.s.). At 6-month postoperative, average slope was not significantly different from time-zero postoperative slope (mean = +0.2°).
The most important finding of this study was that posteromedial placement of an anteriorly angled osteotomy plate augmented with an anterior staple during a biplanar medial opening-wedge proximal tibial osteotomy did not decrease sagittal plane tibial slope. Whether a staple was effective in maintaining tibial slope from time zero to 6 months postoperatively was unable to be assessed due to no significant change in tibial slope from the preoperative postoperative states. The results of this study note that current osteotomy plate designs and surgical techniques are not effective in decreasing sagittal plane tibial slope.
Level of evidence
KeywordsProximal tibial opening-wedge osteotomy High tibial opening-wedge osteotomy Posterior tibial slope Sagittal plane tibial slope Tibial staple
The author, Robert F. LaPrade is on the editorial/governing board for AJSM and KSSTA and has member/committee appointments for AOSSM, ISAKOS, AANA, and ESSKA. Dr. LaPrade is a consultant and receives royalties from Arthrex, Ossur, Smith & Nephew. The Steadman Philippon Research Institute has received financial support not related to this reaerch from the following: Arthrex Inc, Ossur Americas, Smith & Nephew Endoscopy.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
No funds were received to do this research.
This study was approved and performed in accordance with the standards set forth by our institutional review board.
Informed consent was obtained for each patient in the study prior to the surgical procedure.
- 1.Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584CrossRefPubMedGoogle Scholar
- 6.Canty A, Ripley B (2015). boot: Bootstrap R (S-Plus) Functions. R package version 1.3–16Google Scholar
- 17.LaPrade RF, Heikes C, Bakker AJ, Jakobsen RB (2008) The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg Am 90:2069–2076CrossRefPubMedGoogle Scholar