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Posteromedially placed plates with anterior staple reinforcement are not successful in decreasing tibial slope in opening-wedge proximal tibial osteotomy

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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.

Methods

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.

Results

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°).

Conclusions

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

IV.

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Acknowledgments

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.

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Authors and Affiliations

  1. The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA

    Tyler R. Cram & Robert F. LaPrade

  2. Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA

    Chase S. Dean, Jorge Chahla, Lauren M. Matheny, Tyler R. Cram, Samuel G. Moulton, Grant J. Dornan & Justin J. Mitchell

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  1. Chase S. Dean
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  2. Jorge Chahla
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Correspondence to Robert F. LaPrade.

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The authors declare that they have no conflict of interest.

Funding

No funds were received to do this research.

Ethical approval

This study was approved and performed in accordance with the standards set forth by our institutional review board.

Informed consent

Informed consent was obtained for each patient in the study prior to the surgical procedure.

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Dean, C.S., Chahla, J., Matheny, L.M. et al. Posteromedially placed plates with anterior staple reinforcement are not successful in decreasing tibial slope in opening-wedge proximal tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25, 3687–3694 (2017). https://doi.org/10.1007/s00167-016-4311-y

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