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The Role of Osteotomy for the Treatment of PCL Injuries

  • PCL Update (K Jones and M Alaia, section editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The purposes of this review are to (1) describe the anatomic and biomechanical rationale for high tibial osteotomy (HTO) in the setting of posterior cruciate ligament (PCL) deficiency, (2) review the indications for concomitant HTO and PCL reconstruction, (3) provide guidance for the clinical assessment of the patient with suspected PCL deficiency, and (4) summarize the key surgical steps necessary to attain the appropriate sagittal and coronal plane corrections.

Recent Findings

The preponderance of available biomechanical data pertaining to the PCL-deficient knee suggests that an increased proximal tibial slope limits posterior tibial translation under axial compressive loads. Moreover, recent clinical data has demonstrated that decreased proximal tibial slope may exacerbate residual anterior-posterior laxity and jeopardize the durability of PCL reconstruction. Thus, in the setting of PCL deficiency, an HTO that increases the posterior tibial slope may be advisable.

Summary

HTO may be an important treatment adjunct in the surgical management of PCL deficiency. In the setting of chronic injuries and varus malalignment, HTO should be considered in order to ensure a durable ligamentous reconstruction and forestall the progression of secondary osteoarthritis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    João V. Novaretti, Andrew J. Sheean, Jayson Lian, Joseph De Groot & Volker Musahl

  2. Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil

    João V. Novaretti

  3. Albert Einstein College of Medicine, Bronx, New York, New York, USA

    Jayson Lian

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Novaretti, J.V., Sheean, A.J., Lian, J. et al. The Role of Osteotomy for the Treatment of PCL Injuries. Curr Rev Musculoskelet Med 11, 298–306 (2018). https://doi.org/10.1007/s12178-018-9488-x

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