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Hohe tibiale Osteotomie bei anteromedialer oder posterolateraler Knieinstabilität

High tibial osteotomy for anteromedial or posterolateral knee instability

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Arthroskopie Aims and scope

Zusammenfassung

Die valgisierende hohe tibiale Osteotomie (HTO) ist ein etabliertes und effektives Verfahren zur Behandlung der Varusfehlstellung und medialen Gonarthrose. In der Sagittalebene kann eine HTO u. a. die dorsale Neigung des Tibiaplateaus, den sog. Slope, beeinflussen. Dies wird mit einer Vielzahl potenzieller Auswirkungen auf die Kniekinematik assoziiert, u. a. mit einer möglichen Stabilisierung bei anteromedialer wie auch posterolateraler Knieinstabilität. Die aktuelle Studienlage legt den Schluss nahe, dass die alleinige Tibiakopfosteotomie bei der anteromedialen Kniegelenkinstabilität nicht, bei der posterolateralen Knieinstabilität durchaus als zuverlässige Behandlungsmethode angesehen werden kann. Das von den Verfassern praktizierte differenzierte Behandlungskonzept bei Varusfehlstellung bzw. -gonarthrose und anteromedialer bzw. posterolateraler Knieinstabilität wird anhand von Fallbeispielen dargestellt und schematisch zusammengefasst.

Abstract

Valgus-producing high tibial osteotomy (HTO) is an established and effective treatment option for varus deformity and medial osteoarthritis. In the sagittal plane HTO can influence the inclination of the tibial plateau, the so-called slope. This seems to be associated with many potential consequences for knee kinematics, among others a stabilizing effect in anteromedial or posterolateral knee instability. However, in the current literature there is evidence that anteromedial knee instability should not be treated by HTO alone, whereas in posterolateral instability it seems to be a favorable approach. The differentiated treatment concept for varus deformity or varus osteoarthritis and anteromedial or posterolateral knee instability practiced by the authors will be described using case examples and schematically summarized.

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  1. Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Connollystr. 32, 80809, München, Deutschland

    S. Hinterwimmer, A. Rauch, L. Kohn &  A.B. Imhoff

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  1. S. Hinterwimmer
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  2. A. Rauch
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  3. L. Kohn
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  4. A.B. Imhoff
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Correspondence to A.B. Imhoff.

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Hinterwimmer, S., Rauch, A., Kohn, L. et al. Hohe tibiale Osteotomie bei anteromedialer oder posterolateraler Knieinstabilität. Arthroskopie 23, 14–22 (2010). https://doi.org/10.1007/s00142-009-0540-0

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