The effect of distal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints

The present study is aimed at assessing the changes in tibial rotation at the osteotomy site after an open-wedge, high-tibial osteotomy (OWHTO) and analysing the factors that affect rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the same site. This study involved 53 patients (60 knees; 16 males and 37 females) with medial osteoarthritis (OA) who underwent OWHTO and preoperative and 3-month postoperative computed tomography (CT) scans. Rotational angles of the distal tibia were measured using Stryker OrthoMap 3D by comparing preoperative and postoperative CTs. The mean rotational angle yielded an external rotation of 2.9 ° ± 4.8 ° . There were 17 knees with internal rotations, 37 knees with external rotations, and one knee with no rotation. The rotational angle significantly correlated with the resultant change in the femorotibial angle (correction angle) and the angle between the ascending and transverse osteotomy lines on the anterior osteotomised surface on which a flange was formed with the distal tibial osteotomised surface (flange angle). The flange angle affected the rotation, but it may have been affected by our surgical technique. The rotational angle did not significantly correlate with the change in the angle of the posterior tibial slope or body mass index. There were significant correlations between the rotational angle and correction angle ( r = 0.42 , p < 0.05 ). Additionally, the rotational angle correlated with the flange angle ( r = − 0.41 , p < 0.05 ).

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Opening gap width influences distal tibial rotation below the osteotomy site following open wedge high tibial osteotomy

PLoS ONE ◽

10.1371/journal.pone.0227969 ◽

2020 ◽

Vol 15 (1) ◽

pp. e0227969

Author(s):

Jun-Ho Kim ◽

Hoon-Young Kim ◽

Dae-Hee Lee

Keyword(s):

High Tibial Osteotomy ◽

Osteotomy Site ◽

Tibial Rotation ◽

Tibial Osteotomy ◽

Open Wedge ◽

Wedge High Tibial Osteotomy ◽

Gap Width

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Effect of Slope and Varus Correction High Tibial Osteotomy in the ACL-Deficient and ACL-Reconstructed Knee on Kinematics and ACL Graft Force: A Biomechanical Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546520976147 ◽

2020 ◽

pp. 036354652097614

Author(s):

Florian B. Imhoff ◽

Brendan Comer ◽

Elifho Obopilwe ◽

Knut Beitzel ◽

Robert A. Arciero ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Knee Kinematics ◽

Tibial Rotation ◽

Tibial Osteotomy ◽

Correction Osteotomy ◽

Acl Graft ◽

Slope Correction ◽

Internal Tibial Rotation ◽

Reconstructed Knee ◽

Acl Deficient

Background: Correction of high posterior tibial slope is an important treatment option for revision of anterior cruciate ligament (ACL) failure as seen in clinical and biomechanical studies. In cases with moderate to severe medial compartment arthritis, an additional varus correction osteotomy may be added to improve alignment. Purpose: To investigate the influence of coronal and sagittal correction high tibial osteotomy in ACL-deficient and ACL-reconstructed knees on knee kinematics and ACL graft load. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees were selected according to previous computed tomography measurements with increased native slope and slight varus tibial alignment (mean ± SD): slope, 9.9°± 1.4°; medial proximal tibia angle, 86.5°± 2.1°; age, 47.7 ± 5.8 years. A 10° anterior closing-wedge osteotomy, as well as an additional 5° of simulated varus correction osteotomy, were created and fixed using an external fixator. Four alignment conditions—native, varus correction, slope correction, and combined varus and slope correction—were randomly tested in 2 states: ACL-deficient and ACL-reconstructed. Compressive axial loads were applied to the tibia while mounted on a free-moving X-Y table and free-rotating tibia in a knee testing fixture. Three-dimensional motion tracking captured anterior tibial translation (ATT) and internal tibial rotation. Change of tensile forces on the reconstructed ACL graft were recorded. Results: In the ACL-deficient knee, an isolated varus correction led to a significant increase of ATT by 4.3 ± 4.0 mm ( P = .04). Isolated slope reduction resulted in the greatest decrease of ATT by 6.2 ± 4.3 mm ( P < .001). In the ACL-reconstructed knee, ATT showed comparable changes, while combined varus and slope correction led to lower ATT by 3.7 ± 2.6 mm ( P = .01) than ATT in the native alignment. Internal tibial rotation was not significantly altered by varus correction but significantly increased after isolated slope correction by 4.0°± 4.1° ( P < .01). Each isolated or combined osteotomy showed decreased forces on the graft as compared with the native state. The combined varus and slope osteotomy led to a mean decrease of ACL graft force by 33% at 200 N and by 58% at 400 N as compared with the native condition ( P < .001). Conclusion: A combined varus and slope correction led to a relevant decrease of ATT in the ACL-deficient and ACL-reconstructed cadaveric knee. ACL graft forces were significantly decreased after combined varus and slope correction. Thus, our biomechanical findings support the treatment goal of a perpendicular-aligned tibial plateau for ACL insufficiencies, especially in cases of revision surgery. Clinical Relevance: This study shows the beneficial knee kinematics and reduced forces on the ACL graft after combined varus and slope correction.

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Biomechanics of the Patello-Femoral Joint. Part II: A Study of the Effect of Simulated Femoro-Tibial Varus Deformity on the Congruity of the Patello-Femoral Compartment and Movement of the Patella

Engineering in Medicine ◽

10.1243/emed_jour_1983_012_005_02 ◽

1983 ◽

Vol 12 (1) ◽

pp. 13-21 ◽

Cited By ~ 31

Author(s):

K Fujikawa ◽

B B Seedhom ◽

V Wright

Keyword(s):

High Tibial Osteotomy ◽

Early Stage ◽

Varus Deformity ◽

Lateral Side ◽

Tibial Rotation ◽

Tibial Osteotomy ◽

Medial Side ◽

The Difference ◽

Cadaveric Knee

This paper investigates the effect of different degrees of varus deformity on the pattern of contact, congruence of the patello-femoral joint, and movement of the patella. Varus deformity of 5, 10, and 15 degrees was imposed on the same cadaveric knee specimen used in the study reported in Part I (Fujikawa, Seedhom, Wright, 1983). This was done by high tibial osteotomy and the introduction of a wooden wedge of the appropriate thickness to effect the deformity. It was found that the contact gradually shifted to the medial side of the knee, and the congruence of the patello-femoral compartment was gradually destroyed as the degree of varus deformity increased to 15 degrees, although the effect of 5 degrees of varus deformity was minimal. Clinically, contact is shifted to the lateral side of the knee with varus deformity, but this is invariably associated with lateral tibial rotation. This rotation explains the difference between the results of the varus deformity imposed on cadaveric knees and those observed clinically. It is proposed that an adverse change in the congruence of the knee will occur after a sudden correction by high tibial osteotomy, just as that occurring in the normal cadaveric knee after imposing a sudden varus deformity, and therefore it may be useful to consider performing the correction at an early stage of the deformity. The effect of the varus deformity on the movement of the patella is also described.

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