Opening Wedge Tibial Osteotomy: The 3-Triangle Method to Correct Axial Alignment and Tibial Slope

2005 ◽  
Vol 33 (3) ◽  
pp. 378-387 ◽  
Author(s):  
Frank R. Noyes ◽  
Steven X. Goebel ◽  
John West
Keyword(s):  
Proximal Tibia ◽  
Sagittal Plane ◽  
Wedge Angle ◽  
Tibial Slope ◽  
Tibial Tubercle ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Axial Alignment ◽  
Tibial Cortex ◽  
Valgus Alignment

Background Although a change in tibial slope may occur during a medial opening wedge osteotomy, calculations have not been defined to address this problem. The authors investigated geometric factors important to correct axial alignment and tibial slope during osteotomy. Purpose To calculate, through 3-dimensional analysis of the proximal tibia, how the angle of the opening wedge along the anteromedial tibial cortex influences the tibial slope (sagittal plane) and valgus correction (coronal plane) during osteotomy, and to analyze the different radiographic methods reported in the literature to measure medial and lateral tibial slope. The authors postulated that differences in reported normal values of tibial slope in the sagittal plane were technique dependent. Study Design Descriptive laboratory study Methods The proximal anteromedial tibial cortex obliquity on magnetic resonance imaging was measured in 35 knees. Serial computed tomography images of the proximal tibia were digitized, allowing a series of virtual opening wedge osteotomies to be performed. Algebraic calculations defined the effect of an opening wedge osteotomy on the anteromedial tibial cortex opening wedge angle, sagittal tibial slope angle, and coronal valgus alignment. Results The anteromedial tibial cortex oblique angle at the medial osteotomy site was 45°± 6° and determined, along with the degrees of valgus correction, the degrees of the opening wedge angle in the oblique plane. The anterior osteotomy gap at the tibial tubercle was generally one half of the posteromedial gap to maintain the normal sagittal tibial slope. Every millimeter of gap error at the tibial tubercle resulted in approximately 2° of change in the tibial slope. The width of the buttress plate along the anteromedial tibial cortex was 2 to 3 mm less than the computed coronal valgus posteromedial osteotomy gap to achieve tibiofemoral valgus correction. Conclusions A series of measurements preoperatively and intraoperatively are required to obtain the desired correction of tibial slope and valgus alignment.

Anterolateral Proximal Tibial Opening Wedge Osteotomy to Treat Symptomatic Genu Recurvatum with Valgus Alignment

2014 ◽  
Vol 4 (3) ◽  
pp. e71 ◽  
Author(s):  
Trevor R. Gaskill ◽  
Casey M. Pierce ◽  
Evan W. James ◽  
Robert F. LaPrade
Keyword(s):  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Genu Recurvatum ◽  
Valgus Alignment

scholarly journals Tibial Tubercle–Sparing Anterior Closing Wedge Osteotomy With Cross-Screw Fixation to Correct Pathologic Posterior Tibial Slope

2021 ◽  
Vol 10 (3) ◽  
pp. e897-e902
Author(s):  
CPT Christian A. Cruz ◽  
CPT Mitchell C. Harris ◽  
CPT Jeffery L. Wake ◽  
CPT Gregory E. Lause ◽  
Brian J. Mannino ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Tubercle ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Posterior Tibial ◽  
Closing Wedge

scholarly journals The Reliability of Radiographic Evaluation of the Posterior Tibial Slope in Skeletally Immature Patients

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Jordan Liles ◽  
Gregory Pereira ◽  
Richard Danilkowicz ◽  
Jonathan Riboh ◽  
Amanda Fletcher
Keyword(s):  
Acl Reconstruction ◽  
Proximal Tibia ◽  
Tibial Slope ◽  
Observer Agreement ◽  
Posterior Tibial Slope ◽  
Skeletal Maturation ◽  
Skeletally Immature ◽  
Perfect Agreement ◽  
Posterior Tibial ◽  
Tibial Cortex

Objectives: An association exists between increased posterior tibial slope and anterior cruciate ligament (ACL) injuries in pediatric patients with open physes. Additionally, an increased posterior tibial slope is also associated with increased odds of a further ACL injury after ACL reconstruction. Reliable radiographic measurement techniques are important for investigating limb alignment prior to and following pediatric ACL reconstruction. There have been multiple methods described to measure tibial slope, however, it is unknown if these are reliable in the pediatric population given the altered and developing proximal tibia anatomy during skeletal maturation. The purpose of this study is to evaluate the intra- and interobserver reliability of previously described posterior tibial slope measurements from lateral radiographs of skeletally immature patients. Methods: A retrospective chart review was performed including patients age 6-18 years old with available lateral knee radiographs and no prior surgery or musculoskeletal pathology. 130 patients (ten in each age group) were analyzed by three reviewers. Measurements were made using the Centricity Enterprise Web PACS System (Version 3.0; GE Medical Systems, Barrington, Illinois). The posterior tibial slope was measured using three previously described methods: the anterior tibial cortex (ATC), posterior tibial cortex (PTC), and the proximal tibia anatomic axis (TPAA) (Figure 1). The radiographs were graded by each reviewer twice, performed two weeks apart. The intra- and interobserver agreements were determined using the intraclass correlation coefficient (ICC) with the second set of measurements used for interobserver agreement. ICC estimates and their 95% confident intervals were calculated using SAS statistical package (Version 9; SAS Institute, Cary, North Carolina) based on an individual ratings, absolute-agreement, two-way mixed-effects model. As described by Landis and Koch, the interpretation of the ICC was as follows—slight: 0.00 to 0.20; fair: 0.21 to 0.40; moderate: 0.41 to 0.60; substantial: 0.61 to 0.80; almost perfect agreement: 0.81 to 1.00. Results: There were 130 patients included with an average age of 12 years old (range 6-18 years) with 47.7% (n=62) male patients. The mean measurements were ATC: 12.3 degrees, PTC 7.2 degrees, and TPAA: 9.3 degrees. Measures of intra-observer agreement met almost perfect agreement criteria among all three reviewers for all three methods of measuring the posterior tibial slope with a mean of 0.88 (range, 0.86-0.92) for ATC, 0.85 (range, 0.82-0.87) for PTC, and 0.87 (range, 0.82-0.92) for TPAA. (Table 1) Measures of inter-observer agreement was substantial across all three reviewers for all three methods of measuring with an average of 0.72 (range, 0.70-0.83) for ATC, 0.74 (range, 0.68-0.83) for PTC, and 0.74 (range, 0.68-0.84) for TPAA (Table 1). Conclusion: In accordance with prior reports, the ATC measurement yields larger values and PTC smaller values when measuring posterior tibial slope. The three different methods of measuring demonstrated almost perfect agreement for intra-rater reliability and substantial agreement for inter-rater reliability. There was no difference in reliability across the three different measurement methods. Thus, despite the transforming anatomy during skeletal maturation, the posterior tibial slope can be reliability measured in the skeletally immature population using plain lateral radiographs and any of the three described methods- ATC, PTC, or TPAA. [Figure: see text]

Development and validation of formulae to predict leg length following medial opening-wedge osteotomy of the proximal tibia with hemicallotasis

The Knee ◽  
2014 ◽  
Vol 21 (4) ◽  
pp. 815-820 ◽  
Author(s):  
Eiichi Nakamura ◽  
Nobukazu Okamoto ◽  
Hiroaki Nishioka ◽  
Hiroki Irie ◽  
Hiroshi Mizuta
Keyword(s):  
Proximal Tibia ◽  
Wedge Osteotomy ◽  
Leg Length ◽  
Opening Wedge ◽  
Development And Validation

Anterior Opening Wedge Osteotomy of the Proximal Tibia for Genu Recurvatum Caused by Partial Proximal Tibial Epiphyseal Arrest

2013 ◽  
Vol 1 ◽  
pp. 1-4
Author(s):  
Yo Hara ◽  
Yusuke Hashimoto ◽  
Junsei Takigami ◽  
Shinya Yamasaki ◽  
Hiroaki Nakamura
Keyword(s):  
Proximal Tibia ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Genu Recurvatum ◽  
Tibial Epiphyseal

scholarly journals Opening Wedge High Tibial Osteotomy Using Tricalcium Phosphate Wedge

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Sinan Zehir ◽  
Murat Çalbıyık ◽  
Ercan Şahin ◽  
Mahmut Kalem ◽  
Murat Songür ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tricalcium Phosphate ◽  
Tibial Slope ◽  
Joint Space ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Beta Tricalcium Phosphate ◽  
One Year

Objectives: High tibial osteotomy is a standard procedure indicated for early medial sided osteoarthritis in varus knees. In this study, we present the early results of high tibial open wedge osteotomy cases using beta-tricalcium phosphate as a graft substitute and Otis-c plate. Methods: Between years 2010 and 2013, 47 cases of (34F, 13 M) medial compartmental gonarthrosis with genu varum deformity treated with high tibial osteotomy, were evaluated with at least one year follow-up, preoperatively both clinically and radiologically. Clinical evaluation involved functional assessment and pain evaluation using Lysholm and visual analog scale (VAS) scores, including knee range-of-motion. Radiological evaluation included medial joint space measurements on weight bearing knee radiographs with measurements of varus angle and posterior tibial slope. Surgical procedure included standard arthroscopy followed by medial sided opening wedge osteotomy with correction of the varus deformity using β- tricalcium phosphate graft substitute and fixation of the osteotomy site using Otis-C plate and locking screws. All patients were evaluated at the end of minimum one-year follow-up period. Results: Mean age of the patients was 56,7 (50- 65) years and mean follow-up period was 24,5 (12- 44) months. Mean duration of surgery was 47,4±10.2 minutes. No case of nonunion, delayed union, neurovascular injury or iatrogenic fracture was encountered. Two cases developed deep vein thrombosis and one case developed superficial wound infection managed successfully by local debridement with retention of implants and antibiotics. Mean duration of union was 13,4±2.7 weeks. Mean preoperative and follow-up range-of-motion were measured as 131±8.9 and 129±9.1 respectively with no statistical difference. Preoperative and follow-up VAS scores showed significant difference as 7.6±1.76 and 2.3±1.08 respectively (p=0.001). Also Lysholm scores improved significantly at the end of the follow-up period (43.23±4.01 vs. 76.3±3.7 p<0,001). Radiological evaluation revealed mean correction angle of 10.84±2.70 degrees at follow-up. Mean posterior tibial slope was measured relatively unchanged (8.6±1.70° degrees preoperatively versus 8.2±2.30° follow-up). Medial joint space width measurements showed a significant increase (pre-op 3.7±1.6 mm. versus 4.6±1.32 mm. at the follow-up (p<0.001)). Conclusion: Medial opening wedge osteotomy for treatment of early medial compartment gonarthrosis in varus knees is still a valuable option. Our short term preliminary results using beta-tricalcium phosphate wedge graft substitute and Otis-c plate-screw osteosynthesis revealed satisfactory short term clinical and radiological results with acceptable complication rates.

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