Dual-plane high tibial osteotomy to treat posterolateral corner injuries combined with varus deformity of knee joint
10.3760/cma.j.issn.0253-2352.2016.07.002
- VernacularTitle:双平面胫骨高位截骨治疗伴下肢力线不良的膝关节后外复合体损伤
- Author:
Hui ZHANG
;
Hua FENG
;
Lei HONG
;
Xuesong WANG
;
Jin ZHANG
;
Xin LIU
;
Guanyang SONG
- Publication Type:Journal Article
- Keywords:
Knee joint;
Athletic injuries;
Osteotomy;
Gait
- From:
Chinese Journal of Orthopaedics
2016;36(7):392-398
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical outcome of dual?plane high tibial osteotomy to treat posterolateral corner injuries combined with varus and/or hyperextension deformity. Methods From October 2008 to March 2014, there were 12 patients (13 knees) undergoing high tibial osteotomy. All the patients were double or triple varus knee combined with posterior cruciate ligament and posterolateral corner (PLC) injuries. During the surgery, the weight bearing line of lower extremity was set to 62%position of the tibial plateau on the coronal plane. The tibial slope was increased to diminish the hyperextension on the sagit?tal plane. Full?length weight bearing X?ray was used to evaluate the position of weight bearing line, femoral?tibial angle and tibial slope pre? and post?operatively. The stress radiograph was used to evaluate the posterior and posterolateral stability. The Op?ti_knee gait analysis system was used to evaluate the varus of angle during weight bearing stage. Results The weight bearing line was corrected from 19.6%±19.1% preoperatively to 42.6%±17.9% postoperatively (t=-4.178, P=0.002). The femoral?tibial angle was 172.8°±4.2° preoperatively and improved to 178.1°±4.2° postoperatively (t=-4.520, P=0.001). The tibial slope was increased from 10.2° ± 5.3° preoperatively to 18.4° ± 6.3° postoperatively (t=-5.735, P=0.000). The tibial posterior translation was decreased from 11.4±5.3 mm preoperatively to 8.1±6.9 mm postoperatively (t=2.415, P=0.042) in 9 patients. The separa?tion of lateral compartment was decreased from 16.3 ± 6.5 mm preoperatively to 14.2 ± 4.9 mm postoperatively (t=3.194, P=0.019). Gait analysis was performed in 7 patients and showed that the varus was improved from 3.0° ± 2.6° preoperatively to-2.7°±2.5° postoperatively during weight bearing stage (t=-8.500,P=0.014). Eight patients had sufficient improvement in knee function so that a subsequent posterolateral corner reconstruction was not necessary. Conclusion The dual?plane medial open wedge high tibial osteotomy can improve the alignment of lower extremity and the stability of knee joint, and 67%patients do not need a staged PLC and posterior cruciate ligament reconstruction.
