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Tibial Slope Can Be Maintained During Medial Opening-Wedge Proximal Tibial Osteotomy With Sagittally Oriented Hinge, Posterior Plate Position, and Knee Hyperextension: A Cadaveric Study

Published:February 10, 2021DOI:https://doi.org/10.1016/j.arthro.2021.01.065

      Purpose

      The purpose of this study is (1) to determine if, when optimizing modern techniques, medial opening-wedge osteotomies can effectively maintain tibial slope and (2) to determine how different magnitude coronal plane corrections affect tibial slope.

      Methods

      Proximal tibial osteotomies (PTOs) were performed on 10 fresh-frozen cadaveric knees leaving a consistent lateral hinge, using either a 5-mm or a 10-mm trapezoidal wedged osteotomy plate. Techniques including posterior plate placement; a trapezoidal, sloped plate; and knee hyperextension were used during plate fixation to help close the anterior osteotomy gap. Medial coronal proximal tibia angle and posterior tibial slope were measured preosteotomy, after a 5-mm implant, and after a 10-mm implant using true anteroposterior and lateral fluoroscopic images. Three independent observers performed all radiographic measurements, and intraclass correlation coefficients were calculated.

      Results

      The 5-mm and 10-mm osteotomy plates increased the coronal medial proximal tibia angle by a mean of 3.4° (range, 3.0°-3.7°) and 7.3° (range, 6.7°-7.7°), respectively. The 5-mm and 10-mm trapezoidal wedged osteotomy plates decreased the posterior tibial slope by a mean of 0.9° (range, 0.5°-1.2°) and 0.3° (range, 0°-0.6°), respectively. Intraobserver reliability was found to be high for both the coronal medial proximal tibia angle (intraclass correlation coefficient [ICC] = 0.897 [0.821-0.946]) and the tibial slope measurements (ICC = 0.761 [0.672-0.826]).

      Conclusions

      When optimizing the medial opening-wedge proximal tibial osteotomy, including utilization of a sagittally oriented hinge, placement of a trapezoidal plate posteriorly, and fixation with knee hyperextension, posterior tibial slope can be maintained regardless of the degree of coronal correction.

      Clinical Relevance

      Tibial slope has a significant effect on cruciate ligament stress and a better understanding of coronal plane correction, and its effect on tibial slope is critical when performing proximal tibia osteotomies.
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      References

        • Bernhardson A.S.
        • Aman Z.S.
        • DePhillipo N.N.
        • et al.
        Tibial slope and its effect on graft force in posterior cruciate ligament reconstructions.
        Am J Sports Med. 2019; 47: 1168-1174
        • Reider B.
        Slippery slope.
        Am J Sport Med. 2019; 47: 273-276
        • Kolbe R.
        • Schmidt-Hebbel A.
        • Forkel P.
        • Pogorzelski J.
        • Imhoff A.B.
        • Feucht M.J.
        Steep lateral tibial slope and lateral-to-medial slope asymmetry are risk factors for concomitant posterolateral meniscus root tears in anterior cruciate ligament injuries.
        Knee Surg Sport Traumatol Arthrosc. 2019; 27: 2585-2591
        • Bernhardson A.S.
        • Aman Z.S.
        • Dornan G.J.
        • et al.
        Tibial slope and its effect on force in anterior cruciate ligament grafts: Anterior cruciate ligament force increases linearly as posterior tibial slope increases.
        Am J Sports Med. 2019; 47: 296-302
        • Duivenvoorden T.
        • Brouwer R.W.
        • Baan A.
        • et al.
        Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee.
        J Bone Jt Surg. 2014; 96: 1425-1432
        • Ruzbarsky J.J.
        • Dare D.M.
        • Marx R.G.
        Closing versus opening wedge high tibial osteotomy: An evidence-based review.
        HSS J. 2015; 11: 291-293
        • Deng Y.G.
        • Yuan Y.
        • Ren Y.M.
        • et al.
        Differences between open-wedge versus closed-wedge high tibial osteotomy on clinical and radiological outcomes and adverse events.
        Int J Clin Exp Med. 2018; 11: 4371-4388
        • Nha K.W.
        • Kim H.J.
        • Ahn H.S.
        • Lee D.H.
        Change in posterior tibial slope after open-wedge and closed-wedge high tibial osteotomy.
        Am J Sports Med. 2016; 44: 3006-3013
        • Rahnemai-Azar A.A.
        • Yaseen Z.
        • Van Eck C.F.
        • Irrgang J.J.
        • Fu F.H.
        • Musahl V.
        Increased lateral tibial plateau slope predisposes male college football players to anterior cruciate ligament injury.
        J Bone Jt Surg Am. 2016; 98: 1001-1006
        • Lee C.C.
        • Youm Y.S.
        • Cho S. Do
        • et al.
        Does posterior tibial slope affect graft rupture following anterior cruciate ligament reconstruction?.
        Arthroscopy. 2018; 34: 2152-2155
        • Jacobi M.
        • Villa V.
        • Reischl N.
        • et al.
        Factors influencing posterior tibial slope and tibial rotation in opening wedge high tibial osteotomy.
        Knee Surg Sport Traumatol Arthrosc. 2015; 23: 2762-2768
        • Noyes F.R.
        • Goebel S.X.
        • West J.
        Opening wedge tibial osteotomy: The 3-triangle method to correct axial alignment and tibial slope.
        Am J Sports Med. 2005; 33: 378-387
        • Rodner C.M.
        • Adams D.J.
        • Diaz-Doran V.
        • et al.
        Medial opening wedge tibial osteotomy and the sagittal plane: The effect of increasing tibial slope on tibiofemoral contact pressure.
        Am J Sports Med. 2006; 34: 1431-1441
        • Wang J.H.
        • Bae J.H.
        • Lim H.C.
        • Shon W.Y.
        • Kim C.W.
        • Cho J.W.
        Medial open wedge high tibial osteotomy: The effect of the cortical hinge on posterior tibial slope.
        Am J Sports Med. 2009; 37: 2411-2418
        • Chahla J.
        • Dean C.S.
        • Mitchell J.J.
        • Moatshe G.
        • Serra Cruz R.
        • LaPrade R.F.
        Medial opening wedge proximal tibial osteotomy.
        Arthrosc Tech. 2016; 5: e919-e928
        • Dean C.S.
        • Chahla J.
        • Matheny L.M.
        • et al.
        Posteromedially placed plates with anterior staple reinforcement are not successful in decreasing tibial slope in opening-wedge proximal tibial osteotomy.
        Knee Surg Sport Traumatol Arthrosc. 2017; 25: 3687-3694
        • Rubino J.L.
        • Schoderbek R.J.
        • Raymond Golish S.
        • Miller M.D.
        • Baumfeld J.
        The effect of plate position and size on tibial slope in high tibial osteotomy.
        J Knee Surg. 2008; 21: 75-79
        • Jo H.S.
        • Park J.S.
        • Byun J.H.
        • et al.
        The effects of different hinge positions on posterior tibial slope in medial open-wedge high tibial osteotomy.
        Knee Surg Sport Traumatol Arthrosc. 2018; 26: 1851-1858
        • Utzschneider S.
        • Goettinger M.
        • Weber P.
        • et al.
        Development and validation of a new method for the radiologic measurement of the tibial slope.
        Knee Surg Sport Traumatol Arthrosc. 2011; 19: 1643-1648
        • Koo T.K.
        • Li M.Y.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Kaya H.
        • Daştan A.E.
        • Biçer E.K.
        • Taşkiran E.
        Posteromedial open-wedge high tibial osteotomy to avoid posterior tibial slope increase.
        Arthrosc J Arthrosc Relat Surg. 2020; 36: 2710-2717
        • Moon S.W.
        • Park S.H.
        • Lee B.H.
        • et al.
        The effect of hinge position on posterior tibial slope in medial open-wedge high tibial osteotomy.
        Arthroscopy. 2015; 31: 1128-1133