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Recurrent varus angulation after high tibial osteotomy: an anatomic analysis.
James A Shaw1, Danton S Dungy, Steven S Arsht
1The George Washington University Hospital, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA. JAShawMD@aol.com
Clinical Orthopaedics and Related Research
|April 2, 2004
Summary
High tibial osteotomy can lead to knee instability. This study found that closing wedge osteotomies often result in less correction than predicted, causing lateral instability and negating the intended surgical outcome.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Anatomy
Background:
- Recurrent varus deformity and lateral instability are common complications following high tibial osteotomy.
- The underlying causes of these complications remain a significant concern in orthopedic practice.
Purpose of the Study:
- To investigate the anatomical and biomechanical factors contributing to recurrent varus deformity and lateral instability after high tibial osteotomy.
- To evaluate the effectiveness of closing wedge osteotomies in correcting knee alignment and maintaining stability.
Main Methods:
- Anatomical study utilizing fresh cadaveric knee specimens.
- Performance of closing wedge osteotomies on four cadaveric knees.
- Application of varus load to simulate gait-induced adduction moments.
- Progressive closure of osteotomies in 5-degree increments with measurement of angular alignment and joint space changes.
Main Results:
- Postosteotomy angular corrections achieved were 50% or less of the predicted values.
- Progressive osteotomy closure led to increased lateral joint space, resulting in effective lateral instability.
- At osteotomy angles exceeding 10 degrees, the lateral collateral ligament became nonfunctional, with the lateral capsule and anterior cruciate ligament assuming stabilizing roles.
- Closing wedge valgus tibial osteotomy did not alter lateral collateral ligament tension, allowing the knee to revert towards native alignment under varus load.
Conclusions:
- Closing wedge high tibial osteotomy may not provide the intended angular correction due to increased lateral joint space and resultant instability.
- The non-alteration of lateral collateral ligament tension in closing wedge osteotomies contributes to the loss of correction under varus load.
- These findings highlight potential limitations of the closing wedge technique in achieving and maintaining correction for varus deformities, suggesting a need for technique modification or alternative approaches.