Proximal tibial anterior open-wedge oblique osteotomy: A novel technique to correct genu recurvatum

For successful acute correction of genu recurvatum, accurate correction of plateau angle, restoration of anatomical axis, rigid fixation, and preservation of patellar height are essential. However, a surgical treatment that satisfies all these conditions has not yet been established. The purpose of this study was to evaluate the novel technique of proximal tibial anterior open-wedge oblique osteotomy (PT-AOWOO) for the treatment of genu recurvatum.

Five patients with genu recurvatum underwent PT-AOWOO from 2008 to 2013. The open-wedge center of rotation of angulation (CORA) was determined by the intersection of transverse bisector line and tibial posterior cortex to prevent secondary translational deformity. An osteotomy was performed from the distal margin of the tibial tuberosity to the planned CORA to maintain patellar height and provide sufficient space for fixation. The opening gap was calculated by the picture-archiving and communications system (PACS)-Photoshop method.

The mean angle of recurvatum was 17° (range, 14 to 25°) preoperatively and -0.4° (range, -5° to 5°) postoperatively. The mean angle of the tibial plateau was 79.8° (range, 67 to 85°) preoperatively and 98.4° (range, 95 to 105°) postoperatively. Tibial anatomical axis was restored and the patellar height was maintained in all patients. The overall results were excellent in three patients and good in two patients.

The PT-AOWOO and its unique osteotomy level corrected the tibial plateau angle accurately, restored the sagittal tibial axis without translation, maintained patellar height, and enabled rigid fixation. This technique showed satisfactory radiologic and clinical outcomes without any complications.