[Osteotomies around the knee for ligament insufficiency]

Area of Science:

• Orthopedic surgery
• Biomechanics

Background:

• Osseous geometry significantly impacts knee instability post-ligament injury.
• Malalignment is a risk factor for ligament reconstruction failure.
• Osteotomies are vital for treating ligament-deficient, malaligned knees.

Purpose of the Study:

• To explore the role of osteotomies in knee instability and ligament reconstruction.
• To highlight the emerging concept of correcting sagittal imbalance via tibial slope modification.

Main Methods:

• Correction of varus/valgus malalignment.
• Modification of tibial slope to address sagittal imbalance.
• High tibial osteotomy for posterior/posterolateral instability.
• Consideration of slope-decreasing osteotomy for failed ACL reconstructions.

Main Results:

• Even minor tibial slope modifications (≤5°) significantly alter anterior-posterior translation.
• Valgus-producing, slope-increasing osteotomies are primary treatments for chronic instability.
• Isolated tibial slope modification is less common but important in specific cases.

Conclusions:

• Osteotomies are essential for stabilizing the knee in cases of malalignment and ligament deficiency.
• Tibial slope modification is an important emerging technique for knee instability.
• Slope-decreasing osteotomies should be considered for complex ACL reconstruction failures.