Anterior Closing-Wedge Osteotomy for Posterior Slope Correction

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Sports Medicine

Background:

• Recurrent knee instability is a common complication following anterior cruciate ligament reconstruction.
• Increased tibial slope is a significant contributing factor to this instability.
• Conservative management often fails to address the underlying biomechanical issue.

Purpose of the Study:

• To describe a surgical technique for anterior closing-wedge osteotomy to correct increased tibial slope.
• To outline the indications and procedural steps for this specific osteotomy.
• To provide a method for improving knee stability post-anterior cruciate ligament reconstruction.

Main Methods:

• Anterior approach for tibial exposure, 1-2 cm medial to the tibial tuberosity.
• Osteotomy marked with Kirschner wires, creating a closing wedge with the hinge below the posterior cruciate ligament insertion.
• Osteotomy performed with an oscillating saw, preserving the posterior cortex, followed by manual closure and fixation with a lag screw and angular stable plate.

Main Results:

• The described technique allows for precise correction of posterior tibial slope.
• The procedure aims to restore knee stability by addressing the underlying slope deformity.
• Stable fixation is achieved using a lag screw and angular stable plate.

Conclusions:

• Anterior closing-wedge osteotomy is a viable surgical option for correcting increased tibial slope in patients with recurrent instability after ACL reconstruction.
• This technique can effectively address the biomechanical cause of instability.
• Further studies are warranted to evaluate long-term outcomes and compare with other surgical methods.