Biplanar Proximal Tibial Opening-Wedge Osteotomy for a Chronic PCL Tear With Medial Compartment Arthritis

Area of Science:

• Orthopedic surgery
• Biomechanics
• Knee joint reconstruction

Background:

• Chronic posterior cruciate ligament (PCL) insufficiency leads to knee instability, increasing load on medial and patellofemoral compartments.
• This condition progressively damages menisci and chondral surfaces, worsening varus malalignment.
• Biplanar proximal tibial opening-wedge osteotomy (BPTO) addresses chronic PCL tears with medial compartment arthritis, correcting sagittal and coronal alignment.

Purpose of the Study:

• To describe the technique and outcomes of biplanar proximal tibial opening-wedge osteotomy (BPTO) for chronic PCL insufficiency with medial compartment arthritis.
• To evaluate BPTO's effectiveness in correcting varus malalignment and sagittal slope.
• To present BPTO as an alternative to arthroplasty in specific patient populations.

Main Methods:

• Preoperative evaluation includes long-leg radiographs to assess coronal alignment and MRI for soft tissue/chondral injury.
• The technique involves arthroscopy followed by open medial approach and osteotomy.
• Concomitant procedures like chondroplasty and partial medial meniscectomy may be performed.

Main Results:

• Previous studies support PTO as a reliable treatment for varus malalignment.
• A reported 5-year survival rate of 96% with an 8.6% complication rate.
• Significant improvement in Lysholm scores at 60-month follow-up compared to preoperative scores.

Conclusions:

• Biplanar open-wedge PTO corrects mechanical axis and sagittal slope in knees with PCL insufficiency, medial arthritis, and varus malalignment.
• This restores proper load distribution across the tibiofemoral articulation.
• BPTO offers a viable alternative to joint arthroplasty for active patients with these specific knee conditions.