Infratubercle Anterior Closing Wedge Osteotomy Corrects Sagittal Alignment without Affecting Coronal Alignment or Patellar Height

Authors

• Shintaro Onishi
• Youngji Kim
• Hiroshi Nakayama
• Alfred A Mansour
• Walter R Lowe
• Matthieu Ollivier

Language

English

Publication Date

8-11-2024

DOI

10.3390/jcm13164715

PMID

39200857

PMCID

PMC11355623

PubMedCentral® Posted Date

8-11-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Excessive posterior tibial slope (PTS) has been associated with a higher risk of graft failure after anterior cruciate ligament reconstruction (ACLR). Although anterior closing wedge osteotomy (ACWO) can reduce the PTS, it may also change the coronal alignment and patellar height. Purpose: To elucidate the radiological outcomes after infratubercle ACWO, specifically to evaluate its influence on perioperative changes in patellar height.

Methods: Patients who underwent infratubercle ACWO with combined ACLR with a minimum follow-up of 3 months were included. Surgery was indicated when the PTS was greater than 12°. Radiological evaluation included measurements of the hip-knee-ankle angle (HKA), PTS, femoral patellar height index (FPHI), and Caton-Deschamps index (CDI) preoperatively and 3 months postoperatively. Patellar height was classified as patella baja, normal, or alta based on CDI values. Knee recurvatum was measured preoperatively and at final follow-up.

Results: A total of 21 patients with a mean age of 21.6 ± 3.0 years were included. Although HKA did not significantly change, significant corrections were achieved in the PTS from 14.5° ± 1.6° to 5.7° ± 1.0° (p < 0.001). No significant change in FPHI was found (preoperative: 1.33 ± 0.11 vs postoperative: 1.30 ± 0.09). Patellar height categories showed no significant differences pre- and postoperatively, while three patients (14.3%) changed their patellar height category (all moved up one category). Knee recurvatum increased significantly from 4.9° ± 2.9° preoperatively to 7.8° ± 3.1° at the final follow-up (p < 0.001).

Conclusions: Precise sagittal correction was achieved after infratubercle ACWO without altering the coronal alignment and patella height. Level of Evidence: IV, Case series.

Keywords

infratubercle, anterior closing wedge osteotomy, slope reducing osteotomy, anterior cruciate ligament, posterior tibial slope, patellar height

Published Open-Access

yes

Recommended Citation

Onishi, Shintaro; Kim, Youngji; Nakayama, Hiroshi; et al., "Infratubercle Anterior Closing Wedge Osteotomy Corrects Sagittal Alignment without Affecting Coronal Alignment or Patellar Height" (2024). Faculty, Staff and Student Publications. 3940.
https://digitalcommons.library.tmc.edu/uthmed_docs/3940