The Effect of Anterior Closing Wedge Slope-Reducing Osteotomy on Coronal Alignment-Effect of Osteotomy Technique, Starting Point, and Degree of Correction.

Authors

• James Matthew Helm
• Mark Coggins
• Brian Crowley
• Maile Curbo
• Jacob Siahaan
• Alexis Aboulafia
• Alfred A Mansour

Language

English

Publication Date

7-1-2025

Journal

Orthopaedic Journal of Sports Medicine

DOI

10.1177/23259671251358401

PMID

40756375

PMCID

PMC12314350

PubMedCentral® Posted Date

7-29-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Techniques for anterior closing wedge slope-reducing osteotomy (ACW-SRO) remain variable regarding management of the tibial tubercle and osteotomy starting point. Moreover, the potential unintended effect on coronal alignment has not yet been determined.

Purpose: To determine the effect of the ACW-SRO technique and starting point on coronal alignment in knees with an elevated posterior tibial slope (PTS).

Study design: Descriptive laboratory study.

Methods: Full-length lower extremity computed tomography scans were retrospectively reviewed in patients presenting to our level 1 trauma center to identify patients with an elevated PTS of ≥12° without secondary trauma to the lower extremity. Materialise software was used to generate 3-dimensional models and simulate supratubercle, transtubercle, and infratubercle ACW-SROs. Six osteotomies per tibia were simulated, with 3 using an anterior start point centered at the tibial tubercle, and 3 using a start point at the perfect anterior-posterior mid-axis point of the tibia (-AP). The PTS was corrected to 6° universally. Coronal alignment was measured using the medial proximal tibial angle (MPTA) before and after osteotomy.

Results: Eleven tibias were included, with a mean native PTS of 14.5° (range 12°-18°). Transtubercle-AP and infratubercle-AP osteotomies had the largest mean ΔMPTA of 1.72° of varus (range, 0°-3°; P = .03) and 1.82° of varus (range 0°-3.5°; P = .03), respectively. There was a strong positive correlation between the degree of PTS correction and ΔMPTA. Supratubercle-AP, transtubercle-AP, and infratubercle-AP had the strongest correlations (0.77, P = .005; 0.66, P = .03; 0.68, P = .02, respectively). The mean ΔMPTA increased varus in all 6 osteotomies in tibias with PTS corrections of ≥9°.

Conclusion: Isolated ACW-SRO can affect coronal alignment of the knee by introducing additional varus, particularly in transtubercle and infratubercle osteotomies utilizing the AP starting point. This is especially apparent in tibias requiring larger PTS correction. The tibial tubercle-referenced starting point may minimize coronal changes.

Clinical relevance: This simulated study showed that coronal alignment is affected by the ACW-SRO technique and starting point in patients with elevated PTS. All osteotomies created additional varus, which must be considered when planning PTS correction.

Keywords

anterior closing wedge osteotomy, closing wedge 3-dimensional simulation model, slope-reducing osteotomy, tibial osteotomy

Published Open-Access

yes

Recommended Citation

Helm, James Matthew; Coggins, Mark; Crowley, Brian; et al., "The Effect of Anterior Closing Wedge Slope-Reducing Osteotomy on Coronal Alignment-Effect of Osteotomy Technique, Starting Point, and Degree of Correction." (2025). Faculty, Staff and Student Publications. 3978.
https://digitalcommons.library.tmc.edu/uthmed_docs/3978