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J Knee Surg 2021; 34(06): 592-598
DOI: 10.1055/s-0041-1723983
Special Focus Section

Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results

Andreas Weiler
1   Sporthopaedicum, Berlin, Germany
,
Jörg Dickschas
2   Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Germany
,
Clemens Gwinner
3   Center for Musculoskelettal Surgery, Charité University Medicine, Berlin, Germany
› Author Affiliations Funding None.
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Abstract

Recently, the bony anatomy of the proximal tibia has gained strong interest, particularly in the cruciate ligament deficient knee. Regarding the anterior cruciate ligament (ACL), several studies outlined that a steep tibial slope (≥12 degrees) contributes to early failures after ACL reconstruction. As a consequence, the first clinical reports are available on slope reducing osteotomies in revision ACL surgery. Vice versa, biomechanical as well as clinical reports suggest that a flat slope increases the load on the posterior cruciate ligament (PCL) and might contribute to a poor result after PCL reconstruction. Since many decades, slope increasing anterior open wedge osteotomies are used to treat a symptomatic genu recurvatum. The aim of the current report is to describe different surgical techniques and report our first clinical experience of an anterior open wedge osteotomy as a sole procedure in chronic PCL deficient knees with a flat tibial slope. In six cases, a mean preoperative slope of 3.7 degrees (range = 2–5 degrees) was increased to a mean of 11.5 degrees (range = 9–13 degrees). There was one case with a delayed bone healing, which was successfully treated without loss of correction by revision internal fixation and bone grafting.

Keywords

slope - posterior cruciate ligament - genu recurvatum - flexion osteotomy - anterior open wedge osteotomy


Publication History

Received: 22 December 2020

Accepted: 02 January 2021

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

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