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The Role of Osteotomy

  • Annunziato Amendola
  • Michelle Wolcott

Abstract

Reconstruction of the multiple ligament injured knee can be challenging owing to the many factors necessary to achieve a stable, functional joint. The task of assessing limb alignment and malalignment has been largely ignored in the multiple ligament injured knee, and reconstruction has focused on soft tissue constraints. Although it has been shown that joint alignment plays a critical role in the development of arthritis and overload syndromes, osteotomy to control instability has been a controversial subject. Recent evidence suggests that joint alignment may be just as important in maintaining joint stability, particularly in cases of chronic ligamentous injury. Over time, untreated malalignment can worsen ligamentous laxity and lead to symptomatic chronic instability. In the case of the ACL-deficient knee, for example, varus malalignment can be overemphasized as internal rotation of the tibia places more stress on the lateral structures. This deformity can then be manifested as a posterolateral thrust upon ambulation. Malalignment in the coronal or sagittal plane may be a significant contributing factor in the success of reconstruction of the anterior cruciate ligament (ACL). This chapter discusses the role of osteotomy in these unstable knees as a means of ensuring success in the long-term outcome of ligamentous reconstruction.

Keywords

Posterior Cruciate Ligament High Tibial Osteotomy Tibial Slope Anterior Tibial Translation Wedge Osteotomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Markoff KL, Bargar WL, Shoemaker SC, et al. The role of joint load in knee stability. J Bone Joint Surg Am 1988; 70: 977–982.Google Scholar
  2. 2.
    Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament—deficient knees. Am J Sports Med 2000; 28 (3): 282–296.PubMedGoogle Scholar
  3. 3.
    Hughston JC, Jacobsen KE. Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg Am 1985; 67: 351–359.PubMedGoogle Scholar
  4. 4.
    Dejour H, Walch G, Chambat P, et al. Active subluxation in extension: a new concept of study of the ACL deficient knee. Am J Knee Surg 1988; 1: 204–211.Google Scholar
  5. 5.
    Dejour H, Neyret P, Bonnin M. In: Fu F, ed. Knee Surgery. Baltimore, MD: Williams & Wilkins; 1994: 859–875.Google Scholar
  6. 6.
    Amendola AS, Giffin JR, Sanders DW. Osteotomy for knee stability: the effect of increasing tibial slope on anterior tibial translation. Paper presented at: American Association for Orthopaedic Sports Medicine, Specialty Day; March 2001; San Francisco.Google Scholar
  7. 7.
    Naudie D, Amendola A, Fowler P. Opening wedge high tibial osteotomy for chronic posterior instability. Proceedings of the meeting of the American Association for Orthopaedic Sports Medicine; July 2001; Keystone, CO.Google Scholar
  8. 8.
    Clatworthy M, Amendola AS. The anterior cruciate ligament and arthritis. Clin Sports Med 1999; 18: 173–198.PubMedCrossRefGoogle Scholar
  9. 9.
    Coventry MB. Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 1985; 67: 1136–1140.PubMedGoogle Scholar
  10. 10.
    Morrey BE Upper tibial osteotomy for secondary osteoarthritis of the knee. J Bone Joint Surg Br 1989; 71: 554–559.PubMedGoogle Scholar
  11. 11.
    Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. J Bone Joint Surg Am 1965; 47: 984–990.PubMedGoogle Scholar
  12. 12.
    Dejour H, Neyret P, Boileau P, et al. Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop 1994; 299: 220–228.PubMedGoogle Scholar
  13. 13.
    Naudie D, Roth S, Dunning C, Amendola AS, Giffin JR, Johnson JA, Chess D, King GJW. The effect of opening wedge high tibial osteotomy in the posterior cruciate ligament deficient knee. Paper presented at: 56th Annual Meeting of the Canadian Orthopaedic Association; June 1–4, 2001.Google Scholar
  14. 14.
    Amendola A. The effect of opening wedge high tibial osteotomy in the PCL deficient knee. Proceedings of the meeting of the American Association for Orthopaedic Sports Medicine; July 2001; Keystone, CO.Google Scholar
  15. 15.
    Brown G, Amendola A: Radiographic evaluation and preoperative planning for high tibial osteotomies. Oper Techniques Sports Med 2000; 8 (1): 2–14.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Annunziato Amendola
  • Michelle Wolcott

There are no affiliations available

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