Skip to main content
SpringerLink
Log in

The Role of Osteotomy

  • Chapter
  • First Online:
The Multiple Ligament Injured Knee

  • 2158 Accesses

Abstract

Reconstruction of the multiple ligament-injured knee can be challenging due to the many factors necessary to achieve a stable, functional joint. Historically the treatment of multiple ligament-injured knees has been based solely on soft tissue constraints and has lead to some disappointing results. Recent evidence suggests that joint alignment may be just as important in maintaining joint stability, particularly in cases of chronic ligamentous laxity.

A tibial osteotomy needs to be seriously considered under these two circumstances in the patient with a multiple ligament knee injury: for chronic posterolateral rotatory instability in a patient with varus malalignment and as an adjunct to the patients with ACL/PCL deficiency. The former is managed with coronal correction of the malalignment and the latter by alterations in the tibial slope. This chapter discusses the role of osteotomy in the unstable knee as a means of ensuring success in the long-term outcome of ligament reconstructions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am. 1993;75(2):196–201.

    PubMed  CAS  Google Scholar 

  2. Morrey BF. Upper tibial osteotomy for secondary osteoarthritis of the knee. J Bone Joint Surg Br. 1989;71(4):554–9.

    PubMed  CAS  Google Scholar 

  3. Slawski DP. High tibial osteotomy in the treatment of adult osteochondritis dissecans. Clin Orthop Relat Res. 1997;341:155–61.

    Article  PubMed  Google Scholar 

  4. Kim SJ, Moon HK, Chun YM, Chang WH, Kim SG. Is correctional osteotomy crucial in primary varus knees undergoing anterior cruciate ligament reconstruction? Clin Orthop Relat Res. 2010;469(5):1421–6.

    Article  PubMed  Google Scholar 

  5. Makoff KL, Bargar WI, Shoemaker SC, et al. The role of joint load in knee stability. J Bone Surg Am. 1988;70:977–82.

    Google Scholar 

  6. 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):282–96.

    PubMed  CAS  Google Scholar 

  7. Hughston JC, Jacobsen KE. Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg Am. 1985;67:351–9.

    PubMed  CAS  Google Scholar 

  8. 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;1:204–11.

    Google Scholar 

  9. Dejour H, Neyret P, Bonnin M. In: Fu F, editor. Knee surgery. Baltimore, MD: Williams & Wilkins; 1994. p. 859–875.

    Google Scholar 

  10. 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; Mar 2001; San Francisco.

    Google Scholar 

  11. 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; Jul 2001; Keystone, CO.

    Google Scholar 

  12. Clatworthy M, Amendola AS. The anterior cruciate ligament and arthritis. Clin Sports Med. 1999;18:173–98.

    Article  PubMed  CAS  Google Scholar 

  13. Coventry MB. Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am. 1985;67:1136–40.

    PubMed  CAS  Google Scholar 

  14. 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;47:984–90.

    PubMed  CAS  Google Scholar 

  15. Dejour H, Neyret P, Boileau P, et al. Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop. 1994;299:220–8.

    PubMed  Google Scholar 

  16. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop. 1992;274:248–64.

    PubMed  Google Scholar 

  17. 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; 1–4 June 2001.

    Google Scholar 

  18. 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; Jul 2001; Keystone, CO.

    Google Scholar 

  19. Brown G, Amendola A. Radiographic evaluation and preoperative planning for high tibial osteotomies. Oper Techniques Sports Med. 2000;8(1):2–14.

    Article  Google Scholar 

Download references

Acknowledgments

A special thanks to Annunziato Amendola and Michelle Wolcott who served as authors of this chapter in an earlier edition and whose many ideas and theories were re-created here.

Author information

Authors and Affiliations

  1. Sports Medicine Division, Orthopaedic Surgery Department, Duke University Medical Center, Finch Yeager Building, Room 311, 280 Frank Bassett Drive, Durham, NC, 27708, USA

    Claude T. Moorman III M.D. & Katherine J. Coyner M.D.

Authors
  1. Claude T. Moorman III M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine J. Coyner M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claude T. Moorman III M.D. .

Editor information

Editors and Affiliations

  1. GHS Orthopaedics, Woodbine Lane 115, Danville, 17822-5212, Pennsylvania, USA

    Gregory C. Fanelli

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Moorman, C.T., Coyner, K.J. (2013). The Role of Osteotomy. In: Fanelli, G. (eds) The Multiple Ligament Injured Knee. Springer, New York, NY. https://doi.org/10.1007/978-0-387-49289-6_25

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-49289-6_25

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-49287-2

  • Online ISBN: 978-0-387-49289-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation