Skip to main content

The Role of High Tibial Osteotomy in the ACL-Deficient Knee

  • Chapter
  • First Online:

Abstract

High tibial osteotomy for correction of varus overload or malalignment should be considered in ACL deficiency, particularly when associated with medial compartment degeneration. This procedure, either in isolation or in concert with ACL reconstruction, can provide the patient with stability and improved joint mechanics, which can ameliorate the symptoms of unicompartmental gonarthrosis. This chapter discusses the role of high tibial osteotomy in the surgical management of ACL deficiency, and provides evidence-based support for its role in the management of these complex patients. The surgical technique, with pearls and pitfalls, is also described.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
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

Learn about institutional subscriptions

References

  1. Amendola A, Rorabeck CH, et al. Total knee arthroplasty following high tibial osteotomy for osteoarthritis. J Arthroplasty. 1989;4(Suppl):S11–7.

    Article  PubMed  Google Scholar 

  2. Badhe NP, Forster IW. High tibial osteotomy in knee instability: the rationale of treatment and early results. Knee Surg Sports Traumatol Arthrosc. 2002;10(1):38–43.

    Article  PubMed  Google Scholar 

  3. Bettin D, Karbowski A, et al. Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy. Arch Orthop Trauma Surg. 1998;117(1–2):53–7.

    Article  PubMed  CAS  Google Scholar 

  4. Bonin N, Ait Si Selmi T, et al. Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. Knee. 2004;11(6):431–7.

    Article  PubMed  CAS  Google Scholar 

  5. Boss A, Stutz G, et al. Anterior cruciate ligament reconstruction combined with valgus tibial osteotomy (combined procedure). Knee Surg Sports Traumatol Arthrosc. 1995;3(3):187–91.

    Article  PubMed  CAS  Google Scholar 

  6. Chun Y-M, Kim S-J, et al. Evaluation of the mechanical properties of posterolateral structures and supporting posterolateral instability of the knee. J Orthop Res. 2008;26(10):1371–6.

    Article  PubMed  Google Scholar 

  7. Clatworthy M, Amendola A. The anterior cruciate ligament and arthritis. Clin Sports Med. 1999;18(1):173–98, vii.

    Article  PubMed  CAS  Google Scholar 

  8. Coventry MB. Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am. 1985;67(7):1136–40.

    PubMed  CAS  Google Scholar 

  9. Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br. 1994;76(5):745–9.

    PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  12. Fening SD, Kovacic J, et al. The effects of modified posterior tibial slope on anterior cruciate ligament strain and knee kinematics: a human cadaveric study. J Knee Surg. 2008;21(3):205–11.

    Article  PubMed  Google Scholar 

  13. Georgoulis AD, Makris CA, et al. Nerve and vessel injuries during high tibial osteotomy combined with distal fibular osteotomy: a clinically relevant anatomic study. Knee Surg Sports Traumatol Arthrosc. 1999;7(1):15–9.

    Article  PubMed  CAS  Google Scholar 

  14. Giffin JR, Stabile KJ, et al. Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med. 2007;35(9):1443–9.

    Article  PubMed  Google Scholar 

  15. Giffin JR, Vogrin TM, et al. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med. 2004;32(2):376–82.

    Article  PubMed  Google Scholar 

  16. Hernigou P, Medevielle D, et al. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332–54.

    PubMed  CAS  Google Scholar 

  17. Hinman RS, May RL, et al. Is there an alternative to the full-leg radiograph for determining knee joint alignment in osteoarthritis? Arthritis Rheum. 2006;55(2):306–13.

    Article  PubMed  Google Scholar 

  18. Holden DL, James SL, et al. Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg Am. 1988;70(7):977–82.

    PubMed  CAS  Google Scholar 

  19. Jackson J. Osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am. 1958;43-B(4):746–51.

    Google Scholar 

  20. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. Proc R Soc Med. 1960;53(10):888.

    PubMed  CAS  Google Scholar 

  21. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br. 1961;43-B:746–51.

    PubMed  CAS  Google Scholar 

  22. Kessler MA, Behrend H, et al. Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):442–8.

    Article  PubMed  CAS  Google Scholar 

  23. Laprade RF, Engebretsen L, et al. The effect of a proximal tibial medial opening wedge osteotomy on posterolateral knee instability: a biomechanical study. Am J Sports Med. 2008;36(5):956–60.

    Article  PubMed  Google Scholar 

  24. Lattermann C, Jakob RP. High tibial osteotomy alone or combined with ligament reconstruction in anterior cruciate ligament-deficient knees. Knee Surg Sports Traumatol Arthrosc. 1996;4(1):32–8.

    Article  PubMed  CAS  Google Scholar 

  25. MacDonald P, Miniaci A, et al. A biomechanical analysis of joint contact forces in the posterior cruciate deficient knee. Knee Surg Sports Traumatol Arthrosc. 1996;3(4):252–5.

    Article  PubMed  CAS  Google Scholar 

  26. Markolf KL, Burchfield DM, et al. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res. 1995;13(6):930–5.

    Article  PubMed  CAS  Google Scholar 

  27. Markolf KL, Gorek JF, et al. Direct measurement of resultant forces in the anterior cruciate ligament. An in vitro study performed with a new experimental technique. J Bone Joint Surg Am. 1990;72(4):557–67.

    PubMed  CAS  Google Scholar 

  28. Marti CB, Jakob RP. Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction. Arthroscopy. 1999;15(8):864–6.

    Article  PubMed  CAS  Google Scholar 

  29. McDaniel WJ, Dameron TB. The untreated anterior cruciate ligament rupture. Clin Orthop. 1983;172:158–63.

    PubMed  Google Scholar 

  30. Miller BS, Downie B, et al. Complications after medial opening wedge high tibial osteotomy. Arthroscopy. 2009;25(6):639–46.

    Article  PubMed  Google Scholar 

  31. Naudie D, Bourne RB, et al. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to −22-year followup study. Clin Orthop. 1999;367:18–27.

    PubMed  Google Scholar 

  32. Naudie DDR, Amendola A, et al. Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med. 2004;32(1):60–70.

    Article  PubMed  Google Scholar 

  33. Noyes FR, Barber-Westin SD, et al. 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 

  34. Noyes FR, Schipplein OD, et al. The anterior cruciate ligament-deficient knee with varus alignment. An analysis of gait adaptations and dynamic joint loadings. Am J Sports Med. 1992;20(6):707–16.

    Article  PubMed  CAS  Google Scholar 

  35. Odenbring S, Berggren AM, et al. Roentgenographic assessment of the hip-knee-ankle axis in medial gonarthrosis. A study of reproducibility. Clin Orthop. 1993;289:195–6.

    PubMed  Google Scholar 

  36. Phisitkul P, Wolf BR, et al. Role of high tibial and distal femoral osteotomies in the treatment of lateral-posterolateral and medial instabilities of the knee. Sports Med Arthrosc. 2006;14(2):96–104.

    Article  PubMed  Google Scholar 

  37. Sabharwal S, Zhao C. Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg. 2008;90(1):43–51.

    Article  PubMed  Google Scholar 

  38. Sabharwal S, Zhao C, et al. Computed radiographic measurement of limb-length discrepancy. Full-length standing anteroposterior radiograph compared with scanogram. J Bone Joint Surg Am. 2006;88(10):2243–51.

    Article  PubMed  Google Scholar 

  39. Sangeorzan BP, Judd RP, et al. Mathematical analysis of single-cut osteotomy for complex long bone deformity. J Biomech. 1989;22(11–12):1271–8.

    Article  PubMed  CAS  Google Scholar 

  40. Sharma L, Song J, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001;286(2):188–95.

    Article  PubMed  CAS  Google Scholar 

  41. Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg. 2004;124(10):649–53.

    Article  PubMed  Google Scholar 

  42. Tjörnstrand B, Hagstedt B, et al. Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee. J Bone Joint Surg Am. 1978;60(7):973–7.

    PubMed  Google Scholar 

  43. Tunggal JAW, Higgins GA, et al. Complications of closing wedge high tibial osteotomy. Int Orthop. 2010;34(2):255–61.

    Article  PubMed  Google Scholar 

  44. van de Pol GJ, Arnold MP, et al. Varus alignment leads to increased forces in the anterior cruciate ligament. Am J Sports Med. 2009;37(3):481–7.

    Article  PubMed  Google Scholar 

  45. Wildner M, Peters A, et al. Complications of high tibial osteotomy and internal fixation with staples. Arch Orthop Trauma Surg. 1992;111(4):210–2.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christian L. Sybrowsky M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Sybrowsky, C.L., Amendola, A. (2013). The Role of High Tibial Osteotomy in the ACL-Deficient Knee. In: Sanchis-Alfonso, V., Monllau, J. (eds) The ACL-Deficient Knee. Springer, London. https://doi.org/10.1007/978-1-4471-4270-6_24

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4270-6_24

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4269-0

  • Online ISBN: 978-1-4471-4270-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics