Skip to main content
SpringerLink
Log in

Osteotomies in the ACL-Deficient Knee

  • Chapter
  • First Online:
Controversies in the Technical Aspects of ACL Reconstruction

  • 2730 Accesses

Abstract

Historically, osteotomies have been used for localized medial and lateral compartment gonarthrosis with varus and valgus malalignment, due to their ability to redistribute abnormal mechanical forces across the joint. However, over the last several years, the indications for high tibial osteotomy (HTO) have expanded to include cases of concomitant varus malalignment with ACL insufficiency. Although a general consensus on what is the optimal surgical technique is difficult to determine from the literature, there is consensus that the osteotomy can provide an accurate coronal and sagittal correction, while preventing an unintended alteration of the posterior tibial slope.

Because of the role of posterior tibial slope in ACL failure, deflection anterior closing-wedge HTO with or without tibial tubercle detachment, combined with revision ACL reconstruction, has been proposed as an option for the treatment of multiple-failed ACL reconstruction with no bony or ligamentous abnormalities other than posterior slope >10–13°. However, due to the technical complexity of the surgical procedure and the lack of solid clinical evidence, it should be performed carefully only after accurate patient selection and counseling, preoperative planning, intraoperative technical caution, and careful follow-up.

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 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
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. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C et al (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584

    Article  CAS  PubMed  Google Scholar 

  2. Ajuied A et al (2014) Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med 42(9):2242–2252

    Article  PubMed  Google Scholar 

  3. Arun GR, Kumaraswamy V, Rajan D, Vinodh K, Singh AK, Kumar P, Chandrasekaran K, Santosh S, Kishore C (2016) Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope. Arch Orthop Trauma Surg. 136(4):505–11 [Epub ahead of print]

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Blanke F, Kiapour AM, Haenle M, Fischer J, Majewski M, Vogt S, Camathias C (2016) Risk of noncontact anterior cruciate ligament injuries is not associated with slope and concavity of the tibial plateau in recreational alpine skiers: a magnetic resonance imaging-based case-control study of 121 patients. Am J Sports Med. pii: 0363546516632332

    Google Scholar 

  6. Bonasia DE, Dragoni M, Amendola A (2014) Osteotomy for malalignment following failed ACL reconstruction. In: Marx RG (ed) Revision ACL reconstruction: indications and technique. Springer, New York

    Google Scholar 

  7. Bonin N, Ait Si Selmi T, Donell ST et al (2004) Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. Knee 11:431–437

    Article  CAS  PubMed  Google Scholar 

  8. Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, Van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg (Br) 90:1548–1557

    Article  Google Scholar 

  9. Cantin O, Magnussen RA, Corbi F, Servien E, Neyret P, Lustig S (2015) The role of high tibial osteotomy in the treatment of knee laxity: a comprehensive review. Knee Surg Sports Traumatol Arthrosc 23(10):3026–3037

    Article  CAS  PubMed  Google Scholar 

  10. Christensen JJ, Krych AJ, Engasser WM, Vanhees MK, Collins MS, Dahm DL (2015) Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Am J Sports Med 43(10):2510–2514

    Article  PubMed  Google Scholar 

  11. Chun YM, Kim SJ, Kim HS (2008) Evaluation of the mechanical properties of posterolateral structures and supporting posterolateral instability of the knee. J Orthop Res 26:1371–1376

    Article  PubMed  Google Scholar 

  12. Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P (2013) Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(9):1967–1976

    Article  PubMed  Google Scholar 

  13. Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67:1136–1140

    Article  CAS  PubMed  Google Scholar 

  14. Crawford SN, Waterman BR, Lubowitz JH (2013) Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy 29(9):1566–1571

    Article  PubMed  Google Scholar 

  15. Dare DM, Fabricant PD, McCarthy MM, Rebolledo BJ, Green DW, Cordasco FA, Jones KJ (2015) Increased lateral tibial slope is a risk factor for pediatric anterior cruciate ligament injury: an MRI-based case-control study of 152 patients. Am J Sports Med 43(7):1632–1639

    Article  PubMed  Google Scholar 

  16. Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg B 76(5):745–749

    CAS  Google Scholar 

  17. Dejour H, Neyret P, Boileau P et al (1994) Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res 299:220–228

    Google Scholar 

  18. Dejour D, Saffarini M, Demey G, Baverel L (2015) Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc 23(10):2846–2852

    Google Scholar 

  19. Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X et al (2012) Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study. Orthop Traumatol Surg Res 98(1):68–74

    Article  CAS  PubMed  Google Scholar 

  20. Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264

    Google Scholar 

  21. Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382

    Article  PubMed  Google Scholar 

  22. Grassi A, Zaffagnini S, Marcheggiani Muccioli GM, Roberti Di Sarsina T, Urrizola Barrientos F, Marcacci M (2016) Revision anterior cruciate ligament reconstruction does not prevent progression in one out of five patients of osteoarthritis: a meta-analysis of prevalence and progression of osteoarthritis. J ISAKOS Joint Disord Orthop Sports Med 1(1):16–24

    Article  Google Scholar 

  23. Hashemi J, Chandrashekar N, Mansouri H, Gill B, Slauterbeck JR, Schutt RC Jr, Dabezies E, Beynnon BD (2010) Shallow medial tibial plateau and steep medial and lateral tibial slopes: new risk factors for anterior cruciate ligament injuries. Am J Sports Med 38(1):54–62

    Article  PubMed  Google Scholar 

  24. Hohmann E, Bryant A, Reaburn P, Tetsworth K (2011) Is there a correlation between posterior tibial slope and non-contact anterior cruciate ligament injuries? Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):S109–S114

    Article  PubMed  Google Scholar 

  25. Hsu RW, Himeno S, Coventry MB, Chao EY (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res (255):215–227

    Google Scholar 

  26. Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP (2009) Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res 467:2066–2072

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hurwitz DE et al (1998) Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech 31(5):423–430

    Article  CAS  PubMed  Google Scholar 

  28. Kiapour A, Kiapour AM, Kaul V, Quatman CE, Wordeman SC, Hewett TE, Demetropoulos CK, Goel VK (2014) Finite element model of the knee for investigation of injury mechanisms: development and validation. J Biomech Eng 136(1):011002

    Article  PubMed  Google Scholar 

  29. Kutzner I, Trepczynski A, Heller MO, Bergmann G (2013) Knee adduction moment and medial contact force – facts about their correlation during gait. PLoS ONE 8(12):e81036. doi:10.1371/journal.pone.0081036

    Article  PubMed  PubMed Central  Google Scholar 

  30. LaPrade RF, Engebretsen L, Johansen S et al (2008) The effect of a proximal tibial medial opening wedge osteotomy on posterolateral knee instability: a biomechanical study. Am J Sports Med 36:956–960

    Article  PubMed  Google Scholar 

  31. Lattermann C, Jakob RP (1996) High tibial osteotomy alone or combined with ligament reconstruction in anterior cruciate ligament-deficient knees. Knee Surg Sports Traumatol Arthrosc 4(1):32–38

    Article  CAS  PubMed  Google Scholar 

  32. Lecuire F, Lerat JL, Bousquet G, Dejour H, Trillat A (1980) The treatment of genu recurvatum (author’s transl). Rev Chir Orthop Reparatrice Appar Mot 66(2):95–103

    CAS  PubMed  Google Scholar 

  33. Lee YS, Kang JY, Lee MC, Oh WS, Elazab A, Song MK (2016) Effect of the osteotomy length on the change of the posterior tibial slope with a simple distraction of the posterior gap in the uni- and biplanar open-wedge high tibial osteotomy. Arthroscopy 32(2):263–271

    Article  PubMed  Google Scholar 

  34. Li Y, Hong L, Feng H, Wang Q, Zhang J, Song G, Chen X, Zhuo H (2014) Posterior tibial slope influences static anterior tibial translation in anterior cruciate ligament reconstruction: a minimum 2-year follow-up study. Am J Sports Med 42(4):927–933

    Article  PubMed  Google Scholar 

  35. Lipps DB, Oh YK, Ashton-Miller JA, Wojtys EM (2012) Morphologic characteristics help explain the gender difference in peak anterior cruciate ligament strain during a simulated pivot landing. Am J Sports Med 40(1):32–40

    Article  PubMed  Google Scholar 

  36. Marriott K et al (2015) Five-year changes in gait biomechanics after concomitant high tibial osteotomy and ACL reconstruction in patients with medial knee osteoarthritis. Am J Sports Med 43(9):2277–2285

    Article  PubMed  Google Scholar 

  37. McLean SG, Lucey SM, Rohrer S, Brandon C (2010) Knee joint anatomy predicts high-risk in vivo dynamic landing knee biomechanics. Clin Biomech (Bristol, Avon) 25(8):781–788

    Article  Google Scholar 

  38. Moon SW, Park SH, Lee BH, Oh M, Chang M, Ahn JH, Wang JH (2015) The effect of Hinge position on posterior tibial slope in medial open-wedge high tibial osteotomy. Arthroscopy 31(6):1128–1133

    Article  PubMed  Google Scholar 

  39. Nha KW, Kim HJ, Ahn HS, Lee DH (2016) Change in posterior tibial slope after open-wedge and closed-wedge high tibial osteotomy: a meta-Analysis. Am J Sports Med. pii: 0363546515626172

    Google Scholar 

  40. Noyes FR, Barber-Westin SD, Hewett TE (2000) High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med 28:282–296

    Article  CAS  PubMed  Google Scholar 

  41. Noyes FR, Barber SD, Simon R (1993) High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two- to seven-year follow-up study. Am J Sports Med 21(1):2–12

    Article  CAS  PubMed  Google Scholar 

  42. Noyes FR, Schipplein OD, Andriacchi TP, Saddemi SR, Weise M (1992) The anterior cruciate ligament-deficient knee with varus alignment. An analysis of gait adaptations and dynamic joint loadings. Am J Sports Med 20(6):707–716

    Article  CAS  PubMed  Google Scholar 

  43. Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H (2016) Effect of wedge insertion angle on posterior tibial slope in medial opening wedge high tibial osteotomy. Orthop J Sports Med 4(2):2325967116630748

    Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  46. Schipplein OD, Andriacchi TP (1991) Interaction between active and passive knee stabilizers during level walking. J Orthop Res 9(1):113–119

    Article  CAS  PubMed  Google Scholar 

  47. Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. Am J Sports Med 44(2):362–369

    Article  PubMed  Google Scholar 

  48. Sonnery-Cottet B, Archbold P, Cucurulo T, Fayard JM, Bortolletto J, Thaunat M, Prost T, Chambat P (2011) The influence of the tibial slope and the size of the intercondylar notch on rupture of the anterior cruciate ligament. J Bone Joint Surg (Br) 93(11):1475–1478

    Article  CAS  Google Scholar 

  49. Sonnery-Cottet B, Mogos S, Thaunat M, Archbold P, Fayard JM, Freychet B, Clechet J, Chambat P (2014) Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction. Am J Sports Med 42(8):1873–1880

    Article  PubMed  Google Scholar 

  50. Tayton E, Verma R, Higgins B, Gosal H (2009) A correlation of time with meniscal tears in anterior cruciate ligament deficiency: stratifying the risk of surgical delay. Knee Surg Sports Traumatol Arthrosc 17(1):30–34

    Article  PubMed  Google Scholar 

  51. Tunggal JA, Higgins GA, Waddell JP (2010) Complications of closing wedge high tibial osteotomy. Int Orthop 34:255–261

    Article  PubMed  Google Scholar 

  52. Van de Pol GJ et al (2009) Varus alignment leads to increased forces in the anterior cruciate ligament. Am J Sports Med 37(3):481–487

    Article  PubMed  Google Scholar 

  53. Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP (2013) Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med 41(12):2800–2804

    Article  PubMed  Google Scholar 

  54. Westermann RW, DeBerardino T, Amendola A (2014) Minimizing alteration of posterior tibial slope during opening wedge high tibial osteotomy: a protocol with experimental validation in paired cadaveric knees. Iowa Orthop J 34:16–23

    PubMed  PubMed Central  Google Scholar 

  55. Wordeman SC, Quatman CE, Kaeding CC, Hewett TE (2012) In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: a systematic review and meta-analysis. Am J Sports Med 40(7):1673–1681

    Article  PubMed  PubMed Central  Google Scholar 

  56. Zaffagnini S, Bonanzinga T, Grassi A, Marcheggiani Muccioli GM, Musiani C, Raggi F, Iacono F, Vaccari V, Marcacci M (2013) Combined ACL reconstruction and closing-wedge HTO for varus angulated ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc 21(4):934–941

    Article  PubMed  Google Scholar 

  57. Zhang Y, Wang J, Xiao J, Zhao L, Li ZH, Yan G, Shi ZJ (2014) Measurement and comparison of tibial posterior slope angle in different methods based on three-dimensional reconstruction. Knee 21(3):694–698

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy

    Alberto Grassi

  2. Duke Sports Sciences Institute, Duke University, Durham, NC, USA

    Alberto Grassi & Annunziato Amendola

  3. Centre for Limb Deformity Correction and Joint Preserving Surgery, Kliniek Via Sana, Mill, The Netherlands

    Ronald van Heerwaarden

Authors
  1. Alberto Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald van Heerwaarden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annunziato Amendola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Annunziato Amendola .

Editor information

Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

Rights and permissions

Reprints and permissions

Copyright information

© 2017 ISAKOS

About this chapter

Cite this chapter

Grassi, A., van Heerwaarden, R., Amendola, A. (2017). Osteotomies in the ACL-Deficient Knee. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_46

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-52742-9_46

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-52740-5

  • Online ISBN: 978-3-662-52742-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation