Institute of Orthopedics Carlos E Ottolenghi, Department of Orthopedic Surgery of the Italian Hospital, Potosi 4247, Capital Federal, Buenos Aires, Argentina.
Clin Orthop Relat Res. 2012 Apr;470(4):986-92. doi: 10.1007/s11999-011-1855-5.
The literature suggests rotatory knee instability (pseudolaxity) can be associated with depressions of the lateral tibial plateau in patients despite an intact arcuate ligament complex. Correcting this bone deformity by an open-wedge osteotomy of the lateral tibia plateau, elevating the depressed bone may restore knee stability.
QUESTIONS/PURPOSES: We therefore asked whether: (1) knee stability is restored after this procedure; (2) Lysholm functional scores improve after this treatment; and (3) the limb alignment changes.
We retrospectively evaluated 12 patients who underwent a subchondral open-wedge osteotomy of the lateral tibial plateau combined with a knee arthroscopic procedure for the treatment of a knee rotational instability secondary to a lateral compartment bone deficit between 2000 and 2007. Eleven patients with a mean age of 35 years were available for followup at a minimum of 2 years (average, 5.4 years; range, 2-9 years). Preoperatively and at last followup, patients were clinically and radiographically evaluated by the Lysholm score and with comparative knee radiographs. Complications were recorded.
At last followup all patients rated their knees as stable. All osteotomies healed uneventfully. The Lysholm score improved from 62 to 87. Followup radiographs showed no changes in the femorotibial axis as result of the osteotomy.
Patients with chronic depression of the posterolateral tibial plateau may exhibit symptoms of posterolateral knee instability, a sort of pseudolaxity. In these patients, an open-wedge osteotomy of the lateral tibia plateau, elevating the depressed bone, and tensioning posterolateral structures improves this secondary posterolateral knee instability.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
文献表明，尽管弧形韧带复合体完整，旋转性膝关节不稳定（假性松弛）可与外侧胫骨平台凹陷有关。通过外侧胫骨平台的开放式楔形骨切开术纠正这种骨畸形，抬高凹陷的骨骼可以恢复膝关节稳定性。
问题/目的：因此，我们提出以下问题：（1）该手术后膝关节稳定性是否恢复；（2）经此治疗后 Lysholm 功能评分是否提高；以及（3）肢体对线是否改变。
我们回顾性评估了 2000 年至 2007 年间因外侧间室骨缺损导致膝关节旋转不稳定而接受外侧胫骨平台骨下楔形切开术联合膝关节镜手术的 12 例患者。11 例患者平均年龄 35 岁，随访至少 2 年（平均 5.4 年；范围，2-9 年）。术前和末次随访时，采用 Lysholm 评分和比较性膝关节 X 线片对患者进行临床和影像学评估。记录并发症。
末次随访时，所有患者均自述膝关节稳定。所有截骨均愈合良好。Lysholm 评分从 62 分提高到 87 分。随访 X 线片显示截骨术未导致股胫轴线改变。
慢性后外侧胫骨平台凹陷的患者可能会出现后外侧膝关节不稳定的症状，这是一种假性松弛。在这些患者中，外侧胫骨平台的开放式楔形骨切开术抬高凹陷的骨骼并拉紧后外侧结构可改善这种继发性后外侧膝关节不稳定。
IV 级，治疗性研究。欲了解完整的证据水平描述，请参见作者指南。
