Robin Jonathan G, Neyret Philippe
Box Hill Hospital, Eastern Health Network, Australia.
Lyon 1 University, France.
EFORT Open Rev. 2017 Mar 13;1(1):3-11. doi: 10.1302/2058-5241.1.000001. eCollection 2016 Jan.
Patients with unstable, malaligned knees often present a challenging management scenario, and careful attention must be paid to the clinical history and examination to determine the priorities of treatment.Isolated knee instability treated with ligament reconstruction and isolated knee malalignment treated with periarticular osteotomy have both been well studied in the past. More recently, the effects of high tibial osteotomy on knee instability have been studied.Lateral closing-wedge high tibial osteotomy tends to reduce the posterior tibial slope, which has a stabilising effect on anterior tibial instability that occurs with ACL deficiency.Medial opening-wedge high tibial osteotomy tends to increase the posterior tibia slope, which has a stabilising effect in posterior tibial instability that occurs with PCL deficiency.Overall results from recent studies indicate that there is a role for combined ligament reconstruction and periarticular knee osteotomy.The use of high tibial osteotomy has been able to extend the indication for ligament reconstruction which, when combined, may ultimately halt the evolution of arthritis and preserve their natural knee joint for a longer period of time. Cite this article: Robin JG, Neyret P. High tibial osteotomy in knee laxities: Concepts review and results. 2016;1:3-11. doi: 10.1302/2058-5241.1.000001.
膝关节不稳定、排列不齐的患者常常面临具有挑战性的治疗情况，必须仔细关注临床病史和检查以确定治疗重点。过去，韧带重建治疗单纯膝关节不稳定以及关节周围截骨术治疗单纯膝关节排列不齐均已得到充分研究。最近，胫骨高位截骨术对膝关节不稳定的影响也得到了研究。外侧闭合楔形胫骨高位截骨术往往会减小胫骨后倾坡度，这对前交叉韧带（ACL）缺失时出现的胫骨前向不稳定具有稳定作用。内侧开放楔形胫骨高位截骨术往往会增加胫骨后倾坡度，这对后交叉韧带（PCL）缺失时出现的胫骨后向不稳定具有稳定作用。近期研究的总体结果表明，韧带重建与膝关节周围截骨术联合应用具有一定作用。胫骨高位截骨术的应用能够扩大韧带重建的适应证，二者联合应用最终可能会阻止关节炎的发展，并在更长时间内保留患者的天然膝关节。引用本文：Robin JG, Neyret P. High tibial osteotomy in knee laxities: Concepts review and results. 2016;1:3 - 11. doi: 10.1302/2058 - 5241.1.000001.
