Queiros Carlos Mesquita, Abreu Felipe Galvao, Moura Joao Luis, de Abreu Guilherme Venturi, Vieira Thais Dutra, Helfer Lionel, Sonnery-Cottet Bertrand
Centre Orthopédique Santy, FIFA Médical Center of Excellence, Groupe Ramsay - Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France.
Arthrosc Tech. 2019 Sep 19;8(10):e1105-e1109. doi: 10.1016/j.eats.2019.05.026. eCollection 2019 Oct.
An excessive posterior tibial slope has been identified as a potential risk factor for anterior cruciate ligament tears. Anterior closing-wedge osteotomy decreases the posterior slope and can eliminate this risk factor in patients with recurrent instability and greater than 12° posterior slope. We will describe an anterior closing-wedge osteotomy technique performed at the tibial tubercle (TT), in which the TT is not detached to preserve the extensor mechanism attachment. A vertical cut is performed in the sagittal plane just posterior to the TT, leaving a distal cortical hinge. Two proximal parallel K-wires and 2 distal parallel K-wires convergent to the proximal ones are inserted from the anterior cortex on both sides of the tubercle toward the tibial posterior cortex at the posterior cruciate ligament's tibial insertion. Proximal and distal cuts are performed to remove the bone wedge. Reduction is achieved by gentle knee extension. Fixation is completed with 2 staples placed medially and laterally to the TT.
胫骨后倾过大已被确定为前交叉韧带撕裂的潜在风险因素。前闭合楔形截骨术可减小后倾角度，并可消除复发性不稳定且后倾角度大于12°患者的这一风险因素。我们将描述一种在胫骨结节（TT）处进行的前闭合楔形截骨术技术，其中TT不被分离以保留伸肌机制附着点。在矢状面上于TT后方进行垂直切割，留下远端皮质铰链。从结节两侧的前皮质向胫骨后皮质在胫骨后交叉韧带附着处插入两根近端平行克氏针和两根向近端克氏针汇聚的远端平行克氏针。进行近端和远端截骨以去除骨楔。通过轻柔地伸展膝关节实现复位。通过在TT内侧和外侧放置两枚钉完成固定。
