Tensho Keiji, Kumaki Daiki, Yoshida Kazushige, Shimodaira Hiroki, Horiuchi Hiroshi, Takahashi Jun
Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto Japan.
Arthrosc Tech. 2023 Nov 20;12(12):e2303-e2311. doi: 10.1016/j.eats.2023.07.059. eCollection 2023 Dec.
A large posterior tibial slope (PTS) has been widely recognized as a potential risk factor in loosening and retear after anterior cruciate ligament reconstruction. Anterior closed-wedge osteotomy is an effective surgical approach to mitigate this risk factor but presents several disadvantages. We describe in this Technical Note an original PTS correction technique called the posterior open-wedge osteotomy. The posterior surface of the proximal tibia is exposed, and 2 K-wires are inserted anteroposteriorly as osteotomy guides, and one wire is inserted mediolaterally as a hinge blocker. The osteotomy is performed from the posterior side and advanced to the anterior side using a single-bladed reciprocating saw. The slope is corrected by opening the osteotomy plane posteriorly with a spreader. The correction is maintained by inserting the harvested fibula fragments into the open space, and the fixation is completed with a locking plate to ensure firm fixation and allow early rehabilitation. This procedure can be an effective solution for patients with various risk factors for retear of the anterior cruciate ligament graft, including abnormal PTS.
较大的胫骨后倾坡度（PTS）已被广泛认为是前交叉韧带重建术后松动和再撕裂的潜在风险因素。前侧闭合楔形截骨术是减轻这一风险因素的有效手术方法，但存在几个缺点。我们在本技术说明中描述了一种名为后侧开放楔形截骨术的原始PTS矫正技术。暴露胫骨近端的后表面，从前向后插入2根克氏针作为截骨导向，从内侧向外侧插入1根克氏针作为铰链阻挡器。使用单刃往复锯从后侧进行截骨并向前推进。通过用撑开器向后打开截骨平面来矫正坡度。通过将切取的腓骨碎片插入开放空间来维持矫正，并用锁定钢板完成固定，以确保牢固固定并允许早期康复。对于包括异常PTS在内的前交叉韧带移植物再撕裂的各种风险因素的患者，该手术可以是一种有效的解决方案。
