Twin Cities Orthopedics, Edina, Minnesota, USA.
Orthopedics Northwest, Yakima, Washington, USA.
Am J Sports Med. 2024 Jul;52(8):1990-1996. doi: 10.1177/03635465241252982. Epub 2024 Jun 3.
Because of the increased prevalence of revision anterior cruciate ligament (ACL) reconstruction, there has been a desire to understand the role of posterior tibial slope on increased anterior tibial translation and increased ACL graft forces. One potential concern in supratubercle anterior closing wedge proximal tibial osteotomy (ACW-PTO) for decreasing the posterior tibial slope is the risk of altering the patellar height.
To radiographically assess changes in (1) patellar height, (2) anterior tibial translation, and (3) posterior tibial slope after supratubercle ACW-PTO.
Case series; Level of evidence, 4.
Patients who underwent supratubercle ACW-PTO by a single surgeon between July 2019 and June 2023 were included. Standardized lateral knee weightbearing radiographs to assess patellar height (via the Caton-Deschamps index), anterior tibial translation of the lateral tibial plateau relative to the lateral femoral condyle, and posterior tibial slope were obtained at 4 time points (preoperatively and 1 day, 3 months, and 6 months postoperatively). Paired test was used to compare differences between preoperative, 1-day, and 3- and 6-month values for patellar height as measured using the Caton-Deschamps index and for posterior tibial slope. Paired test was also used to compare differences in the preoperative and 6-month postoperative values for anterior tibial translation.
In 20 patients after ACW-PTO, the Caton-Deschamps index demonstrated a significant increase in patellar height on postoperative day 1 ( < .001) but no significant differences at 3 ( = .057) and 6 ( = .176) months postoperatively. Anterior tibial translation on standing lateral knee radiographs was significantly decreased by a mean of 8.9 mm from preoperatively to 6 months postoperatively ( < .001). Posterior tibial slope was significantly decreased by a mean of 11.2° from preoperatively to 6 months postoperatively ( < .001).
Supratubercle ACW-PTO performed for ACL reconstruction failure in the setting of an increased posterior tibial slope did not induce significant changes in patellar height postoperatively. Furthermore, after ACW-PTO, there was a significant decrease in anterior tibial translation and posterior tibial slope.
由于前交叉韧带（ACL）重建后翻修的发病率增加，人们越来越希望了解胫骨后斜率对胫骨前向平移增加和 ACL 移植物力增加的作用。在用于降低胫骨后斜率的胫骨结节上侧闭合楔形近端胫骨截骨术（ACW-PTO）中，一个潜在的担忧是改变髌骨高度的风险。
通过放射学评估胫骨结节上侧 ACW-PTO 后（1）髌骨高度、（2）胫骨前向平移和（3）胫骨后斜率的变化。
病例系列；证据水平，4 级。
纳入了由一名外科医生在 2019 年 7 月至 2023 年 6 月期间进行胫骨结节上侧 ACW-PTO 的患者。在 4 个时间点（术前、术后 1 天、3 个月和 6 个月）获得标准化的外侧膝关节负重位 X 线片，以评估髌骨高度（通过 Caton-Deschamps 指数）、相对于外侧股骨髁的外侧胫骨平台的胫骨前向平移和胫骨后斜率。配对 t 检验用于比较 Caton-Deschamps 指数测量的髌骨高度和胫骨后斜率的术前、术后 1 天和 3 个月和 6 个月值之间的差异。配对 t 检验也用于比较术前和术后 6 个月的胫骨前向平移值之间的差异。
在接受 ACW-PTO 的 20 名患者中，Caton-Deschamps 指数显示髌骨高度在术后 1 天（<0.001）显著增加，但在术后 3 个月（=0.057）和 6 个月（=0.176）时无显著差异。站立位外侧膝关节 X 线片上的胫骨前向平移平均减少 8.9mm，从术前到术后 6 个月（<0.001）。胫骨后斜率从术前到术后 6 个月平均降低 11.2°（<0.001）。
在胫骨后斜率增加的情况下，为 ACL 重建失败而进行的胫骨结节上侧 ACW-PTO 并未导致术后髌骨高度发生显著变化。此外，ACW-PTO 后，胫骨前向平移和胫骨后斜率均显著降低。
