Schuster Philipp, Mayer Philipp, Schubert Ilona, Leiprecht Janina, Micicoi Gregoire, Reuter Benoit, Richter Jörg, Dickschas Jörg
Orthopedic Hospital Markgroeningen, Centre of Sports Orthopedics and Special Joint Surgery, Markgroeningen, Germany.
Department of Orthopedics and Traumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 Mar;33(3):1033-1043. doi: 10.1002/ksa.12559. Epub 2024 Dec 15.
Different techniques of slope-decreasing anterior closed-wedge proximal tibial osteotomy (ACW-PTO) have been described. To determine the peri- and post-operative complication rate and obtain data on bone healing in ACW-PTO with an infratuberositary approach.
A total of 170 consecutive ACW-PTO of two sports-orthopaedic centres were retrospectively evaluated (97 and 73, respectively). Routine follow-up was performed after 6 weeks and was available in 166 cases (97.7%). Medical charts and x-rays of these cases were reviewed with regard to technique-specific complications. Lateral x-rays (n = 155) at 6 weeks post-operatively were evaluated with regard to bone healing (completely healed, partially healed or with no or delayed signs of bone healing). A multivariate binary logistic regression was performed to detect factors that influence bone healing.
There was one case with haematoma and superficial wound-healing problems after 5 weeks with progression to a deep wound infection and revision surgery (plate exchange) at 11 weeks after the index surgery. One case with delayed bone healing was treated with plate exchange combined with revision anterior cruciate ligament reconstruction after 4 months. The further course of both cases was uneventful. No other complications were observed. Therefore, the overall complication rate was 1.2% (2 out of 166). Radiologic evaluation at 6 weeks showed complete healing in 104 cases (67.1%), partial healing in 50 cases (32.3%) and delayed healing only in the aforementioned case (0.6%), respectively. All cases of partial healing showed complete healing at 12 weeks. In regression analysis, a completely closed osteotomy (odds ratio [OR] = 3.5, p = 0.003) and compression of the osteotomy (OR = 2.5, p = 0.026) were significantly associated with complete bone healing at 6 weeks.
ACW-PTO using an infratuberositary approach is very safe with regard to complication rate and shows rapid bone healing. The osteotomy should be completely closed and compression should be applied for optimal bone healing.
Case series with pooled data of two centres.
Level 4.
已描述了不同的胫骨近端前侧闭合楔形截骨术（ACW-PTO）的截骨技术。本研究旨在确定经胫骨结节下入路的ACW-PTO围手术期及术后的并发症发生率，并获取骨愈合的数据。
回顾性评估两个运动骨科中心连续进行的170例ACW-PTO（分别为97例和73例）。术后6周进行常规随访，166例（97.7%）有随访资料。对这些病例的病历和X线片进行了技术特异性并发症方面的审查。术后6周的侧位X线片（n = 155）用于评估骨愈合情况（完全愈合、部分愈合或无骨愈合迹象或延迟骨愈合迹象）。进行多因素二元逻辑回归分析以检测影响骨愈合的因素。
1例在术后5周出现血肿和浅表伤口愈合问题，进展为深部伤口感染，并在初次手术后11周进行了翻修手术（更换钢板）。1例延迟骨愈合患者在4个月后行钢板更换联合前交叉韧带翻修重建术治疗。两例患者后续恢复顺利。未观察到其他并发症。因此，总体并发症发生率为1.2%（166例中有2例）。术后6周的影像学评估显示，104例（67.1%）完全愈合，50例（32.3%）部分愈合，仅上述1例延迟愈合（0.6%）。所有部分愈合的病例在12周时均完全愈合。回归分析显示，完全闭合截骨术（优势比[OR]=3.5，p = 0.003）和截骨术加压（OR = 2.5，p = 0.026）与术后6周的完全骨愈合显著相关。
经胫骨结节下入路的ACW-PTO在并发症发生率方面非常安全，且骨愈合迅速。截骨术应完全闭合，并施加加压以实现最佳骨愈合。
两个中心汇总数据的病例系列。
4级。
