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斜度降低型胫骨平台平整截骨术

Slope-Reducing Tibial Plateau-Leveling Osteotomy.

作者信息

Ollivier Matthieu, Hoffer Alexander J, Onishi Shintaro, Brilhault Jean, Frey-Ollivier Solenne, Godshaw Brian, Kley Kristian

机构信息

Institute of Movement Sciences, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France.

Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A.

出版信息

Arthrosc Tech. 2024 Sep 22;14(3):103264. doi: 10.1016/j.eats.2024.103264. eCollection 2025 Mar.


DOI:10.1016/j.eats.2024.103264
PMID:40207317
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11977168/
Abstract

Increased posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) tear and ACL reconstruction failure. Anterior closing-wedge osteotomy (ACWO) decreases the PTS and the risk of reinjury after revision ACL reconstruction. ACWO techniques include supratubercular, transtubercular, or infratubercular. However, there are limitations to the amount of slope correction an ACWO can achieve in the context of a massively abnormal slope. If the necessary slope correction is greater than 20°, a supratubercular ACWO cannot achieve the required correction without high risk of brittle fixation, a transtubercular ACWO would introduce increased morbidity of a secondary osteotomy and change the biomechanics of the patellofemoral joint resulting in significant patella alta, and an infratubercular ACWO would require a major anterior tibial metaphysodiaphyseal resection. The tibial plateau leveling osteotomy (TPLO) is an alternative curved osteotomy commonly used in canines that avoids the adverse events associated with a large ACWO. Further benefits of TPLO for massive slope correction include improved maintenance of native soft-tissue tension, avoidance of major recurvatum, and the ability to control the correct degree. We describe an open technique for a TPLO to decrease the PTS and the risk of recurrent ACL injury.

摘要

胫骨后倾坡度(PTS)增加是前交叉韧带(ACL)撕裂和ACL重建失败的一个风险因素。前闭合楔形截骨术(ACWO)可降低PTS以及翻修ACL重建术后再次受伤的风险。ACWO技术包括结节上、经结节或结节下截骨术。然而,在坡度严重异常的情况下,ACWO能够实现的坡度矫正量存在局限性。如果所需的坡度矫正大于20°,结节上ACWO在不伴有高风险的脆性固定的情况下无法实现所需的矫正,经结节ACWO会增加二次截骨的发病率,并改变髌股关节的生物力学,导致明显的高位髌骨,而结节下ACWO则需要对胫骨近端干骺端进行大面积切除。胫骨平台平整截骨术(TPLO)是一种常用于犬类的替代性弧形截骨术,可避免与大型ACWO相关的不良事件。TPLO用于大量坡度矫正的进一步益处包括更好地维持原生软组织张力、避免严重的膝关节后凸以及控制正确角度的能力。我们描述了一种用于TPLO的开放技术,以降低PTS和复发性ACL损伤的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/da01f52dc631/gr13.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/f289473fd81f/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/f06a4d97dcb8/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/ef3736ca2ab2/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/f71307a23501/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/edae347a32fd/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/9c45ed07c1b3/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/b2de41f48559/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/ec099c6c8daf/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/2abb22daac6e/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/6023ac29751c/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/8fa36e04e361/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/b3e32ebb9c4b/gr12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/da01f52dc631/gr13.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/f289473fd81f/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/f06a4d97dcb8/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/ef3736ca2ab2/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/f71307a23501/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/edae347a32fd/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/9c45ed07c1b3/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/b2de41f48559/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/ec099c6c8daf/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/2abb22daac6e/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/6023ac29751c/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/8fa36e04e361/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/b3e32ebb9c4b/gr12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37c1/11977168/da01f52dc631/gr13.jpg

相似文献

[1]
Slope-Reducing Tibial Plateau-Leveling Osteotomy.

Arthrosc Tech. 2024-9-22

[2]
Systematic Review of Clinical Outcomes After Proximal Tibia Anterior Closing-Wedge Osteotomy With ACL Reconstruction.

Orthop J Sports Med. 2023-12-13

[3]
Current Concepts in Anterior Tibial Closing Wedge Osteotomies for Anterior Cruciate Ligament Deficient Knees.

Curr Rev Musculoskelet Med. 2021-12

[4]
Determining the Ratio of Wedge Height to Degree of Correction for Anterior Tibial Closing Wedge Osteotomies for Excessive Posterior Tibial Slope.

Am J Sports Med. 2021-11

[5]
A Supratuberosity Anterior Closing-Wedge Proximal Tibial Osteotomy Increases Patellar Height: A Simulated Time Zero Uniplanar Radiographic Study.

Arthroscopy. 2024-5

[6]
Anterior cruciate ligament reconstruction with anterior closing wedge osteotomy for failed high tibial osteotomy-A case report.

Int J Surg Case Rep. 2020

[7]
Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊.

Orthop Traumatol Surg Res. 2023-6

[8]
The application of proximal tibial anterior closing wedge osteotomy in anterior cruciate ligament reconstruction.

Asia Pac J Sports Med Arthrosc Rehabil Technol. 2024-7-17

[9]
Editorial Commentary: Different Levels for Posterior Tibial Slope Reducing Anterior Closing Wedge Osteotomy to Reduce Anterior Cruciate Ligament Reconstruction Failure Present Different Risks.

Arthroscopy. 2024-5

[10]
In proximal tibial anterior closing wedge (slope changing) osteotomy lower starting points imply larger bone resection.

Orthop Traumatol Surg Res. 2025-2

本文引用的文献

[1]
Anterior cruciate ligament zoobiquity: Can man's best friend tell us we are being too cautious with the implementation of osteotomy to correct posterior tibial slope.

Knee Surg Sports Traumatol Arthrosc. 2024-5

[2]
Editorial Commentary: Different Levels for Posterior Tibial Slope Reducing Anterior Closing Wedge Osteotomy to Reduce Anterior Cruciate Ligament Reconstruction Failure Present Different Risks.

Arthroscopy. 2024-5

[3]
A Supratuberosity Anterior Closing-Wedge Proximal Tibial Osteotomy Increases Patellar Height: A Simulated Time Zero Uniplanar Radiographic Study.

Arthroscopy. 2024-5

[4]
Elevated Posterior Tibial Slope Is Associated With Anterior Cruciate Ligament Reconstruction Failures: A Systematic Review and Meta-analysis.

Arthroscopy. 2023-5

[5]
Closing-Wedge Posterior Tibial Slope-Reducing Osteotomy in Complex Revision ACL Reconstruction.

Orthop J Sports Med. 2023-1-11

[6]
Anterior Closing Wedge Osteotomy for Failed Anterior Cruciate Ligament Reconstruction: State of the Art.

J Am Acad Orthop Surg Glob Res Rev. 2022-9-1

[7]
An increased posterior tibial slope is associated with a higher risk of graft failure following ACL reconstruction: a systematic review.

Knee Surg Sports Traumatol Arthrosc. 2022-7

[8]
Posterior tibial slope measurements based on the full-length tibial anatomic axis are significantly increased compared to those based on the half-length tibial anatomic axis.

Knee Surg Sports Traumatol Arthrosc. 2022-4

[9]
Posterior Tibial Slope Measurements Using the Anatomic Axis Are Significantly Increased Compared With Those That Use the Mechanical Axis.

Arthroscopy. 2021-1

[10]
Tibial Plateau Leveling Osteotomy for Cranial Cruciate Ligament Rupture in Canines: Patient Selection and Reported Outcomes.

Vet Med (Auckl). 2019-12-27

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