Ollivier Matthieu, Hoffer Alexander J, Onishi Shintaro, Brilhault Jean, Frey-Ollivier Solenne, Godshaw Brian, Kley Kristian
Institute of Movement Sciences, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France.
Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A.
Arthrosc Tech. 2024 Sep 22;14(3):103264. doi: 10.1016/j.eats.2024.103264. eCollection 2025 Mar.
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.
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。
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