Dirnberger Jack, Homan Morgan D, Kennedy Nicholas I, LaPrade Robert F
School of Medicine & Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA.
Twin Cities Orthopedics, Edina, Minnesota, USA.
Video J Sports Med. 2024 May 1;4(3):26350254231213392. doi: 10.1177/26350254231213392. eCollection 2024 May-Jun.
Symptomatic genu recurvatum is defined as greater than 5° of knee hyperextension and can be caused by osseous deformity, soft tissue laxity, or a combination. Common symptoms include pain, weakness, instability, decreased range of motion, leg length discrepancy, and stretching of the posterior capsuloligamentous structures of the knee. In instances where the genu recurvatum is caused by reverse tibial slope, literature supports the use of anterior opening-wedge proximal tibial osteotomy (OW PTO) to treat genu recurvatum by increasing tibial slope. Correction of anterior slope to a more anatomic, posterior orientation allows any stressed ligaments to return to their normal tension and restores the native biomechanics of the knee.
The primary indication for OW PTO is genu recurvatum that is nonresponsive to physical therapy or genu recurvatum with concurrent ligamentous injury. The heel-height test provides an objective assessment for the identification and measurement of knee hyperextension.
2 guide pins are placed parallel to the tibial plateau, engaging the posterior cortex. A small micro sagittal saw is used to cut the anterior cortex. Osteotomes are used to complete the osteotomy, preserving a posterior hinge. An opening spreader device is placed and opened slowly while keeping the posterior cortex intact. The new slope is maintained by use of an opening wedge osteotomy plate and screws. Allograft bone graft is packed thoroughly into the osteotomy site. Fluoroscopy is used throughout the case to assess appropriate orientation and depth of the osteotomy, as well as the final opening width.
A review of 5 studies demonstrated adequate reduction in hyperextension, with a mean knee hyperextension ranging from 17° to 32° preoperatively and 0° to 7° postoperatively. Patients had significantly improved postoperative clinical outcomes compared with the preoperative state.
DISCUSSION/CONCLUSION: Anterior OW PTO has been shown to be a safe method of accurately correcting tibial plateau slope for the treatment of genu recurvatum. Patients can expect correction of knee hyperextension, restoration of anatomic posterior tibial slope, decreased posterior tibial translation, and increased subjective outcome scores.
The author(s) attest that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
症状性膝反屈被定义为膝关节过伸超过5°，可由骨性畸形、软组织松弛或两者共同引起。常见症状包括疼痛、无力、不稳定、活动范围减小、腿长差异以及膝关节后囊韧带结构的拉伸。在膝反屈由胫骨反向倾斜引起的情况下，文献支持采用胫骨近端前开口楔形截骨术（OW PTO）来增加胫骨倾斜度以治疗膝反屈。将前倾斜度矫正为更符合解剖结构的后倾方向可使任何受力的韧带恢复至正常张力，并恢复膝关节的原始生物力学。
OW PTO的主要适应症是对物理治疗无反应的膝反屈或并发韧带损伤的膝反屈。足跟高度试验为识别和测量膝关节过伸提供了客观评估。
两根导针平行于胫骨平台放置，穿透后皮质。使用小型微型矢状锯切割前皮质。用骨刀完成截骨，保留后方铰链。放置撑开器并缓慢撑开，同时保持后皮质完整。通过使用开口楔形截骨板和螺钉维持新的倾斜度。将同种异体骨充分填充到截骨部位。整个手术过程中使用荧光透视来评估截骨的合适方向和深度以及最终的撑开宽度。
对5项研究的综述表明，过伸得到了充分矫正，术前平均膝关节过伸范围为17°至32°，术后为0°至7°。与术前状态相比，患者术后临床结果有显著改善。
讨论/结论：前OW PTO已被证明是一种安全的方法，可准确矫正胫骨平台倾斜度以治疗膝反屈。患者有望实现膝关节过伸的矫正、解剖学后倾胫骨倾斜度的恢复、胫骨后移减少以及主观结果评分提高。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交发表的文章附上患者的豁免声明或其他书面批准形式。
