Banovetz Mark T, Braaten Jacob A, Homan Morgan D, Kennedy Nicholas I, LaPrade Robert F
University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Twin Cities Orthopedics, Edina, Minnesota, USA.
Video J Sports Med. 2023 Jul 13;3(4):26350254231174911. doi: 10.1177/26350254231174911. eCollection 2023 Jul-Aug.
Chronic posterior cruciate ligament (PCL) insufficiency leads to instability of the knee, resulting in increased loading of the medial and patellofemoral compartments. Chronic PCL insufficiency progressively damages the menisci and chondral surfaces and can accentuate and worsen varus malalignment. Biplanar proximal tibial opening-wedge osteotomy (BPTO) is a treatment option for chronic PCL tears with medial compartment arthritis which concurrently treats sagittal (flat slope) and varus coronal alignment.
Opening-wedge BPTO is indicated in active patients who present with varus malalignment and flat slope with concomitant degenerative medial compartment osteoarthritis and PCL insufficiency. In general, BPTO is contraindicated in patients with a significantly elevated body mass index (BMI), smokers, or in those who have advanced tricompartmental osteoarthritis.
Preoperative long-leg radiographs are essential to preoperative evaluation. Ideal coronal alignment following correction would have the mechanical axis pass through the apex of the lateral tibial eminence to properly off-load the medial compartment. Magnetic resonance imaging (MRI) studies are also useful for determining the presence and extent of concomitant soft tissue and chondral injury, especially in the lateral compartment. This video demonstrates the senior author's preferred technique for a biplanar proximal tibial opening (PTO) with concomitant chondroplasty and partial medial meniscectomy (PMM). The senior author's preferred order of operations is also displayed and involves first performing an arthroscopy, then proceeding with the open portions of the case, including the medial approach and subsequent osteotomy.
Past studies have supported PTO as a reliable treatment option for varus malalignment. Bode et al reported a 5-year survival rate of 96% of patients with an overall complication rate of 8.6%. The authors also reported that Lysholm scores were also significantly improved at 60-month follow-up compared with preoperative scores.
This is a technique for the correction of a varus malalignment with concomitant flat slope and PCL insufficiency with biplanar open-wedge PTO. This operation corrects the mechanical axis and sagittal slope of the knee and restores proper load distribution across the tibiofemoral articulation. In conclusion, a biplanar open-wedge PTO is a useful alternative to joint arthroplasty for active patients with a chronic PCL tear, medial compartment arthritis, and varus malalignment.
The author(s) attests 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.
慢性后交叉韧带（PCL）功能不全导致膝关节不稳定，致使内侧和髌股关节间负荷增加。慢性PCL功能不全逐渐损害半月板和软骨表面，并可加重和恶化内翻畸形。双平面胫骨近端开放性楔形截骨术（BPTO）是治疗伴有内侧间室关节炎的慢性PCL撕裂的一种治疗选择，它同时治疗矢状面（平斜度）和内翻冠状面排列。
开放性楔形BPTO适用于出现内翻畸形和平斜度且伴有退行性内侧间室骨关节炎和PCL功能不全的活动患者。一般而言，体重指数（BMI）显著升高的患者、吸烟者或患有晚期三关节间室骨关节炎的患者禁忌行BPTO。
术前长腿X线片对术前评估至关重要。矫正后的理想冠状面排列应使机械轴穿过胫骨外侧隆起的顶点，以正确减轻内侧间室的负荷。磁共振成像（MRI）研究也有助于确定伴随的软组织和软骨损伤的存在及程度，尤其是在外侧间室。本视频展示了资深作者对于双平面胫骨近端开口（PTO）并同时行软骨成形术和部分内侧半月板切除术（PMM）的首选技术。还展示了资深作者的首选手术顺序，包括首先进行关节镜检查，然后进行手术的开放部分，包括内侧入路及随后的截骨术。
既往研究支持PTO作为内翻畸形的可靠治疗选择。博德等人报告，患者5年生存率为96%，总体并发症发生率为8.6%。作者还报告，与术前评分相比，在60个月随访时Lysholm评分也有显著改善。
这是一种通过双平面开放性楔形PTO矫正伴有平斜度和PCL功能不全的内翻畸形的技术。该手术矫正膝关节的机械轴和矢状斜度，并恢复胫股关节间的正常负荷分布。总之，对于患有慢性PCL撕裂、内侧间室关节炎和内翻畸形的活动患者，双平面开放性楔形PTO是关节置换术的一种有用替代方法。
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，作者在本次提交发表时已包含患者的豁免声明或其他书面形式的批准文件。
