Olson Conner, Tollefson Luke V, Shoemaker Evan P, Kennedy Nicholas I, LaPrade Robert F
Twin Cities Orthopedics, Edina, Minnesota, USA.
Video J Sports Med. 2024 Mar 14;4(2):26350254231204637. doi: 10.1177/26350254231204637. eCollection 2024 Mar-Apr.
Anatomically, native posterior tibial slope (PTS) ranges from 6° to 10° and have significant effects on cruciate ligament stability. PTS <6° is correlated with increased posterior tibial translation (PTT) and force on the posterior cruciate ligament (PCL), predisposing individuals to PCL injuries and an increased risk of PCL graft attenuation. In rare cases, a reverse tibial slope can occur (<0°) as a result of trauma, physeal arrest, or abnormal development. This results in increased PTT and can lead to posterior tibial subluxation. Reverse tibial slopes in patients can be treated with an anterior opening wedge proximal tibial osteotomy, which increases the PTS to a more anatomic position.
Biplanar anterior opening wedge proximal tibial osteotomies are indicated in patients with a reverse tibial slope both with the absence of PCL insufficiency or in conjunction with PCL reconstruction.
Under fluoroscopic imaging, 2 guide pins were placed perpendicular to the tibial shaft. An oscillating saw and osteotomes completed the osteotomy in line with the guide pins with the posterior cortex remaining intact. The osteotomy site was slowly opened with a spreader device to 9 mm until the posterior drawer was such that the palpable step-off between the anterior aspect of the medial femoral condyle and the medial tibial plateau was comparable to the contralateral knee. Due to the patient having slight valgus coronal plane alignment, an opening-wedge posteriorly sloped plate was then placed anterolaterally and fixed while wedges held the osteotomy open.
Biplanar anterior opening wedge osteotomies correct a flattened PTS and reverse tibial slope, and coronal malalignment, and has been shown to decrease PCL laxity, preventing future PCL failure.
Biomechanical studies have shown that decreased tibial slope is correlated with an increased risk of PCL injury and PCL graft failure. In patients with reverse tibial slope, experienced instability can mimic PCL insufficiency despite there being no ligamentous damage. We describe a technique that corrects reverse tibial slope and with a discussion of surgical pearls and pitfalls. This technique restores anatomic position and normal function of the knee while correcting the sagittal malalignment that could lead to future injuries.
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.
从解剖学角度来看，正常的胫骨后倾坡度（PTS）范围为6°至10°，对交叉韧带稳定性有显著影响。PTS<6°与胫骨后移增加（PTT）以及后交叉韧带（PCL）上的力增加相关，使个体易患PCL损伤以及PCL移植物衰减风险增加。在罕见情况下，由于创伤、骨骺阻滞或发育异常，可能会出现反向胫骨坡度（<0°）。这会导致PTT增加，并可能导致胫骨后半脱位。患者的反向胫骨坡度可通过胫骨近端前开口楔形截骨术进行治疗，该手术可将PTS增加到更符合解剖学的位置。
双平面胫骨近端前开口楔形截骨术适用于不存在PCL功能不全或与PCL重建联合存在反向胫骨坡度的患者。
在荧光透视成像下，将2根导针垂直于胫骨干放置。用摆动锯和骨凿按照导针完成截骨，后皮质保持完整。用撑开器将截骨部位缓慢撑开至9毫米，直到后抽屉试验显示内侧股骨髁前方与内侧胫骨平台之间可触及的台阶与对侧膝关节相当。由于患者在冠状面有轻度外翻对线，然后将一个后倾的开口楔形钢板放置在前外侧并固定，同时用楔形物保持截骨部位张开。
双平面胫骨近端前开口楔形截骨术可纠正变平的PTS和反向胫骨坡度以及冠状面畸形，并且已显示可降低PCL松弛度，预防未来PCL失效。
生物力学研究表明，胫骨坡度降低与PCL损伤和PCL移植物失效风险增加相关。在有反向胫骨坡度的患者中，尽管没有韧带损伤，但经历的不稳定可能会模拟PCL功能不全情况。我们描述了一种纠正反向胫骨坡度并讨论手术要点和陷阱的技术。该技术在纠正可能导致未来损伤的矢状面畸形的同时，恢复了膝关节的解剖位置和正常功能。
作者证明已从本出版物中出现的任何患者处获得同意书。如果个体可被识别，作者已随本提交物包含一份患者的豁免声明或其他书面批准形式以供发表。
