Radiographic Investigation of Coronal Plane and Patellar Height and Changes Following Tibial Deflection Osteotomy for Correction of Tibial Slope in Combination With ACL Reconstruction.

Autor:	Cance N; Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France., Dan MJ; Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France.; East Coast Athletic Orthopaedics, Macquarie and Lingard Hospital, Merewether and Sydney, Australia., Pineda T; Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France.; Hospital el Carmen, Santiago, Chile., Demey G; Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France., DeJour DH; Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2024 Mar; Vol. 52 (3), pp. 691-697. Date of Electronic Publication: 2024 Jan 29.
DOI:	10.1177/03635465231222643
Abstrakt:	Background: A tibial deflexion osteotomy (TDO) is performed to decrease the sagittal tibial slope to reduce the relative risk of anterior cruciate ligament (ACL) reconstruction (ACLR) graft failure. Given that coronal plane osteotomies can cause consequential changes in the sagittal plane to patellar height and tibial slope, potential changes to coronal plane alignment and patellar height can result after a sagittal plane osteotomy. Purpose: To compare preoperative and postoperative coronal plane alignment after TDO, as well as to analyze the effect of the osteotomy on patellar height. Study Design: Case series; Level of evidence, 4. Methods: This study was conducted on a consecutive series of patients with primary and revision ACLR with concomitant TDO between 2011 and 2022. Inclusion criteria were 1-stage autograft ACLR combined with supratubercular TDO with pre- and 3 months postoperative radiographs of sufficient quality. Indications for TDO were anterior instability requiring ACL revision surgery and a posterior tibial slope (PTS) >9° or a PTS >14° in the primary ACL surgery patients. Anteroposterior and lateral knee radiographs were reviewed, and the medial proximal tibial angle (MPTA), PTS, Caton-Deschamps index (CDI), and modified Insall-Salvati ratio were measured directly from the radiographs by 2 independent reviewers. Results: A total of 68 patients were included in this study. Pre- and postoperative radiographs were performed 1 month before and 3 months after surgery, respectively. There was a significant increase in the mean MPTA of 0.95° varus (SD, 2.1°; range, increase of 4.23° valgus to increase of 7.74° varus; P < .01), a decreased PTS of 8.86° (SD, 3.03°; P < .01), and an increased CDI of 0.08 (range, decrease of 0.27 to increase of 0.64) ( P < .01; SD, 0.17) in patients undergoing TDO. Insall-Salvati ratio measurements showed no difference. There was good intra- and interobserver reliability, with intraclass correlation coefficients of 0.97 and 0.91 for MPTA, 0.97 and 0.87 for PTS, 0.87 and 0.93 for CDI, and 0.88 and 0.76 the Insall-Salvati ratio. Conclusion: This study, the largest series on TDO for ACLR, demonstrates that the TDO can be performed safely without large changes to coronal alignment or patellar height. The tibial slope was reduced by a mean of 8.86° (range, 2.3°-11.5°; P < .01). The TDO produces a small statistically significant change to coronal alignment, inducing a mean increased varus of <1° and an increased patellar height of 0.1 CDI. Therefore, TDO can be performed safely without dramatic changes to coronal alignment or patellar height, this study highlights technical aspects to minimize iatrogenic varus. Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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