Summary

Varus osteotomy in the proximal tibia, if indicated in cases of valgus in the tibia and joint line with obliquity less than 10°, is a viable option in the correction of valgus deformity and leads to good results.

Abstract

Introduction

Geno Valgus deformity is a risk factor for progression of arthrosis in the lateral compartiment of the knee. When symptomatic, and without improvement of pain with clinical treatment, varus osteotomy becomes a treatment option. Usually the correction of the deformity is made in the distal femur. But often the deformity can occur in the tibia. In these cases, and without the obliquity of the joint line , the proximal tibia varus osteotomy is the choice. An advantage of the tibial osteotomy is to correct the axis in flexion and extension, differently of the femoral osteotomy that only corrects in extension.

Objective

To evaluate the evolution of patients who presented valgus deformity in a symptomatic knee and underwent correction through the medial closure wedge varus osteotomy of the proximal tibia.

Methods

Patients with valgus deformity of up to 12° were included, and joint line obliquity less than 10° were submitted to surgical treatment. The objective of the correction is the axis of 180°, avoiding the hypercorrection in Varus. After the resection of the medial wedge, the osteotomy was fixed with a small locked plaque, discharged on the following day without immobilization and with a load with crutches as tolerated. We selected 54 patients from 2005 to 2020, 21 males with a mean age of 46 years (20-67). In 2 cases it was associated with anterior cruciate ligament (ACL) reconstruction, 1 case with mosaicoplasty and 1 case of medial patelo femoral ligament reconstruction. We revised 46 patients with the mean follow up of 7.5 years (6 months to 15 years).

Results

All cases healed, there was no alteration of the patellar height or tibial slope. There was one complication that was infection, where the plaque was removed. 23 patients without pain complaints were very satisfied, and 21 with mild pain were satisfied. 89,4% increased their activities, and improved pain, and would do the procedure again. There were some medial instability after the surgery in 9 patients (24%). The Lysholm score was 72,3, KOOS 66% and IKDC 57,95%. The SF 36 results were also good. 1 Patient with mild pain was unsatisfied and 2 with moderate pain were also dissatisfied. These, 2 were obese and the initial deformity was in the femur and not in the tibia. 1 patient evolved with re-rupture of the ACL being submitted to revision and 1 evolved to total knee arthroplasty 9 years after osteotomy.

Conclusion

Varus osteotomy in the proximal tibia, if indicated in cases of valgus in the tibia and joint line with obliquity less than 10°, is a viable option in the correction of valgus deformity and leads to good results.