2025 ISAKOS Biennial Congress ePoster
In Proximal Tibial Anterior Closing Wedge (Slope Changing) Osteotomy Lower Starting Points Imply Larger Bone Resection
Youngji Kim, MD, PhD, Tokyo JAPAN
Shintaro Onishi, MD, PhD, Nishinomiya, Hyogo JAPAN
Mitsuaki Kubota, MD, PhD, Bunkyo-Ku, Tokyo JAPAN
Raghbir S. Khakha, MBBS, MSc, FRCS, London UNITED KINGDOM
Muneaki Ishijima, MD, PhD, Tokyo JAPAN
Matthieu Ollivier, Prof, MD, PhD , Marseille FRANCE
Institut du Mouvement et de l’appareil Locomoteur, Hˆopital Sainte-Marguerite, Marseille, FRANCE
FDA Status Not Applicable
Summary
The selecting a distal starting osteotomy point with the anterior closed wedge (slope changing) osteotomy for the anterior cruciate ligament re-injury is directly proportional to the observed increase in bone resection, providing valuable insights for pre-operative planning.
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Abstract
Background
Anterior closing wedge osteotomy (ACWO) for tibial slope correction is a validated procedure in revision anterior cruciate ligament reconstruction (ACLR). This study aims to determine how different starting points of the osteotomy affect the amount of bone resection in ACWO. We hypothesized that the lower osteotomy starting points in ACWO imply larger bone resection.
Methods
A total 52 patients who underwent ACWO using infra-tuberosity technique in our institution were included in this study. Each of patients was simulated using additional two separate methods (based on osteotomy level: supra- and trans-tuberosity) based on lateral calibrated pre-operative X-rays of the whole tibia according to the post-operative correction angle. The resection height of the closing wedge, which corresponded to the base of the osteotomy, was measured and compared among the three groups.
Results
The mean actual pre-operative proximal posterior tibial angle (PPTA) was 75.8 ± 2.0◦. Post-operatively, PPTA was 84.0 ± 0.6◦, and correction angle was 8.2 ± 2.2◦. The mean resection height in the supra-tuberosity group was 7.5 ± 0.2 mm, 8.0 ± 2.1 mm in the trans-tuberosity group, and 9.2 ± 2.1 mm in the infra-tuberosity group. There were significant differences between each approach (p ≦ 0.0001). Resection height was moderate positively correlated with the starting point of osteotomy (r = 0.33, 95%CI: 0.18–0.46, p < 0.0001).
Conclusion
This study suggests that selecting a distal starting point for the osteotomy in ACWO is directly proportional to the observed increase in bone resection, providing valuable insights for pre-operative planning. These findings are clinically relevant and will aid in preoperatively deciding approach in ACWO.