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Infratuberositary Slope-Decreasing Anterior Closed Wedge Proximal Tibial Osteotomy is Safe and Shows Rapid Bone Healing

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Infratuberositary Slope-Decreasing Anterior Closed Wedge Proximal Tibial Osteotomy is Safe and Shows Rapid Bone Healing

Philipp Schuster, Prof. Dr., GERMANY Philipp Mayer, MD, GERMANY Janina Leiprecht, MD, GERMANY Grégoire Micicoi, MD-PhD, FRANCE Jörg Dickschas, MD, GERMANY

Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgröningen, Germany, and Department of Orthopedics and Traumatology, Klinikum Bamberg, Germany., Markgröningen and Bamberg, GERMANY

2025 Congress ePoster Presentation 2025 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Ligaments Bones

Diagnosis / Condition

Instability

Treatment / Technique

Osteotomy Arthroscopy Failed Repair / Reconstruction

Ligaments

ACL

Patient Populations

Sport Specific Population

Summary: Infratuberositary approach for slope-decreasing osteotomy is safe and shows fast bone healing

Background

The posterior tibial slope (PTS) has gained increasing interest in anterior cruciate ligament (ACL) injuries and surgery, especially in revision cases. Different techniques of slope-decreasing proximal tibial osteotomies have been described, however, only limited data is available on the safety and complication rates of the different approaches.

Purpose

To determine the peri- and postoperative complication rate and obtain data on the progress of bone healing in slope decreasing, anterior closed-wedge proximal tibial osteotomy (ACW-PTO) with an infratuberositary approach, without the need of a separate osteotomy of the tibial tuberosity.
Study Design: Case series with pooled data of two centers; Level of evidence, 4.

Methods

Two sports-orthopedic centers with a high volume of ACL surgery and slope-changing osteotomies pooled their data for this retrospective study. From January 2019 to April 2024 a total of 170 consecutive ACW-PTO in identical technique were performed at both institutions (97 and 73, respectively). Routine follow-up was performed after six weeks and was available in 166 cases (follow-up rate 97.7%) .The surgical reports, medical charts and x-rays of these cases were reviewed with regard to technique specific complications (hinge-fracture, injury to vessels or nerves, infection, secondary dislocation). Lateral x-rays at 6 weeks postoperatively were evaluated with regard to secondary dislocation and delayed union. Bone healing was graded whether the osteotomy was completely healed, partially healed, or showed only delayed or no signs of bone healing.

Results

At six weeks follow-up there was one case with substantial hematoma and superficial wound healing problems with progression to a deep wound infection and revision surgery (plate exchange) at 11 weeks after the index surgery. Further, there was one case of delayed bone healing, with delayed bone healing in further follow up. This case was treated with plate exchange together with the planned revision ACL reconstruction four months after the index surgery. The further course of both cases was uneventful. With these two cases the overall complication rate was 1.2% (2 out of 166). Radiologic evaluation at six weeks was performed in 155 cases and showed a completely healed osteotomy in 104 cases (67.1%), partially healed osteotomy in 50 cases (32.3%) and delayed or no substantial signs of healing in the aforementioned case (0.6%), respectively. In all cases of partial healing a complete healing was seen at 12 weeks from the index procedure.

Conclusion

ACW-PTO using an infratuberositary approach is a safe procedure with regard to complication rate and shows rapid and reliable bone healing.

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Infratuberositary Slope-Decreasing Anterior Closed Wedge Proximal Tibial Osteotomy is Safe and Shows Rapid Bone Healing

Infratuberositary Slope-Decreasing Anterior Closed Wedge Proximal Tibial Osteotomy is Safe and Shows Rapid Bone Healing

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Purpose

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Results

Conclusion

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Infratuberositary Slope-Decreasing Anterior Closed Wedge Proximal Tibial Osteotomy is Safe and Shows Rapid Bone Healing

Infratuberositary Slope-Decreasing Anterior Closed Wedge Proximal Tibial Osteotomy is Safe and Shows Rapid Bone Healing

Background

Purpose

Methods

Results

Conclusion