Abstract
In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, Brazil. Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. There was an average increase in tibial slope angle after surgery of 2.38 degrees (95% confidence interval: +/- 0.73 degrees ). There was no correlation (r = -0.28) between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13). Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis.
Highlights
There was a significant increase in the tibial slope angle, on average 2.38° (95% confidence interval, CI: ± 0.73°; SD ± 1.97°) after surgery (P = 2 x 10-7)
Brazier et al measured the tibial slope in 83 knees using lateral radiographs, and concluded that the methods based on the proximal tibial anatomical axis or the posterior tibial cortex gave higher reliability than other methods did.[29]
Medial opening wedge tibial osteotomy led to a small increase in tibial slope
Summary
High tibial osteotomy was initially reported by Jackson and Waugh[1] in 1961 and later popularized by the research staff of Coventry et al.[2,3,4,5] Young patients with symptomatic medial compartment varus gonarthrosis have been treated with relative success on a long-term basis.[5,6,7,8,9,10] Tibial osteotomy is best indicated for young patients with early osteoarthritic changes, good range of motion and no ligamentous laxity.[11,12] significant relief can be obtained for active patients over the age of 60 with initial patellofemoral osteoarthritis who can sustain at least 70° of motion.[5,11,12,13]The success achieved through high tibial osteotomy has been related to the alignment and amount of femorotibial angular correction obtained postoperatively.[2,11,14,15,16,17,18] Coventry and Bowman recommended a valgus position from 10 to 13°.19 Insall et al stated that the postoperative femorotibial angle should be between 10 and 14°, and that non-achievement of the best alignment is not the main factor leading to deterioration of the results with time.[6,17] Saggin et al reported better clinical results when the femorotibial angle was corrected to 6 to 14° of valgus.[17]. The success achieved through high tibial osteotomy has been related to the alignment and amount of femorotibial angular correction obtained postoperatively.[2,11,14,15,16,17,18] Coventry and Bowman recommended a valgus position from 10 to 13°.19. Insall et al stated that the postoperative femorotibial angle should be between 10 and 14°, and that non-achievement of the best alignment is not the main factor leading to deterioration of the results with time.[6,17] Saggin et al reported better clinical results when the femorotibial angle was corrected to 6 to 14° of valgus.[17] Hernandez et al used the mechanical axis of the knee as a parameter, such that the axis should be located at between 60 and 70% of the tibial plateau extension, slightly laterally to the center of the knee.[20]
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