Role of Osteotomy in Ligament Injuries: Updates on Corrective Osteotomy Combined Ligament Procedure Techniques

Abstract

Proximal tibial osteotomies are an effective treatment option for addressing knee instability secondary to alignment-based overload on ligamentous structures. Proximal tibial osteotomies effectively alter the mechanical axis to redistribute forces across the knee, resulting in improved stability and overall function. Factors such as tibial slope and coronal alignment can affect the biomechanical forces experienced by the ligaments in the knee. This becomes especially important when treating recurrent instability following primary reconstruction of one or more of the ligaments of the knee. A variety of osteotomy procedures exist to address a wide range of alignment disorders. These include proximal tibial closing wedge osteotomies, anterolateral opening wedge osteotomies, anterolateral opening wedge osteotomies, and proximal tibial medial opening wedge osteotomies. Recently, the indications of medial opening wedge osteotomies have been expanded to include treatment of chronic central and posterolateral ligament instability. Early rehabilitation in the recovery phase should focus on limb protection, symptom management, protected range of motion, quadriceps muscle activation, and monitoring for overall patient well-being. Clear guidelines for safe quadriceps training progressions following osteotomy do not exist due to the paucity of biomechanical literature. The patient should gradually progress through the transition and rebuild phases of recovery over the first 24 weeks following surgery. Patients may not progress into the restore phase of rehabilitation as this population typically completes the second stage of the 2-stage ligamentous reconstruction during the latter half of the Rebuild phase once sufficient healing from the first procedure has occurred. Currently, data regarding clinical outcomes and return to sport data following PTO for knee instability is limited.