Online citations, reference lists, and bibliographies.
← Back to Search

High Tibial Osteotomy In Knee Instability: The Rationale Of Treatment And Early Results

N. Badhe, I. W. Forster
Published 2001 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
We treated 14 patients having knee instability and varus alignment with tibial osteotomy with or without ligament reconstruction. Five patients with varus angulated anterior cruciate deficiency (double varus) were treated with single-stage closed-wedge tibial osteotomy and anterior cruciate ligament reconstruction. The remaining nine patients had varying amount of posterior cruciate and postero-lateral corner ligament injuries with varus angulation (triple varus); six of these patients had a ligament reconstruction using the Ligament Advanced Reconstruction System ligament with tibial osteotomy (intra-articular–posterior cruciate ligament/extra-articular–postero-lateral corner reconstruction), while the remaining three had a tibial osteotomy without a ligament reconstruction. Four of the nine patients with triple varus had open-wedge tibial osteotomy, and the remaining five had closed-wedge tibial osteotomy. The mean time interval between injury and index surgery of an osteotomy and ligament surgery was 8.3 years (range 1–20 years). At a mean follow-up of 2.8 years after tibial osteotomy, 12 knees (86%) were stable and eliminated of giving way while the remaining 2 were unstable. In one of these patients the result was compromised with severe infection, while in another there was combined cruciate ligament deficiency with postero-lateral corner ligament deficiency. Thirteen (93%) of the patients were able to participate in light recreational activities. None of these patients could return to competitive sports. Five (35%) continued to have pain of varying degree. The mean Cincinnati Knee Score improved from a mean preoperative of 53 (range 40–58) to a mean postoperative of 74 (range 58–82). Accordingly, there were two poor, four fair and eight good results. In-patients with triple-varus, open-wedge tibial osteotomy had better scores than those with closed-wedge procedure. The results of this series are encouraging, and we recommend a high tibial osteotomy along with ligament reconstruction in these complex injuries with varus alignment.
This paper references
10.1302/0301-620X.72B2.2312563
High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up.
I. Ivarsson (1990)
Reconstruction of anterior cruciate ligament . A techique using central one third of patellar ligament
KJ Jones (1963)
10.2106/00004623-196345050-00003
RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT. A TECHNIQUE USING THE CENTRAL ONE-THIRD OF THE PATELLAR LIGAMENT.
K. Jones (1963)
10.2106/00004623-198062050-00002
Untreated ruptures of the anterior cruciate ligament. A follow-up study.
W. McDaniel (1980)
10.1177/036354659302100102
High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees
F. Noyes (1993)
10.1097/00003086-199402000-00031
Anterior cruciate reconstruction combined with valgus tibial osteotomy.
H. Dejour (1994)
Rigorous statistical reliability, validity, and responsiveness testing of the Cincinnati Knee Rating System in 350 subjects with uninjured, injured, or anterior cruciate ligament-reconstructed knee.
E. Roos (2000)
10.2106/00004623-198769030-00005
Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.
P. Hernigou (1987)
10.1302/0301-620X.56B2.236
The technique and complications of upper tibial osteotomy. A review of 226 operations.
J. Jackson (1974)
Late degenerative changes after menesectomy
PR Allen (1993)
Preoperative planning for high tibial osteotomy.
J. Cass (1987)
10.2106/00004623-198365020-00003
The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals.
F. Noyes (1983)
10.2106/00004623-198466070-00010
High tibial osteotomy for varus gonarthrosis. A long-term follow-up study.
J. Insall (1984)
Active subluxation in extension . A new concept of anterior cruciate ligament deficient knee
H Dejour (1988)
[Tibial osteotomy in gonarthrosis].
J. Gagnaire (1970)
10.2106/00004623-198567030-00001
Chronic posterolateral rotatory instability of the knee.
J. C. Hughston (1985)
10.2106/00004623-198163040-00007
The role of joint load in knee stability.
K. Markolf (1981)
10.1177/036354659202000612
The anterior cruciate ligament-deficient knee with varus alignment
F. Noyes (1992)
La subluxation tibiale anterieure en appui monopodal dans les ruptures du ligament croise anterieur : etude clinique et biomecanique
M. Bonnin (1990)
The symptomatic anterior cruciate deficient knee.
F. Noyes (1983)
10.1177/036354659602400404
Surgical Restoration to Treat Chronic Deficiency of the Posterolateral Complex and Cruciate Ligaments of the Knee Joint
F. Noyes (1996)
10.3109/17453677708989742
Osteoarthrosis following insufficiency of the cruciate ligaments in man. A clinical study.
K. Jacobsen (1977)
10.1177/03635465990270040201
Rigorous Statistical Reliability, Validity, and Responsiveness Testing of the Cincinnati Knee Rating System in 350 Subjects with Uninjured, Injured, or Anterior Cruciate Ligament-Reconstructed Knees
S. Barber-Westin (1999)
10.1302/0301-620X.75B1.8421030
Results of partial meniscectomy related to the state of the anterior cruciate ligament. Review at 20 to 35 years.
P. Neyret (1993)
10.1177/03635465000280030201
High Tibial Osteotomy and Ligament Reconstruction for Varus Angulated Anterior Cruciate Ligament-Deficient Knees *
F. Noyes (2000)



This paper is referenced by
10.1177/2325967116633419
Clinical Outcomes of High Tibial Osteotomy for Knee Instability
Chase S. Dean (2016)
10.1007/978-3-642-45349-6_39
Results of Combined High Tibial Osteotomy (HTO) and ACL Reconstruction
Christophe Hulet (2014)
Title Simultaneous medial opening wedge high tibial osteotomy and revision anterior cruciate ligament reconstruction using a bone-patella tendon-bone graft : A case report
Sugihara (2018)
10.1016/j.arth.2009.07.026
Comparison of autograft vs allograft in opening-wedge high tibial osteotomy.
Marshall A. Kuremsky (2010)
10.1007/978-1-4614-0766-9_22
Osteotomy for Malalignment Following Failed ACL Reconstruction
Davide Edoardo Bonasia (2014)
10.1053/J.OTO.2008.12.003
Computer-Assisted Open-Wedge High Tibial Osteotomy
J. Menetrey (2008)
10.1016/j.ijscr.2012.03.011
Realignment osteotomies in the treatment of chronic instabilities of the knee associated with malalignment (case report).
K. Bilsel (2012)
10.1016/J.ORTHTR.2017.09.001
Knöcherne Deformitätenkorrektur bei vorderer Instabilität?: „Slope“ und „varus thrust“
Wolf Petersen (2017)
10.1016/j.jor.2019.10.023
High tibial osteotomy in a lax knee: A review of current concepts.
Roshan N Wade (2020)
10.1016/J.EATS.2016.03.009
Varus-Producing Lateral Distal Femoral Opening-Wedge Osteotomy.
Justin J. Mitchell (2016)
10.3810/psm.2011.09.1920
High Tibial Osteotomy for the Treatment of Unicompartmental Knee Osteoarthritis: A Review of the Literature, Indications, and Technique
A. Gomoll (2011)
10.5435/00124635-200507000-00007
High Tibial Osteotomy
J. Wright (2005)
10.1177/0363546517750855
Double-Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years’ Follow-up: Outcomes Were Comparable to Anterior Cruciate Ligament Reconstructions
R. LaPrade (2018)
10.1055/s-0035-1558856
Role of Osteotomy in Posterolateral Instability of the Knee.
Benjamin V. Herman (2015)
10.1055/s-0037-1606127
Razonamiento Quirúrgico en Inestabilidad Crónica Posterolateral de Rodilla
Pedro Díaz Allende (2017)
10.1007/s00256-016-2436-1
Imaging features of iBalance, a new high tibial osteotomy: what the radiologist needs to know
Erin FitzGerald Alaia (2016)
10.1097/JSA.0000000000000247
Complications in Posterior Cruciate Ligament Injuries and Related Surgery
Niv Marom (2020)
10.1053/OTOR.2003.0172
Correction of lower extremityangular malunion
R. Probe (2003)
10.1007/978-0-387-21553-2_14
Realignment of the Femur and Tibia
J. Roe (2004)
10.1177/0363546503258907
Opening Wedge High Tibial Osteotomy for Symptomatic Hyperextension-Varus Thrust
D. Naudie (2004)
10.1097/00132585-200311020-00008
Ligament Deficiency With Mal Alignment
H. Elkousy (2003)
10.1177/0363546507304717
Proximal Tibial Opening Wedge Osteotomy as the Initial Treatment for Chronic Posterolateral Corner Deficiency in the Varus Knee
A. Arthur (2007)
10.1007/978-1-4471-4270-6_13
Indications for Ancillary Surgery in the ACL-Deficient Knee
Biju Benjamin (2013)
10.1007/978-3-662-52742-9_46
Osteotomies in the ACL-Deficient Knee
Alberto Grassi (2017)
10.1007/978-0-387-21601-0
Posterior Cruciate Ligament Injuries
G. Fanelli (2001)
10.1097/JSA.0b013e3180310a89
The Role of the High Tibial Osteotomy in the Unstable Knee
J. Robert Giffin (2007)
10.1142/S0218810414500154
Posterolateral rotatory instability of the elbow after corrective osteotomy for previously asymptomatic cubitus varus deformity.
Sang Gyo Seo (2014)
10.1097/JSA.0b013e318278f71d
Surgical Treatment of Osteoarthritis in the Middle-aged Athlete: New Horizons in High Tibial Osteotomies
Laura E. Scordino (2013)
10.1097/JSA.0b013e318172b547
Navigated Open Wedge High Tibial Osteotomy
E. Song (2008)
10.1055/S-0037-1606126
Principios Biomecánicos en Inestabilidad Crónica Posterolateral de Rodilla
Pedro Díaz Allende (2017)
10.1016/j.knee.2016.09.003
Coronal alignment on the single-limb stance radiograph in posterolateral rotatory instability, osteoarthritis and healthy knees.
Y. G. Na (2017)
10.1177/0363546507312380
The Effect of a Proximal Tibial Medial Opening Wedge Osteotomy on Posterolateral Knee Instability
R. LaPrade (2008)
See more
Semantic Scholar Logo Some data provided by SemanticScholar