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

The Role Of Osteotomy For The Treatment Of PCL Injuries

J. Novaretti, Andrew J Sheean, Jayson Lian, Joseph De Groot, V. Musahl
Published 2018 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
Purpose of ReviewThe purposes of this review are to (1) describe the anatomic and biomechanical rationale for high tibial osteotomy (HTO) in the setting of posterior cruciate ligament (PCL) deficiency, (2) review the indications for concomitant HTO and PCL reconstruction, (3) provide guidance for the clinical assessment of the patient with suspected PCL deficiency, and (4) summarize the key surgical steps necessary to attain the appropriate sagittal and coronal plane corrections.Recent FindingsThe preponderance of available biomechanical data pertaining to the PCL-deficient knee suggests that an increased proximal tibial slope limits posterior tibial translation under axial compressive loads. Moreover, recent clinical data has demonstrated that decreased proximal tibial slope may exacerbate residual anterior-posterior laxity and jeopardize the durability of PCL reconstruction. Thus, in the setting of PCL deficiency, an HTO that increases the posterior tibial slope may be advisable.SummaryHTO may be an important treatment adjunct in the surgical management of PCL deficiency. In the setting of chronic injuries and varus malalignment, HTO should be considered in order to ensure a durable ligamentous reconstruction and forestall the progression of secondary osteoarthritis.
This paper references
10.2106/00004623-198870010-00014
Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures.
E. Grood (1988)
10.1007/s00167-016-4052-y
Incidence and long-term follow-up of isolated posterior cruciate ligament tears
T. Sanders (2016)
10.1016/S0749-8063(05)80424-4
Posterior cruciate ligament injuries in trauma patients
G. Fanelli (1993)
10.1177/03635465000280020901
The Magnetic Resonance Imaging Appearance of Individual Structures of the Posterolateral Knee
R. LaPrade (2000)
10.5435/00124635-200907000-00004
Surgical Treatment of Posterior Cruciate Ligament Tears: An Evolving Technique
M. Matava (2009)
10.2106/00004623-198769050-00016
Radiographic analysis of the axial alignment of the lower extremity.
J. R. Moreland (1987)
10.1007/s001670050057
Arthroscopic posterior cruciate ligament reconstruction with bone-tendon-bone patellar graft
P. Mariani (1997)
10.2214/AJR.07.2921
MRI appearance of posterior cruciate ligament tears.
W. Rodriguez (2008)
10.1177/036354659302100102
High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees
F. Noyes (1993)
10.1177/03635465030310040901
The Biomechanical Effect of Posterior Cruciate Ligament Reconstruction on Knee Joint Function
T. Gill (2003)
10.1007/s00167-005-0686-x
Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments
A. Amis (2005)
10.1016/0021-9290(94)90028-0
The mechanical properties of the two bundles of the human posterior cruciate ligament.
A. Race (1994)
10.1053/JARS.2002.32208
Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon autograft and quadruple hamstring tendon graft.
C. Chen (2002)
10.1177/0363546504269034
Opening Wedge Tibial Osteotomy: The 3-Triangle Method to Correct Axial Alignment and Tibial Slope
F. Noyes (2005)
10.1177/0363546503258880
Effects of Increasing Tibial Slope on the Biomechanics of the Knee
J. Robert Giffin (2004)
10.1016/J.ARTHRO.2004.11.013
Subjective results of nonoperatively treated, acute, isolated posterior cruciate ligament injuries.
K. Shelbourne (2005)
10.1177/0363546517734201
Posterior Tibial Translation Measurements on Magnetic Resonance Imaging Improve Diagnostic Sensitivity for Chronic Posterior Cruciate Ligament Injuries and Graft Tears
Nicholas N. DePhillipo (2018)
10.1007/s001670100244
High tibial osteotomy in knee instability: the rationale of treatment and early results
N. Badhe (2001)
10.1177/0363546507304665
Importance of Tibial Slope for Stability of the Posterior Cruciate Ligament—Deficient Knee
J. Robert Giffin (2007)
Arthroscopic double-bundled posterior cruciate ligament reconstruction with quadriceps tendonpatellar bone autograft. Arthroscopy
CH Chen (2000)
10.1016/S0278-5919(02)00110-2
Epidemiology of athletic head and neck injuries.
M. Cooper (2003)
10.1177/0363546516666354
Tibial Slope Strongly Influences Knee Stability After Posterior Cruciate Ligament Reconstruction: A Prospective 5- to 15-Year Follow-up
C. Gwinner (2017)
10.2106/00004623-198062020-00013
Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study.
D. Butler (1980)
10.2106/JBJS.G.00448
Topography of the femoral attachment of the posterior cruciate ligament.
O. V. Lopes (2008)
10.1016/J.KNEE.2006.01.005
Epidemiology of athletic knee injuries: A 10-year study.
M. Majewski (2006)
[The tibial slope. Proposal for a measurement method].
P. Génin (1993)
10.2106/00004623-198870030-00010
Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee.
D. Daniel (1988)
10.1177/036354659602400107
Knee hyperextension gait abnormalities in unstable knees. Recognition and preoperative gait retraining.
F. Noyes (1996)
10.1115/1.3138409
In-vitro measurement of static pressure distribution in synovial joints--Part I: Tibial surface of the knee.
A. Ahmed (1983)
10.2106/00004623-197658030-00009
Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments.
J. C. Kennedy (1976)
10.1016/S0736-0266(01)00184-X
Biomechanical consequences of PCL deficiency in the knee under simulated muscle loads—an in vitro experimental study
G. Li (2002)
10.1177/0363546512439180
The Effect of Proximal Tibial Slope on Dynamic Stability Testing of the Posterior Cruciate Ligament– and Posterolateral Corner–Deficient Knee
F. Petrigliano (2012)
10.1302/0301-620X.76B5.8083263
Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared.
H. Dejour (1994)
injuries : a 10 - year study
TL Sanders (2006)
10.2106/JBJS.K.01710
Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament.
C. J. Anderson (2012)
10.1177/03635465990270030201
The Natural History of Acute, Isolated, Nonoperatively Treated Posterior Cruciate Ligament Injuries
K. Shelbourne (1999)
10.1177/0363546515572770
Emerging Updates on the Posterior Cruciate Ligament
Christopher M. LaPrade (2015)
10.1097/00003086-197606000-00034
Ligament length patterns, strength, and rotational axes of the knee joint.
P. Trent (1976)
10.1016/S0276-1092(08)79413-6
A Clinically Relevant Assessment of Posterior Cruciate Ligament and Posterolateral Corner Injuries: Evaluation of Isolated and Combined Deficiency
B. Morrey (2009)
10.1177/0363546513486771
Minimum 10-Year Follow-up of Patients After an Acute, Isolated Posterior Cruciate Ligament Injury Treated Nonoperatively
K. Shelbourne (2013)
10.1016/0749-8063(95)90127-2
Posterior cruciate ligament injuries in trauma patients: Part II.
G. Fanelli (1995)
10.1177/0363546507304717
Proximal Tibial Opening Wedge Osteotomy as the Initial Treatment for Chronic Posterolateral Corner Deficiency in the Varus Knee
A. Arthur (2007)
10.1177/0363546503258907
Opening Wedge High Tibial Osteotomy for Symptomatic Hyperextension-Varus Thrust
D. Naudie (2004)
10.1177/0363546504271210
Posterior Cruciate Ligament Revision Reconstruction, Part 1
F. Noyes (2005)
10.1007/s00167-012-2132-1
An isolated rupture of the posterior cruciate ligament results in reduced preoperative knee function in comparison with an anterior cruciate ligament injury
A. Årøen (2012)
10.1177/0363546513504287
Kinematic Analysis of the Posterior Cruciate Ligament, Part 1
Nicholas I. Kennedy (2013)
10.1016/S0883-5403(00)90330-9
Posterior slope of tibial plateau in Chinese.
K. Y. Chiu (2000)
10.1007/s00402-004-0728-8
Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees
J. Agneskirchner (2004)
Treatment of acute and chronic posterior cruciate ligament deficiency. New approaches.
J. C. L'insalata (1996)
10.2106/00004623-198365030-00004
Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure.
W. Clancy (1983)
10.1177/03635465030310021101
Codominance of the Individual Posterior Cruciate Ligament Bundles: An Analysis of Bundle Lengths and Orientation
C. Ahmad (2003)
10.2165/00007256-199825030-00002
Proprioception of the Ankle and Knee
S. Lephart (1998)
10.1177/0363546514550982
Transtibial Versus Tibial Inlay Techniques for Posterior Cruciate Ligament Reconstruction
E. Song (2014)
10.2106/JBJS.K.00030
Revision posterior cruciate ligament reconstruction using a modified tibial-inlay double-bundle technique.
S. Lee (2012)
The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints.
Y. Fujisawa (1979)
10.1177/2325967117697287
The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence
T. Tischer (2017)
10.1249/MSS.0b013e318277acca
Epidemiology of knee injuries among U.S. high school athletes, 2005/2006-2010/2011.
D. M. Swenson (2013)
10.1053/JARS.2000.8020
Arthroscopic double-bundled posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft.
C. Chen (2000)
Treatment of acute and chronic posterior cruciate ligament deficiency
JC L'Insalata (1996)
Chronically Injured Posterior Cruciate Ligament Magnetic Resonance Imaging
D. Tewes (1997)
10.2106/JBJS.J.01638
Isolated and combined grade-III posterior cruciate ligament tears treated with double-bundle reconstruction with use of endoscopically placed femoral tunnels and grafts: operative technique and clinical outcomes.
S. Spiridonov (2011)
10.1177/036354659302100122
Nonoperatively treated isolated posterior cruciate ligament injuries
P. M. Keller (1993)
10.1007/s00402-002-0471-y
Epidemiology of posterior cruciate ligament injuries
M. S. Schulz (2003)
10.1007/s00167-004-0501-0
Tibial slope changes following dome-type high tibial osteotomy
E. Çullu (2004)
10.1097/00003086-197501000-00033
The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis.
F. Girgis (1975)
Anatomy of the posterior cruciate ligament
J. Marais (2009)
10.1007/s10195-010-0120-0
Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner
E. Savarese (2010)
10.1016/J.ARTHRO.2005.07.028
Evaluation of posterior cruciate ligament healing: a study using magnetic resonance imaging and stress radiography.
P. Mariani (2005)
10.1177/0363546511435783
In Vivo Analysis of the Isolated Posterior Cruciate Ligament–Deficient Knee During Functional Activities
K. Goyal (2012)
10.1007/s00167-006-0192-9
Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament
M. Takahashi (2006)
10.2106/00004623-197456010-00016
Roentgenographic measurement of tibial-plateau depression due to fracture.
T. Moore (1974)
10.1016/0021-9290(95)00161-1
Loading of the two bundles of the posterior cruciate ligament: an analysis of bundle function in a-P drawer.
A. Race (1996)
Human knee ligaments: mechanical tests and ultrastructural observations.
G. Marinozzi (1983)
Comprehensive Physical Examination for Instability of the Knee
J. Lubowitz (2008)
Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy
GC Fanelli (1995)
10.1016/J.CLINBIOMECH.2004.11.014
Effects of the posterior cruciate ligament reconstruction on the biomechanics of the knee joint: a finite element analysis.
N. Ramaniraka (2005)
10.1177/036354659602400404
Surgical Restoration to Treat Chronic Deficiency of the Posterolateral Complex and Cruciate Ligaments of the Knee Joint
F. Noyes (1996)
10.1007/s00167-002-0288-9
Posterior cruciate ligament reconstruction with the quadriceps tendon in chronic injuries
P. Aglietti (2002)
10.1016/S0749-8063(05)80187-2
Posterior cruciate ligament allograft reconstruction with and without a ligament augmentation device.
F. Noyes (1994)
Posterior cruciate ligament allograft reconstruction with and without a ligament augmentation device. Arthroscopy
FR Noyes (1994)
10.1177/036354658901700104
Anatomy of the posterior cruciate ligament
B. V. Van Dommelen (1989)
10.2106/00004623-198264020-00018
An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque.
T. Fukubayashi (1982)
10.2106/00004623-199305000-00008
The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee.
M. Skyhar (1993)
[Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees].
J. C. Brazier (1996)
10.2106/00004623-196547050-00008
OSTEOTOMY OF THE UPPER PORTION OF THE TIBIA FOR DEGENERATIVE ARTHRITIS OF THE KNEE. A PRELIMINARY REPORT.
M. Coventry (1965)
10.1177/0363546507310075
Effect of Posterior Cruciate Ligament Deficiency on in vivo Translation and Rotation of the Knee during Weightbearing Flexion
G. Li (2008)
10.2106/00004623-198769020-00010
The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study.
D. Gollehon (1987)
Posterior tibial slope in the normal and varus knee.
S. Matsuda (1999)
10.1097/00003086-200209000-00010
Diagnosis and treatment of posterolateral knee injuries.
R. LaPrade (2002)
10.1053/JARS.2003.50037
Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees.
M. Strobel (2003)
Arthroscopic evaluation of articular cartilage lesions in posteriorcruciate-ligament-deficient knees. Arthroscopy
MJ Strobel (2003)



This paper is referenced by
Semantic Scholar Logo Some data provided by SemanticScholar