Emre ÇULLU, Semih AYDOĞDU, Bülent ALPARSLAN, Hakkı SUR

KUBBE TİPİ YÜKSEK TİBİAL OSTEOTOMİ SONRASI SAGİTAL PLANDAKİ TİBİAL EĞİM DEĞİŞİKLİKLERİ

Anahtar Kelimeler:

Tibia, osteotomi, tibial eğim

Tibial Slope Changes Following Dome Type High Tibial Osteotomy

Purpose: Tibial slope (TS) contributes to knee biomechanics as an important factor in such a way that its changes after high tibial osteotomy (HTO) may affect ligament function and kinematics of the knee. We aimed to investigate whether there is a change of tibial slope following dome type high tibial osteotomy. Patients and Method: Fourty patients operated on for unilateral medial gonarthrosis by dome-type HTO and external fixation combination were reviewed retrospectively for the changes of TS. Four different measurement methods [anterior tibial cortex (ATC), tibial proximal anatomical axis (TPAA), posterior tibial cortex (PTC), fibular proximal anatomical axis (FPAA)] were used. Patients were grouped according to the length of follow-up period and to the corrections postoperatively obtained. Correlation between different parameters was also searched. Results: Preoperative mean ATC angle was 11.2°, TPAA angle was 7.5°, PTC angle was 5.6°, FPAA angle was 8.2°. Postoperative mean ATC angle was 7.9°, TPAA angle was 4.8°, PTC angle was 2.2°, FPAA angle was 3.7° after mean 55 months follow-up. All the parameters used for TS measurement decreased postoperatively. No significant difference in TS among groups with different durations of follow-up could be found. Conclusion: Patients with hypocorrection (or recurrence of deformity) had a relatively larger decrease in TS, even in the form of anterior slope than those with normo- or hypercorrection. The higher the degree of postoperative femoro-tibial valgus, the higher was the degree of tibial posterior slope. All the measurement techniques showed a significant correlation both pre- and postoperatively. Tibial slope measured by 4 different techniques showed a significant decrease after dome-type HTO. Dome-type HTO may also change significantly as seen in other HTO techniques, although it does not depend on a bone wedge removal or addition. This “parasitically” sagittal plane changes should be taken into account for subsequent reconstructive procedures such as total knee arthroplasty.

Keywords:

Tibia, osteotomy, tibial slope,

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1. Burstein, AH. Biomechanics of the Knee. In. Insall JN(ed). Surgery of the Knee, 1st ed. New York, Churchill Livingstone, 1984: 21-39.
2. Bonnin M, Neyre Ph. Place des osteotomies dans les laxites chroniques du genu. 7èmes journees lyonnaises de chirurgie du genu, Lyon: 11-13 Avril 1991: 280-9.
3. Panisset JC, Neyret Ph, Dubrana F, Boileau P. Laxite posterieure et osteotomie. 7èmes journees lyonnaises de chirurgie du genu, Lyon: 11-13 Avril 1991: 275-7.
4. Singerman R, Dean JC, Pagan HD, Goldberg VM. Decreased posterior tibial slope increases strain in the posterior cruciate ligament following total knee arthroplasty. J Arthroplasty 1996; 11(1): 99-103.
5. Goutallier D, Hernigou P, Medevielle D, Debeyre J. Devenir à plus de 10 ans de 93 ostéotomies tibiales effectuées pour gonarthrose interne sur genu-varum. Rev Chirurgie Ortop 1986; 72: 101-13.
6. Moore TM, Harvey JP. Roentgenographic measurement of tibial-plateau depression due to fracture. J Bone Joint Surg 1974; 56(A): 155-60.
7. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. J Bone Joint Surg 1987; 69(A): 332-54.
8. Dejour H, Bonin M. Tibial translation after anterior cruciate ligament rupture. J Bone Joint Surg 1994; 76(B): 745-9.
9. Jenny JY, Rapp E, Kehr P. La pente méniscale de lextrémité proximale du tibia: comparaison avec la pente osseuse. Rev Chirurgie Ortop 1997; 83: 435- 38.
10. Julliard R, Genin P, Weil G, Palmkrantz P. La pente tibiale fonctionelle mëdiane. Rev Chirurgie Ortop 1993; 79: 625- 34.
11. Migaud H, De Ladoucette A, Dohin B, Cloutier JM, Gougeon F, Duquennoy A. Influence de la pente tibiale sur la translation tibiale et la mobilitë dune prothese totale du genu non contrainte. Rev Chirurgie Ortop 1996; 82: 7-13.
12. Kettelkamp DB. Tibial osteotomy. In Evarts CM (eds) Surgery of the musculoskeletal system 2nd ed. Churchill Livingstone. New York Edinburg, London, Melbourne, 1990; 3551-67.
13. Boileau P, Neyret Ph. Resultats des osteotomies tibiales de valgisation associees aux plasties du ligament croise anterior dans le traitment des laxites anterieures chroniques evoluees. 7èmes journees lyonnaises de chirurgie du genu, 232-49, 11-13 Avril 1991, Lyon.
14. Lerat JL, Moyen B, Garin C, Mandrino A, Besse JL, Brunet-Guedj E. Laxité antérieure et arthrose interne du genou. Rev Chirurgie Ortop 1993; 79: 365- 74.
15. Blunn GW, Walker PS, Joshi A, Hardinge K. The dominance of cyclic sliding in producing wear in total knee replacements. Clin Orthop 1991; 273: 251-60.
16. Dorr LD, Boiardo RA. Technical considerations in total knee arthroplasty. Clin Orthop 1986; 205: 5-11.
17. Genin P, Weill G, Julliard R. La pente tibiale. J Radiol 1993; 74(1): 27-33.
18. Çullu E, Özkan Ý, Þavk SO, Alparslan B. Tibial eðim. Artroplasti ve Artroskopik Cerrahi Dergisi. 1999; 10(2): 174-8.
19. Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A. Evaluation des mëthodes de mesure radiographique de la pente tibiale. Rev Chirurgie Ortop 1996; 82: 195-200.
20. Levigne Ch, Bonnin M. Osteotomie tibiale de valgisation pour arthrose Femoro-tibiale interne. 7èmes journees lyonnaises de chirurgie du genu, Lyon: 11-13 Avril 1991: 142-68.