Aim of the study The aim of this study was to evaluate the radiographic effect of sagittal tibial osteotomy (STO), flexion tibial osteotomy (FTO) and deflexion tibial osteotomy (DTO) around the knee. It has been hypothesized that proximal STO modifies patellar height and could cause varus/valgus changes of the anatomical tibial axis: The purpose of the study was to verify this and to analyse these modifications. Method Patients underwent proximal STO in our department between 2007 and 2018: overall 28 consecutive patients (19 males, 9 females; 28 knees). Twelve patients underwent DTO, and 16 patients underwent FTO. Two independent observers measured the pre-operative and post-operative radiological indexes: posterior tibial slope, Caton-Deschamps Index (CDI) and Modified Insall-Salvati Index (MISI) in the lateral views; medial Tibial Plateau-Tibial Shaft (mTPTS) and medial Femoral Shaft-Tibial Shaft (mFTA) anatomical angles were measured in the frontal plane. Results No complications were reported at the average follow-up of 1.6 +/- 1.1 years. The mean mTPTS significantly increased from 0.6 degrees +/- 2.4 degrees pre-operatively to 2.9 degrees +/- 2.6 degrees of varus post-operatively (DTO (pre-operative 0.3 +/- 3.1 degrees, post-operative 2.4 +/- 2.1 degrees, ns); FTO (pre-operative 0.9 +/- 1.9 degrees, post-operative 3.2 +/- 3.0 degrees, P < 0.05)). The mean mFTA significantly reduced from 186.2 degrees +/- 4.9 degrees pre-operatively to 182.7 degrees +/- 3.9 degrees post-operatively (DTO (pre-operative 183.4 +/- 3.3 degrees, post-operative 180.6 +/- 3.5 degrees, ns); FTO (pre-operative 188.5 +/- 4.9 degrees, post-operative 184.4 +/- 3.4 degrees, P < 0.05)). The overall analysis reported no differences statistically significant in patellar height indexes. Discussion The main finding of this study is that STO slightly modifies tibial anatomical axes. This finding is more evident in FTOs. This surgical technique, due to its design, does not influence the patellar height. The tibial tuberosity osteotomy, performed in most of the cases to better expose tibial metaphysis and to avoid patellar tendon damages, provides another benefit that is the possibility to easily preserve the native patellar height. Conclusion Sagittal tibial osteotomies slightly modify tibial anatomical axes in frontal plan without influencing the patellar height. This surgical procedure resulted to be effective and reliable in correcting the sagittal knee alignment but reporting, particularly of FTO, varus changes of anatomical tibial axis.

Effects of sagittal tibial osteotomy on frontal alignment of the knee and patellar height / F. Luceri, M. Basilico, C. Batailler, P.S. Randelli, G.M. Peretti, E. Servien, S. Lustig. - In: INTERNATIONAL ORTHOPAEDICS. - ISSN 0341-2695. - (2020). [Epub ahead of print] [10.1007/s00264-020-04580-3]

Effects of sagittal tibial osteotomy on frontal alignment of the knee and patellar height

F. Luceri
Primo
;
P.S. Randelli;G.M. Peretti;
2020

Abstract

Aim of the study The aim of this study was to evaluate the radiographic effect of sagittal tibial osteotomy (STO), flexion tibial osteotomy (FTO) and deflexion tibial osteotomy (DTO) around the knee. It has been hypothesized that proximal STO modifies patellar height and could cause varus/valgus changes of the anatomical tibial axis: The purpose of the study was to verify this and to analyse these modifications. Method Patients underwent proximal STO in our department between 2007 and 2018: overall 28 consecutive patients (19 males, 9 females; 28 knees). Twelve patients underwent DTO, and 16 patients underwent FTO. Two independent observers measured the pre-operative and post-operative radiological indexes: posterior tibial slope, Caton-Deschamps Index (CDI) and Modified Insall-Salvati Index (MISI) in the lateral views; medial Tibial Plateau-Tibial Shaft (mTPTS) and medial Femoral Shaft-Tibial Shaft (mFTA) anatomical angles were measured in the frontal plane. Results No complications were reported at the average follow-up of 1.6 +/- 1.1 years. The mean mTPTS significantly increased from 0.6 degrees +/- 2.4 degrees pre-operatively to 2.9 degrees +/- 2.6 degrees of varus post-operatively (DTO (pre-operative 0.3 +/- 3.1 degrees, post-operative 2.4 +/- 2.1 degrees, ns); FTO (pre-operative 0.9 +/- 1.9 degrees, post-operative 3.2 +/- 3.0 degrees, P < 0.05)). The mean mFTA significantly reduced from 186.2 degrees +/- 4.9 degrees pre-operatively to 182.7 degrees +/- 3.9 degrees post-operatively (DTO (pre-operative 183.4 +/- 3.3 degrees, post-operative 180.6 +/- 3.5 degrees, ns); FTO (pre-operative 188.5 +/- 4.9 degrees, post-operative 184.4 +/- 3.4 degrees, P < 0.05)). The overall analysis reported no differences statistically significant in patellar height indexes. Discussion The main finding of this study is that STO slightly modifies tibial anatomical axes. This finding is more evident in FTOs. This surgical technique, due to its design, does not influence the patellar height. The tibial tuberosity osteotomy, performed in most of the cases to better expose tibial metaphysis and to avoid patellar tendon damages, provides another benefit that is the possibility to easily preserve the native patellar height. Conclusion Sagittal tibial osteotomies slightly modify tibial anatomical axes in frontal plan without influencing the patellar height. This surgical procedure resulted to be effective and reliable in correcting the sagittal knee alignment but reporting, particularly of FTO, varus changes of anatomical tibial axis.
Deflexion tibial osteotomy; Flexion tibial osteotomy; Knee instability; Posterior tibial slope; Sagittal tibial osteotomy
Settore MED/33 - Malattie Apparato Locomotore
2020
9-mag-2020
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/734105
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