2015 ISAKOS Biennial Congress ePoster #1724
Proximal Tibial Anterior Open Wedge Oblique Osteotomy for the Treatment of Genu Recurvatum
Tae Woo- Kim, MD, Seoul KOREA, REPUBLIC OF
Kee Yun Chung, Seoul KOREA, REPUBLIC OF
Ki Bum Kim
Hyuk-Soo Han, MD, PhD, Seoul KOREA, REPUBLIC OF
Sahnghoon Lee, MD, PhD, Seoul KOREA, REPUBLIC OF
Sang Cheol Seong, MD, PhD, mapo-gu, Seoul city KOREA, REPUBLIC OF
Myung Chul Lee, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF
Seoul National University, Seoul, KOREA
FDA Status Not Applicable
Summary: The novel technique of proximal tibial anterior open wedge oblique osteotomy for the treatment of genu recurvatum showed satisfactory radiological and clincal outcomes without any complication.
For successful acute correction of genu recurvatum, accurate correction of tibial plateau angle, restoration of anatomical axis, and rigid fixation for bone consolidation are essential. However, surgical treatment that satisfies all of these necessities has not yet been established.
The purpose of this study was to evaluate the novel technique of proximal tibial anterior open wedge oblique osteotomy for the treatment of genu recurvatum.
Study design : Case series ; Level of evidence, 4.
Four patients with genu recurvatum (including two osseous type and two combined type) underwent proximal tibial anterior open wedge oblique osteotomy from 2008 to 2012. The mean age of the patients was 24.5 years (range, 19-30 years). Center of rotation of angulation (CORA) was determined by intersection of transverse bisector line and tibial posterior cortex. Osteotomy was performed from the distal margin of tibial tuberosity to the planned CORA. Opening gap was calculated by the picture-archiving and communications system-photoshop method. Anatomical locking plate was applied with auto-iliac bone graft after osteotomy. The postoperative results were evaluated with a modification of the scoring system described by Lecuire et al., which assesses pain, instability, range of motion, weakness, sports activity, patient evaluation, angle of recurvatum, tibial plateau angle, and patellar height.
All four osteotomies achieved complete union clinically by 3 months without any complication. The mean angle of recurvatum was 17° (range, 15°-20°) preoperatively and -2.5° (range, -5°-0°) postoperatively. The mean angle of tibial plateau was 78.5° (range, 66°-85°) before surgery and 97° (range, 96°-98°) after surgery. Discrepancy between preoperative target angle (97°) and postoperative tibial plateau angle was within 1° in all cases and anatomical axis was also restored completely in each cases. Patellar height was not changed postoperatively in all cases and limb length was increased by 0.9cm(range,0.7-1.2cm) Two cases combined with posterior instability showed improved posterior instability by grade 1 postoperatively. The mean duration of follow up was 36months (range, 20-59 months). The overall results were excellent in three patients and good in one patient.
The proximal tibial anterior open wedge oblique osteotomy corrected tibial plateau angle accurately, restored anatomical axis without translation, and enabled rigid fixation with sufficient proximal fragment in genu recurvatum. In addition, maintenance of patellar height, improvement of posterior instability, and increase of limb length was observed after osteotomy. This novel technique showed satisfactory clinical outcomes without any complication.