title: Comparison of Lateral Closing-Wedge Versus Medial Opening-Wedge High Tibial Osteotomy on Knee Joint Alignment and Kinematics in the ACL-Deficient Knee.
abstract: Lateral closing-wedge (LCW) and medial opening-wedge (MOW) high tibial osteotomies (HTOs) correct varus knee alignment and stabilize the anterior cruciate ligament (ACL)-deficient knee. Tibiofemoral and patellofemoral alignment and kinematics after HTO are not well quantified.
  
  
  
  To compare the effect of LCW and MOW HTO on tibiofemoral and patellofemoral alignment in the ACL-deficient knee.
  
  
  
  Controlled laboratory study.
  
  
  
  Anterior drawer, Lachman, and pivot-shift tests were performed on cadaveric specimens (N = 16), and anterior tibial translation and tibial rotation were measured for the native and ACL-sectioned knee. The right and left knee of each cadaveric specimen underwent an LCW and MOW HTO, respectively, and stability testing was repeated. All cadavers underwent pre- and postosteotomy computerized tomography with 3-dimensional computer modeling to determine the effect of HTO on posterior tibial slope, as well as tibial and patellofemoral axial plane alignment (tibial axial rotation and patellar axial tilt).
  
  
  
  Correction to neutral coronal alignment was obtained with both osteotomy techniques; however, larger posterior tibial slope neutralization was achieved with LCW compared with MOW (mean ± SD, 11° ± 3.8° vs 5° ± 5°). LCW demonstrated a greater decrease in anterior tibial translation (P < .05) during Lachman testing, with translation values approximating those of the native knee, especially for the lateral compartment. A similar decrease in anterior tibial translation with LCW was not found during anterior drawer testing. Anterior tibial translation did not improve for either the Lachman or the anterior drawer test after MOW. Osteotomy type did not affect tibial rotation with pivot shift. Relative to MOW, LCW resulted in greater tibial axial rotation and patellar axial tilt (7.7° ± 4° and 5.6° ± 3.9° [LCW], 2.8° ± 2.3° and 2.4° ± 0.9° [MOW], respectively; P < .05).
  
  
  
  LCW shows more reproducible posterior tibial slope neutralization and decreased anterior tibial translation in ACL deficiency compared with MOW; however, LCW is associated with increased external tibial axial rotation and lateral patellar tilt, which may adversely affect the patellofemoral joint. More work is needed to understand the clinical and functional outcome of these biomechanical findings in the ACL-deficient knee.
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA ranawatanil@hss.edu.
authors: Anil S
authors: AS
authors: Ranawat
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors: Benedict U
authors: BU
authors: Nwachukwu
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors: Andrew D
authors: AD
authors: Pearle
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors: Hendrik A
authors: HA
authors: Zuiderbaan
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors: Kenneth D
authors: KD
authors: Weeks
authors: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors: Saker
authors: S
authors: Khamaisy
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001696:Biomechanical Phenomena; D002102:Cadaver; D005205:Fascia; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D010329:Patella / Q000503:physiopathology; D057071:Patellofemoral Joint / Q000503:physiopathology; D012399:Rotation; D013977:Tibia / Q000601:surgery
keywords: ACL; cadaver; high tibial osteotomy; outcomes