Posteromedially placed plates with anterior staple reinforcement are not successful in decreasing tibial slope in opening-wedge proximal tibial osteotomy.
OBJECTIVE
To document the effectiveness of a novel technique to decrease tibial slope in patients who underwent a proximal opening-wedge osteotomy with an anteriorly sloped plate placed in a posteromedial position. The hypothesis was that posteromedial placement of an anteriorly sloped osteotomy plate with an adjunctive anterior bone staple on the tibia would decrease, and maintain, the tibial slope correction at a minimum of 6 months following the osteotomy.


METHODS
All patients who underwent biplanar medial opening-wedge proximal tibial osteotomy with anterior staple augmentation to decrease sagittal plane tibial slope were included, and data were collected prospectively and reviewed retrospectively. Indications for decreasing tibial slope included medial compartment osteoarthritis with at least one of the following: ACL deficiency, posterior meniscus deficiency, or flexion contracture. Preoperative, immediate postoperative, and 6-month postoperative radiographs were reviewed.


RESULTS
Twenty-one patients (14 males and 7 females) were included in the study with a mean age of 36.5 years. Intrarater and interrater reliability of slope measurements were excellent at all time points (ICC ≥ 0.94, ICC ≥ 0.85). The osteotomy resulted in an average tibial slope decrease of 0.8 from preoperative (n.s.). At 6-month postoperative, average slope was not significantly different from time-zero postoperative slope (mean = +0.2°).


CONCLUSIONS
The most important finding of this study was that posteromedial placement of an anteriorly angled osteotomy plate augmented with an anterior staple during a biplanar medial opening-wedge proximal tibial osteotomy did not decrease sagittal plane tibial slope. Whether a staple was effective in maintaining tibial slope from time zero to 6 months postoperatively was unable to be assessed due to no significant change in tibial slope from the preoperative postoperative states. The results of this study note that current osteotomy plate designs and surgical techniques are not effective in decreasing sagittal plane tibial slope.


METHODS
IV.
Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
Chase S
CS
Dean
Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
Jorge
J
Chahla
Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
Lauren M
LM
Matheny
The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.|Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
Tyler R
TR
Cram
Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
Samuel G
SG
Moulton
Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
Grant J
GJ
Dornan
Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
Justin J
JJ
Mitchell
The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA. drlaprade@sprivail.org.
Robert F
RF
LaPrade
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011184:Postoperative Period; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013537:Sutures; D013977:Tibia / Q000601:surgery*; D055815:Young Adult
High tibial opening-wedge osteotomy; Posterior tibial slope; Proximal tibial opening-wedge osteotomy; Sagittal plane tibial slope; Tibial staple