Proximal Tibial Opening Wedge Osteotomy...Knee Instability

Authors:

Ariel N. Rodriguez, M.S., Foley Schreier, B.S., Gregory B. Carlson, M.D., and Robert F. LaPrade, M.D., Ph.D.

Abstract:

Decreased posterior tibial slope has been associated with increased risk of graft failure and knee instability after posterior cruciate ligament (PCL) reconstruction. Premature physeal arrest at the tibial tubercle is a common cause of osseous genu recurvatum. Surgical management is recommended to correct the tibial slope and prolong the integrity of the PCL graft. This article discusses our preferred treatment using a proximal tibial opening wedge osteotomy for surgical management of posterior knee instability and genu recurvatum secondary to significant anterior tibial slope.

Proximal tibial opening wedge osteotomies are indicated for cases of symptomatic genu recurvatum or increased anterior slope. A systematic review supported surgical management of symptomatic genu recurvatum using an anterior opening-wedge PTO to increase the tibial slope. Correcting the anterior slope to a more anatomic, posterior orientation would allow the ligaments to return to their normal tension and restore the native biomechanics of the knee.1 Symptomatic genu recurvatum is defined as symptomatic hyperextension of the knee >5°.1 The most common symptoms of genu recurvatum include pain, weakness, instability, decreased range of motion, leg length discrepancy, and stretching of the posterior capsuloligamentous structures of the knee.1,2 Genu recurvatum can be categorized as osseous, ligamentous, or combined. Premature physeal arrest, which in many cases occurs at the tibial tubercle growth plate, is a major cause of osseous genu recurvatum.1,2 Flattening of the tibial slope has been shown to correlate with higher remaining posterior tibial translation (PTT) and less reduction of PTT after posterior cruciate ligament (PCL) reconstruction.3, 4, 5, 6 Decreased posterior slope has also been shown to be associated with greater hyperextension of the knee.6,7 Because of the effect of tibial slope on PTT, patients with PCL reconstruction are at increased risk of postoperative instability.3

You may download the full study here: Proximal Tibial Opening Wedge Osteotomy for the Treatment of Posterior Knee Instability and Genu Recurvatum Secondary to Increased Anterior Tibial Slope

Robert LaPrade, MD PhD

Average rating:

26 reviews

Sue Stanek

Jan 2, 2020

by Sue Stanek on Robert LaPrade, MD PhD

So glad I waited for the best

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.
You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!
- From your 63 year old very appreciative patent ~

Nancy S Stevenson

Aug 14, 2019

by Nancy S Stevenson on Robert LaPrade, MD PhD

Right Knee Surgery After Auto Bicycle Accident

Dr. Robert F. LaPrade operated on my right knee in May of 2010. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. I can run, bike, & climb mountains. In fact 2 years ago I finished climbing the top 100 peaks in CO.

Jordan

Aug 2, 2019

by Jordan on Robert LaPrade, MD PhD

Very helpful

I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. This answers all my questions!

Proximal Tibial Opening Wedge Osteotomy…Knee Instability

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About the Author: Robert LaPrade, MD

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