Authors:

Kaitlyn H. Smith, B.S., Nicholas K. Retzer, B.S., Benjiman J. Wilebski, M.D., A.T.C., Luke V. Tollefson, B.S., Matthew T. Rasmussen, M.D., Dustin R. Lee, M.D.,  and Robert F. LaPrade, M.D., Ph.D.

 

Abstract:

The primary role of the posterior cruciate ligament (PCL) is to prevent posterior tibial translation (PTT). PCL graft forces increase as the posterior tibial slope decreases. Therefore, in the setting of a failed PCL reconstruction, the posterior tibial slope should be evaluated as a potential factor to offload the PCL graft. Patients with a failed PCL reconstruction or chronic PCL instability have an additional risk of meniscal tear and osteoarthritis (OA) development. PCL reconstruction failures may be associated with a decreased tibial slope and varus malalignment, which further increases the risk of subsequent meniscal and cartilage injuries.

A slope increasing medial opening-wedge proximal tibial osteotomy (MOWPTO) has been shown to slow progression of medial knee OA, decrease the amount of PTT in the PCL deficient knee, protect PCL reconstructions, and postpone the need for a total knee arthroplasty. A revision second-stage PCL reconstruction may be indicated to address ligament instability after the slope increasing MOWPTO heals, if the patient has symptomatic residual PTT. This Technical Note outlines the technique for a slope increasing MOWPTO to offload the PCL and to correct varus malalignment that may accelerate degenerative effects on the medial compartment in the setting of a failed PCL reconstruction and medial compartment OA.

You can download the study: Slope Increasing Medial Opening Wedge Proximal Tibial Osteotomy for Preventive Offloading of the Posterior Cruciate Ligament and to Correct Varus Malalignment in the Setting of a Failed Posterior Cruciate Ligament Reconstruction

Video Credit:

Kaitlyn H. Smith, B.S., Nicholas K. Retzer, B.S., Benjiman J. Wilebski, M.D., A.T.C., Luke V. Tollefson, B.S., Matthew T. Rasmussen, M.D., Dustin R. Lee, M.D., and Robert F. LaPrade, M.D., Ph.D.

As per the study found in “Arthroscopy Techniques”:

Slope Increasing Medial Opening Wedge Proximal Tibial Osteotomy for Preventive Offloading of the Posterior Cruciate Ligament and to Correct Varus Malalignment in the Setting of a Failed Posterior Cruciate Ligament Reconstruction

Video Summary:

This video demonstrates a slope-increasing medial opening wedge proximal tibial osteotomy used to prevent posterior cruciate ligament (PCL) overload and correct varus malalignment following a failed PCL reconstruction. After confirming PCL insufficiency, the surgeon reuses the previous incision and performs subperiosteal dissection. Arthroscopic evaluation identifies a nonfunctional PCL graft and ACL laxity, which is corrected with anterior tibial reduction. The old PCL tunnels are debrided to bleeding bone to prepare for revision. Under fluoroscopic guidance, a precise medial opening wedge osteotomy is created using guide pins and osteotomes to achieve the desired posterior tibial slope. The osteotomy is stabilized with a sloped plate, screws, and a staple for fixation, and bone allograft is packed into the site to promote healing. This procedure sets the foundation for a later staged PCL reconstruction while correcting biomechanical alignment and reducing posterior tibial stress.