Slope and frontal axis: three-dimensional analysis and correction with patient-specific cutting guides for the proximal tibia

Oper Orthop Traumatol. 2023 Jun 7. doi: 10.1007/s00064-023-00815-9. Online ahead of print.ABSTRACTOBJECTIVE: Three-dimensional correction of the bony alignment in the frontal and sagittal plane of the proximal tibia; surgery is performed via an open- or closing-wedge osteotomy to improve ligament stability and reduce joint degeneration.INDICATIONS: Chronic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) instability and ligament revision surgeries; subjective knee instability in patients who are ambitious athletes and people who do physical labor; moderate joint degeneration with meniscus and cartilage damage, post-traumatic deformities.CONTRAINDICATIONS: Time pressure (immediate meniscus surgery, since planning and production of patient-specific tools is time-consuming), lack of compliance (need for partial weight bearing, crutches), excessive smoking, vascular pathologies.SURGICAL TECHNIQUE: Planning based on computed tomography (CT) data, determination of the axis of rotation with open or closing wedge, or dome osteotomy; production of corresponding patient-specific cutting blocks. Surgery is performed using the known standard approaches for a high tibial osteotomy (HTO). Exact positioning of cutting guides on the exposed bone. Sawing and adjusting the correction using an osteotomy chisel so that the reduction guide can be attached. Fixation of the achieved correction with angle-stable plate fixator.POSTOPERATIVE MANAGEMENT: Partial weight bearing base...
Source: Operative Orthopadie und Traumatologie - Category: Orthopaedics Authors: Source Type: research