high tibial osteotomy

Calculate Desired Correction on Long Leg Views

1.  Simple Calculations

Measure anatomic femoral tibial angle

- normally 5-8^o

Calculate correction desired

- need to overcorrect to 8^o femoro-tibial alignment

- or correct to mechanical axis of 180^o

Position

- patient supine on radiolucent table

- place ECG lead and artery clip over centre of femoral head

- useful to put II ipsilateral to leg, and place knee on cassette

Position

- GA, IV Abx

- supine on radiolucent table

Aetiology Unicompartmental OA

Trauma

Meniscectomy

Osteonecrosis

Varus or valgus malalignment

Goals of Osteotomy

Relief of pain

Improve function

No loss of ROM

No or slight restriction of activity

Allow heavy functional demands 

Issues

Limb alignment

Risk that late posterolateral corner reconstruction will fail in the setting of the varus knee

- varus knee alignment and varus thrust in stance phase

- consider osteotomy first in this setting

Results

Posterolateral Corner Reconstruction

Moulton et al. Am J Sports Med 2016

- systematic review of PCL reconstruction for chronic injuries

- 450 patients