Wen-Chuan Zhao, Hong Chen, Yi-Xin Li, Jun-Wei Wang
{"title":"胫骨近端前方闭合楔形截骨术在前交叉韧带重建中的应用","authors":"Wen-Chuan Zhao, Hong Chen, Yi-Xin Li, Jun-Wei Wang","doi":"10.1016/j.asmart.2024.06.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Posterior tibial slope (PTS) plays a vital role in knee stability. PTS of more than 12° may be considered with increased strain on the native anterior cruciate ligament (ACL) fibers. To handle the instability caused by changes in PTS degree, Proximal Tibial Anterior Closing Wedge Osteotomy (PT-ACWO) is adopted by surgeons.</p></div><div><h3>Methods</h3><p>Between October 2015 and October 2019, our department conducted a retrospective analysis of patients who experienced anterior cruciate ligament reconstruction (ACLR) graft failures, with a particular focus on pathological PTS. The time from initial ACLR to revision ranged from 1 to 10 years, with a mean of 2.5 years. Radiological assessments of PTS were conducted, and outcomes were quantified using the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. The surgical technique and the use of 3D Patient-Specific Instrumentation (PSI) were outlined. Preoperative imaging included the use of Kirschner wires to establish tibial plateau reference points, and 3D-PSI was employed to guide the location and depth of the tibial osteotomy, which was performed obliquely. In a notable instance, a novel tibial tunnel was mapped out, and ortho-bridge system (OBS) fixation was utilized to ensure adequate space for the new tunnel.</p></div><div><h3>Results</h3><p>In a cohort of seven patients with a mean follow-up of 28.1 months, a significant reduction in PTS was noted postoperatively (median [interquartile range, IQR], from 15.27° [13.46°, 16.60°] to 6.25° [5.89°, 6.78°]; <em>P</em> = 0.002). IKDC score improved to 85.10 (80.25, 88.10), <em>P</em> < 0.001; the Lysholm score to 88.00 (73.00, 90.50), <em>P</em> < 0.001; and the Tegner score to 8.00 (7.20, 8.05), <em>P</em> = 0.025 at final follow-up. Skin incision healing delays occurred in two instances, yet achieved closure by six weeks. Radiographs at three months demonstrated faster bone healing in oblique osteotomies than transverse ones. Knee joint stability was maintained, with no additional complications or evidence of instability noted. Magnetic resonance imaging (MRI) confirmed graft integrity in all patients, without signs of enlargement or mispositioning at last observation.</p></div><div><h3>Conclusion</h3><p>An augmented PTS angle exceeding 12 may constitute a potential etiology for the failure of ACLR grafts. In such patients, the implementation of ACLR combined with PT-ACWO could mitigate the risk of surgical failure during initial ACLR or subsequent revision procedures.</p></div>","PeriodicalId":44283,"journal":{"name":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214687324000153/pdfft?md5=e61c6b45a6ee3c1c6524ca5da92bc736&pid=1-s2.0-S2214687324000153-main.pdf","citationCount":"0","resultStr":"{\"title\":\"The application of proximal tibial anterior closing wedge osteotomy in anterior cruciate ligament reconstruction\",\"authors\":\"Wen-Chuan Zhao, Hong Chen, Yi-Xin Li, Jun-Wei Wang\",\"doi\":\"10.1016/j.asmart.2024.06.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Posterior tibial slope (PTS) plays a vital role in knee stability. PTS of more than 12° may be considered with increased strain on the native anterior cruciate ligament (ACL) fibers. To handle the instability caused by changes in PTS degree, Proximal Tibial Anterior Closing Wedge Osteotomy (PT-ACWO) is adopted by surgeons.</p></div><div><h3>Methods</h3><p>Between October 2015 and October 2019, our department conducted a retrospective analysis of patients who experienced anterior cruciate ligament reconstruction (ACLR) graft failures, with a particular focus on pathological PTS. The time from initial ACLR to revision ranged from 1 to 10 years, with a mean of 2.5 years. Radiological assessments of PTS were conducted, and outcomes were quantified using the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. The surgical technique and the use of 3D Patient-Specific Instrumentation (PSI) were outlined. Preoperative imaging included the use of Kirschner wires to establish tibial plateau reference points, and 3D-PSI was employed to guide the location and depth of the tibial osteotomy, which was performed obliquely. In a notable instance, a novel tibial tunnel was mapped out, and ortho-bridge system (OBS) fixation was utilized to ensure adequate space for the new tunnel.</p></div><div><h3>Results</h3><p>In a cohort of seven patients with a mean follow-up of 28.1 months, a significant reduction in PTS was noted postoperatively (median [interquartile range, IQR], from 15.27° [13.46°, 16.60°] to 6.25° [5.89°, 6.78°]; <em>P</em> = 0.002). IKDC score improved to 85.10 (80.25, 88.10), <em>P</em> < 0.001; the Lysholm score to 88.00 (73.00, 90.50), <em>P</em> < 0.001; and the Tegner score to 8.00 (7.20, 8.05), <em>P</em> = 0.025 at final follow-up. Skin incision healing delays occurred in two instances, yet achieved closure by six weeks. Radiographs at three months demonstrated faster bone healing in oblique osteotomies than transverse ones. Knee joint stability was maintained, with no additional complications or evidence of instability noted. Magnetic resonance imaging (MRI) confirmed graft integrity in all patients, without signs of enlargement or mispositioning at last observation.</p></div><div><h3>Conclusion</h3><p>An augmented PTS angle exceeding 12 may constitute a potential etiology for the failure of ACLR grafts. In such patients, the implementation of ACLR combined with PT-ACWO could mitigate the risk of surgical failure during initial ACLR or subsequent revision procedures.</p></div>\",\"PeriodicalId\":44283,\"journal\":{\"name\":\"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-07-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2214687324000153/pdfft?md5=e61c6b45a6ee3c1c6524ca5da92bc736&pid=1-s2.0-S2214687324000153-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2214687324000153\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2214687324000153","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
The application of proximal tibial anterior closing wedge osteotomy in anterior cruciate ligament reconstruction
Introduction
Posterior tibial slope (PTS) plays a vital role in knee stability. PTS of more than 12° may be considered with increased strain on the native anterior cruciate ligament (ACL) fibers. To handle the instability caused by changes in PTS degree, Proximal Tibial Anterior Closing Wedge Osteotomy (PT-ACWO) is adopted by surgeons.
Methods
Between October 2015 and October 2019, our department conducted a retrospective analysis of patients who experienced anterior cruciate ligament reconstruction (ACLR) graft failures, with a particular focus on pathological PTS. The time from initial ACLR to revision ranged from 1 to 10 years, with a mean of 2.5 years. Radiological assessments of PTS were conducted, and outcomes were quantified using the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. The surgical technique and the use of 3D Patient-Specific Instrumentation (PSI) were outlined. Preoperative imaging included the use of Kirschner wires to establish tibial plateau reference points, and 3D-PSI was employed to guide the location and depth of the tibial osteotomy, which was performed obliquely. In a notable instance, a novel tibial tunnel was mapped out, and ortho-bridge system (OBS) fixation was utilized to ensure adequate space for the new tunnel.
Results
In a cohort of seven patients with a mean follow-up of 28.1 months, a significant reduction in PTS was noted postoperatively (median [interquartile range, IQR], from 15.27° [13.46°, 16.60°] to 6.25° [5.89°, 6.78°]; P = 0.002). IKDC score improved to 85.10 (80.25, 88.10), P < 0.001; the Lysholm score to 88.00 (73.00, 90.50), P < 0.001; and the Tegner score to 8.00 (7.20, 8.05), P = 0.025 at final follow-up. Skin incision healing delays occurred in two instances, yet achieved closure by six weeks. Radiographs at three months demonstrated faster bone healing in oblique osteotomies than transverse ones. Knee joint stability was maintained, with no additional complications or evidence of instability noted. Magnetic resonance imaging (MRI) confirmed graft integrity in all patients, without signs of enlargement or mispositioning at last observation.
Conclusion
An augmented PTS angle exceeding 12 may constitute a potential etiology for the failure of ACLR grafts. In such patients, the implementation of ACLR combined with PT-ACWO could mitigate the risk of surgical failure during initial ACLR or subsequent revision procedures.
期刊介绍:
The Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology (AP-SMART) is the official peer-reviewed, open access journal of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS) and the Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). It is published quarterly, in January, April, July and October, by Elsevier. The mission of AP-SMART is to inspire clinicians, practitioners, scientists and engineers to work towards a common goal to improve quality of life in the international community. The Journal publishes original research, reviews, editorials, perspectives, and letters to the Editor. Multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines will be the trend in the coming decades. AP-SMART provides a platform for the exchange of new clinical and scientific information in the most precise and expeditious way to achieve timely dissemination of information and cross-fertilization of ideas.