Medial schließende biplanare Osteotomie an der proximalen Tibia zur Korrektur des Genu valgum

Objective

Correction of a proximal tibial valgus deformity.

Indications

Lateral osteoarthritis of the knee or cartilage damage in a valgus deformity > 5° with a medial proximal tibial angle (MPTA) > 90°.

Contraindications

Medial proximal tibial angle < 90°, medial cartilage damage, medial meniscus loss.

Surgical technique

Skin incision medial of the tibial tuberosity approximately 8–10 cm. Insertion of two converging guidewires directly above the pes anserinus, ascending obliquely, and ending at the tip of the fibula. Control of the wire position with the image intensifier. Osteotomy with an oscillating saw. Removal of the wedge and closure of the osteotomy. Osteosynthesis with a medial angle-stable plate.

Postoperative management

Partial load bearing with 10–20 kg for 2 weeks, then step-wise increase in load. Mobility: free.

Results

We performed this surgery in the manner described in 21 patients with lateral osteoarthritis or cartilage damage (17 men, 4 women, average age: 51 years). The valgus deformity was reduced from an average of 5.6 to −0.5°. The KOOS-PS (Knee Injury and Osteoarthritis Outcome Score–Physical Function Short-form) score decreased significantly from 39.1 ± 14 to 25.8 ± 20 points.