Effects of Anterior Closing Wedge Tibial Osteotomy on Anterior Cruciate Ligament Force and Knee Kinematics

The American Journal of Sports Medicine
Kent T YamaguchiFrank A Petrigliano

Abstract

A certain percentage of patients undergoing anterior cruciate ligament (ACL) reconstruction will experience graft failure, and there is mounting evidence that an increased posterior tibial slope (PTS) may be a predisposing factor. Theoretically, under tibiofemoral compression force (TFC), a reduced PTS would induce less anterior tibial translation (ATT) and lower ACL force. Ten-degree anterior closing wedge osteotomy of the proximal tibia will significantly reduce ACL force and alter knee kinematics during robotic testing. Controlled laboratory study. Eleven fresh-frozen human knees were instrumented with a load cell that measured ACL force as the knee was flexing continuously from 0° to 50° under 200-N TFC as our initial testing condition, followed by the addition of the following tibial loads: 45-N anterior force (AF), 5-N·m valgus moment (VM), 2-N·m internal torque (IT), and all loads combined. ACL force and knee kinematics were recorded before and after osteotomy. Osteotomy produced significant changes in the tibiofemoral position at full extension (as defined by a 2-N·m knee extension moment). This resulted in apparent knee hyperextension (9.4° ± 1.9°), posterior tibial translation (7.9 mm ± 1.6 mm), internal tibial rotati...Continue Reading

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