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Online ISSN 1827-1707
ADVANCES IN KNEE SURGERY LIGAMENT - PART II
Massin P., Deschamps G.
1 Orthopedic Surgery Department, CHU Bichat Claude Bernard, Paris, France.
2 Medico-Surgical center, Dracy le Fort, France
In post-traumatic arthritis of the knee, tibial osteotomy can be performed for 2 reasons: first for correcting a post-traumatic deformation, and second, for treating unicompartmental arthritis. Two bone sections may be required, but most often both goals can be reached with a single bone section. Usually, rotational deformities follow closed intra-medullary nailing of a diaphyseal fracture, while axial deformity results from complex tibial plateau fractures and may combine intra and extra-articular malunions. A three dimensional analysis of the deformation, based on long leg standing radiographs and a computed tomograohy (CT) scan, is mandatory. Axial deformities can be corrected in the upper metaphysis, while rotational deformities are better corrected in the lower metaphysis. A mild unicompartmental arthritis of the knee with an extra-capsular deformity of more than 10° in either plan is the best indication for a corrective osteotomy. If the degenerative changes are more severe, an associated arthroplasty should be considered in elderly patients. Upper tibial osteotomies are compatible with a simultaneous total knee replacement using the same approach. The treatment of intra-capsular deformities is more controversial. Intra-articular osteotomy should be considered in severe deformities in young patients. Osteotomies reproducing the traject of the initial separation-fracture are technically demanding, and will principally restore the articular profile. Extra-capsular osteotomies can be a useful adjunct. Unexpected satisfactory results may be obtained in young patients, which will allow delaying the prosthesis. In case of failure, total knee replacement will be facilitated.