OSTEOTOMY FOR INCREASED POSTERIOR SLOPE AFFECTS ACL STRAIN AND TIBIAL TRANSLATION

Abstract

Purpose: Previous research has reported that increasing the posterior tibial slope through an opening wedge osteotomy results in an anterior shift in the position of the tibia relative to the femur. However, the effect of this on anterior cruciate ligament (ACL) strain remains insufficiently understood. The purpose of this study was to examine the relationship between tibial slope and tibial translation, as well as between tibial slope and ACL strain. It was hypothesized that increasing the posterior tibial slope would result in an increase in anterior tibial translation thereby increasing strain in the ACL.

Methods: Five cadaveric knees were subjected to a randomized experimental design study. One knee was excluded due to failure of a strain gauge during experimentation, resulting in data for four knees. The femoral and tibial portions of the knee were potted with PMMA and fixed using fixation pins. An anterior-based osteotomy was performed with no osteotomy plate present. A strain gauge was then placed in the anteromedial bundle of the ACL. Each knee was mounted at a flexion angle of 15° and loaded with various combinations of A-P loads (18N, 108N, 209N) and axial loads (216N, 418N), according to the study design. Osteotomies of 5mm and 10mm were then performed and measurements of strain and tibial translation were taken after each according to the study design. Tibial slopes were determined through lateral fluoroscopic imaging.

Results: As posterior tibial slope increased, anterior tibial translation increased as anticipated. However, contrary to expectations, as posterior slope increased, ACL strain decreased. One explanation for this result could be that by performing the osteotomy, the insertions sites of the ACL were being moved closer together resulting in increased ACL laxity. At higher slope angles, translation levels off, suggesting constraint of some tissue besides the ACL.

Conclusions: Although increasing the tibial slope through opening wedge osteotomy leads to an anterior tibial translation, there is no increase in strain on the ACL. Further studies are needed to examine the effect of opening wedge osteotomy on other soft tissue restraints of the knee.