Purpose: We analysed knee prostheses preserving the posterior cruciate ligament (or both cruciates) performed after tibial osteotomy. We determined outcome as a function of any tibial callus deformation created by the tibial osteotomy.

Material and methods: This retrospective study included a consecutive series of 56 knee prostheses with preservation of the posterior cruciate ligament (n=43) or both cruciate ligaments (n=13). The patients had undergone prior tibial osteotomy for valgisation (n=47) or varisation (n=9). Seven groups were defined as a function of the preoperative tibial angle prior to TKA. The angle were measured with telegonometry. Minimum follow-up was one year, mean follow-up 4.1±2.8 years.

Results: The tibial tuberosity was raised in 15 cases. If there was major valgus or rotation deformation, tibial osteotomy was associated with the prothesis (n=9). At last follow-up, the mean IKSg, IKSf and HSS scores were 81.5, 77.6, and 82.3 respectively. The mean femorotibial angle was 177.4±4.2°. The mean tibial angle was 87.8±3° and the mean femoral angle was 89.8±2°. Preoperative tibial deformation was not influenced by clinical results. In case of preoperative tibial deformation situated between 5° valgus and 5° varus, operation time, blood loss, and femoraotibial axis at last follow-up were not significantly different. To correct for tibial valgus greater than 7°, tibial osteotomy was associated with prosthesis implantation during the same operative time in six out of thirteen cases. For preoperative tibial varus greater than 5°, the femorotibial axis was less well corrected.

Discussion: These clinical results were comparable to those reported in other series with preservation or not of the posterior cruciate ligament. Correction of the femorotibial angle was less satisfactory than in certain series, but the deformation and the surgical history were among the most marked in the literature. Preservation of the posterior cruciate ligament (or both cruciates) appears to have increased the technical difficulties for upper tibia exposure and position of the tibia implant. For tibial callus with valgus greater than 7°, the prostheses cannot be expected to provide a solution alone and osteotomy should be associated. For tibial callus with 5° or more varus, the indication for associated tibial osteotomy merits discussion.

Purpose: Several techniques have been described for the treatment of unstable fractures of the upper humerus. None appear to be appropriate for subtuberosity fractures, associated or not with a fracture of the trochiter or impacted valgus cephalotuberosity fractures, allowing a stable fixation with anatomic reduction while preserving blood supply to the bone fragments. For the last year, we have studied prospectively a percutaneous minimally invasive technique for this type of fracture. Our preliminary results are analysed here.

Material and methods: We used this technique for 12 patients aged 30 to 87 years with five displaced subtuberosity fractures, six subtuberosity fractures with a trochiter fracture and one impacted valgus cephalotuberosity fracture. Excepting the cephalotuberosity fracture, the joint fragment of the head was reduced by external manipulation under image amplifier guidance. Fixation was achieved with two 25/10 threaded pins inserted percutaneously in retrograde fashio from the anterolateral cortical to the humeral shaft. For eight cases, a third pin was inserted percutaneously from the trochiter to the medial cortical of the humerus. When percutaneous reduction of the trochiter was impossible (three cases) and for the cephalotuberosity fracture, we used a minimal transdeltoid lateral incision to reduce the trochiter and achieve reduction.

Results: Reduction was very satisfactory in all cases. There was one superficial infection that required pin withdrawal at three weeks leading to the only secondary displacement that was minimal and tolerable. We removed the pins after a mean two months. There were no nonunions. Seven patients have a follow-up greater than six months and exhibited a Constant score of 87% (71% to 100%).

Discussion: This techniques has provided very satisfactory results for rapid and stable fixation of the cephalic fragment without loss of blood supply and with a material easy to remove.

Conclusion: These early results are very encouraging and incite us to pursue this technique and analyse long-term results.