The Journal of Bone and Joint Surgery (American). 2009;91:101-115.
doi:10.2106/JBJS.H.01500
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Combined Intra-Articular and Varus Opening Wedge Osteotomy for Lateral Depression and Valgus Malunion of the Proximal Part of the Tibia

Surgical Technique

Gino M.M.J. Kerkhoffs, MD, PhD1, Maarten V. Rademakers, MD1, Mark Altena, MD1 and René K. Marti, MD, PhD1

1 Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands. E-mail address for G.M.M.J. Kerkhoffs: g.m.kerkhoffs{at}amc.uva.nl

Investigation performed at the Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 90-A, pp. 1252-7, June 2008

DISCLOSURE: In support of their research for or preparation of this work, the authors received, in any one year, outside funding or grants in excess of $10,000 from the AO-ASIF Research Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A video supplement to this article will be availa ble from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

BACKGROUND: Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus malunions of the proximal part of the tibia.

METHODS: From 1977 through 1998, a combination of an intra-articular elevation and a lateral opening wedge varus osteotomy of the proximal part of the tibia was performed in twenty-three consecutive patients. The patients were assessed clinically and radiographically at a minimum of five years postoperatively.

RESULTS: A correction of the intra-articular depression and the valgus malalignment was achieved and the anatomic lower-extremity axis was restored in all patients. The clinical results were evaluated at a mean of thirteen years (range, two to twenty-six years) after the reconstructive osteotomy. Two patients had an early failure and were considered to have had a poor result. Two other patients had severe progression of osteoarthritis after the osteotomy, four had slight progression, and fifteen had no progression. There were no nonunions. There were two superficial wound infections, which were treated successfully without surgical intervention. According to the scale of Lysholm and Gillquist, the subjective result was excellent for seventeen patients (74%), good for three, fair for one, and poor for two.

CONCLUSIONS: A knee-joint-preserving osteotomy can provide satisfactory results in active patients with painful posttraumatic lateral depression and valgus malunion of the proximal part of the tibia.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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