Bob's ACL WWWBoard On-Line Knee Library |
Click here to return to the main page of the Knee Library's Research Section.
Osteotomies and Complex Bone-Realignment Surgeries
Note: This section focuses on bone surgeries which involve changing the valgus-varus angle of the knee (e.g. to make it less knock-kneed or less bow-legged). For articles dealing specifically with tibial-tubercle transfers, as used to improve patellar tracking (i.e. by moving the point at which the patellar tendon attaches to the tibia), please see Patellofemoral Pain, Chondromalacia, Patellar Dislocation, Patellar-Tendon Disruption.
See also Biomechanics, Knee Alignment, and Component Interdependency
For a brief overview of knee anatomy, physiology, and biomechanics, please click here.
Opening Wedge High Tibial Osteotomy -- An Operative Technique and Rehabilitation Program to Decrease Complications and Promote Early Union and Function, Frank R. Noyes et al.; The American Journal of Sports Medicine, Baltimore; August 2006, Vol 34, p. 1262-1273. Comments: This study is a must-read for anyone who is embarking on a tibial osteotomy. This surgery makes great demands on the surgeon, and so the surgeon should be well-experienced with this type of work. Dr. Frank Noyes has done a lot of pioneering work in this realm.
Opening Wedge Tibial Osteotomy: The 3-Triangle Method to Correct Axial Alignment and Tibial Slope, Frank R. Noyes et al.; The American Journal of Sports Medicine, Baltimore; March 2005, Vol 23, p. 378-387. Comments: This article provides a superb overview of tibial-osteotomy surgery. It gives a comprehensive overview of how the exact angle of bone cut and tibial slope are chosen, via the three-triangle method, in order to properly correct an angular malalignment at the knee.
Opening Wedge High Tibial Osteotomy for Symptomatic Hyperextension-Varus Thrust, Douglas D.R. Naudie et al.; The American Journal of Sports Medicine, Baltimore; January 2004, Vol 32, p. 60-70. Comments: This article discusses the use of high tibial osteotomy (HTO). It also provides an overview of how the knee bears weight, and how important the PCL (posterior cruciate ligament) is. The problem of the knee thrusting outwards (varus thrust), as stemming from a torn PCL (and exacerbated by a knee which hyperextends grotesquely), is dealt with. The authors note that correcting the weight-bearing line of the knee can be done via HTO, but the inherent biomechanical problems resulting from PCL deficiency remain. The authors also touch on varus (outwards) thrusting as stemming from PLC (posterolateral corner) insufficiency. (The PLC, also known as the posterolateral structures, includes the LCL [lateral collateral ligament]. Be careful not to confuse the PLC with the PCL.)
High tibial osteotomy and ligament reconstruction for varus-angulated anterior-cruciate-ligament-deficient knees, Frank R. Noyes and Sue D. Barber-Westin; The American Journal of Sports Medicine, Baltimore; May/Jun 2000, Vol 28/3, p. 282. Comments: This articles describes the staged approach (i.e. high tibial osteotomy, with subsequent ACL reconstruction) in dealing with ACL-deficient patients who also happen to be bow-legged. The impact of bow-leggedness on knee biomechanics is profound; this must be kept in mind when a bow-legged person is pursuing ACL reconstruction.
Note: A deep archive of articles and abstracts from Cincinnati Sports Medicine (CSM) Centre, including many landmark studies in the realm of knee biomechanics and trend-setting articles in the fields of ACL reconstruction and meniscal repair, can be found in directly on the CSM Publications Website. The article-publication dates range from 1980 to present. (Note that some of the newer articles are also present directly in this Knee Library.) On the CSM site, full-text articles are given as scanned-to-PDF files. Microsoft Windows users should, due to file-size considerations, download these by right-clicking and choosing "Save Target As". (The files must then be viewed using Adobe/Xerox Acrobat Reader, which is freely available for all computing platforms here.) Some articles on the CSM site are available only as abstracts; however, full-text printed copies may be obtained by contacting Sue Barber-Westin at sbwestin(at)csmref.org.
Click here to return to the Main Entrance Page of the Knee Library.
Looking for the Main Index Page of Bob's ACL WWWBoard? Click here!
To find recent postings on Bob's ACL WWWBoard, use the Search Engine.
To find older postings on Bob's ACL WWWBoard, use the On-Line Archive.
Site Terms of Use and Aspects of Copyright