PURPOSE: The aim of this study was to investigate the clinical and radiological outcomes of anterior open-wedge high tibial osteotomy (AOW-HTO) performed to increase the posterior tibial slope (PTS) in patients with chronic posterior cruciate ligament (PCL) insufficiency and persistent posterior instability. METHODS: Eleven patients treated between November 2018 and February 2024 were included in this study. All patients presented with chronic symptomatic PCL insufficiency in combination with a reduced PTS, reflected by an increased posterior proximal tibial angle (PPTA), and underwent AOW-HTO for slope correction. Clinical outcomes were assessed using the validated Lysholm Knee Score and Tegner Activity Scale. Scores were recorded retrospectively for the patients' best pre-injury condition, preoperatively at the time of greatest functional impairment and post-operatively at final follow-up. Radiographic evaluation included preoperative, intraoperative and post-operative assessment of the PTS using standardized lateral knee radiographs. Subjective knee stability, patient satisfaction and functional outcomes at follow-up were evaluated using a standardized questionnaire incorporating the Lysholm and Tegner scores. RESULTS: Eleven patients (9 male, 2 female) were included. Mean follow-up was 3.6 ± 1.7 years. The mean preoperative PPTA was 92.2 ± 7.6° (87-111°), which decreased to 83.0 ± 3.9° (80-93°) post-operatively, corresponding to a mean slope correction of 9.2°. AOW-HTO resulted in significant improvements in patient-reported functional outcomes compared with the preoperative condition. The mean Lysholm score improved from 59.0 ± 6.1 points (range, 34-95) preoperatively to 83.0 ± 18.0 points (range, 46-100) at final follow-up (p = 0.0002). Similarly, the mean Tegner activity score increased from 3.0 ± 1.8 (range, 0-7) to 5.3 ± 1.8 (range, 3-8) (p = 0.0004). However, post-operative outcomes remained below the historical pre-injury baseline values. At final follow-up, eight patients reported satisfactory knee stability without episodes of giving way. No patient required secondary PCL reconstruction or additional posterolateral stabilization following osteotomy. Statistical significance was defined as p < 0.05. CONCLUSION: AOW-HTO resulted in satisfactory subjective knee stability and significant functional improvement in selected patients with chronic PCL insufficiency. Isolated tibial slope correction represents a valid therapeutic approach in the management of complex posterior knee instability. LEVEL OF EVIDENCE: Level IV, therapeutic studies (case series with no comparison group).
Dickschas et al. (Mon,) studied this question.
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