Rolle der Extensionsosteotomie bei vorderen Instabilitäten

Background: The posterior tibial slope (PTS) is defined as the inclination of the proximal tibia from a lateral aspect. Due to the combination of the inclination with muscular force, the tibial slope results in a sliding mechanism of the distal femur on the tibial plateau similar to a slide. From biomechanical studies modifications in the PTS are known as treatment options for cruciate ligament insufficiencies of the knee. An increased PTS was also identified as a possible risk factor for anterior cruciate ligament (ACL) rerupture and persistent rotatory instability. Therefore, operative correction of the PTS as a therapeutic option or for protection of a ligament reconstruction has become a focus of interest. Material and methods: By an anterior closed-wedge osteotomy PTS can be reduced and thereby an increased anterior tibial translation, as for an ACL plasty. In this article two different techniques are described, with or without additional osteotomy of the tibial tuberosity. Results: Although only limited evidence for primary ACL reconstruction and slope correction is currently available, in the case of a revision ACL reconstruction this combined operation leads to satisfactory results.