Flexions- und Extensionsosteotomien am Kniegelenk

Objectives: Flexion and extension osteotomy of the knee for symptomatic malalignment in the sagittal plane. Indications: Congenital/posttraumatic bony deficiencies in flexion/pathologic hyperextension in the knee. Additional treatment for ligament reconstruction. Contraindications: Absolute: Infection, critical soft tissue situation, circulatory disorders. Relative: Osteoporosis, heavy smoker, obesity, reduced patient compliance. Surgical technique: Diagnostic arthroscopy of the knee. If the malposition is located at the proximal tibia, an extending or flexing high tibial osteotomy with correction of the tibial slope is carried out. If the malalignment is referred to the distal femur, the adjustment is performed by a distal femoral osteotomy. Postoperative management: Partial weight bearing with 20 kg for the first 6 postoperative weeks. Due to the tuberositas tibiae osteotomy, it is necessary to restrict the movement of the knee for the first 6 weeks. Results: Between 2015 and 2016, 11 patients (2 female, 9 male) were treated with a flexion or extension osteotomy of the knee. Of these patients, 2 had symptomatic hyperflexion, 7 had restriction of movement with an exaggerated tibial slope, and 2 patients had an extension deficiency according to a malalignment of the distal femur. After surgery, the symptomatic pathologic movement of the knee was improved in every patient. One patient had pseudarthrosis during the healing process, which required a second operation with reosteosynthesis and bony grafting. These results are also reflected in an improvement of the preoperative IKDC score from 52.7 (range 37–82) to 1 year postoperative 75.8 (range 67–84). The Lysholm score increased from preoperative 40.2 (range 15–73) to postoperative 84.3 (range 68–91).