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
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.