Dickschas J, Sendner T, Schubert I, Simon M, Neumaier M (2026)
Publication Type: Journal article
Publication year: 2026
DOI: 10.1002/ksa.70522
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).
APA:
Dickschas, J., Sendner, T., Schubert, I., Simon, M., & Neumaier, M. (2026). Anterior open wedge high tibial osteotomy for slope correction as a successful method in PCL insufficiency—Radiological and clinical results of a cohort study. Knee Surgery Sports Traumatology Arthroscopy. https://doi.org/10.1002/ksa.70522
MLA:
Dickschas, Jörg, et al. "Anterior open wedge high tibial osteotomy for slope correction as a successful method in PCL insufficiency—Radiological and clinical results of a cohort study." Knee Surgery Sports Traumatology Arthroscopy (2026).
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