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Original Research

Ann Med Res. 2005; 12(3): 153-157


The Medial Opening Wedge Osteotomy in Which The Tibial Tubercle Remains Attached to the Proximal Fragment: An Anatomıc Study

İrfan Esenkaya*, Nurzat Elmalı*, Mesut Mısırlıoğlu*, Kadir Ertem*, Alper Atasever**

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Abstract


 

Objectives: Aim of this study is to perform and to evaluate the medial opening wedge osteotomy technique in which the tibial tubercle remains attached to the proximal fragment of osteotomy on plastic tibial models and human cadaveric and amputated tibiae.

Material and Methods: The medial opening wedge osteotomy in which the tibial tubercle (tuberositas tibiae, tibial tuberosity), the area of insertion of the patellar ligament, remains attached to the proximal fragment were applied on 10 plastic tibial models and six human cadaveric and four amputated tibiae. The level of the osteotomy was planned which should be started 4 centimeters distal to the medial joint line and obliquely directed laterally and proximally 1.5 centimeters distal to the lateral joint line and 1 centimeter medial to the lateral cortex. Medial cortex, anterior

cortex around the tibial tubercle and posterior cortex were cut in which the tibial tubercle remains attached to the proximal fragment

Results: When the medial opening wedge osteotomy in which the tibial tubercle remains attached to the proximal fragment was carried out at human cadaveric tibiae, fracture of tibial tubercle was observed in the first application.

The reason of this complication was determined that not to have been noticed posterior angulation of proximal tibia metaphyseal region during the drilling to weaken the bone and later to cut the bone from medial to lateral. We didn’t have another fracture in the other bone specimens which was cut 120°-125° angulated anterior cut around and behind the tuberosity.


Conclusıons: Distal tuberosity osteotomy in open wedge proximal osteotomy can prevent patella infera because of the patellar ligament

and its insertion area tibial tubercle were not exposed to the stretching. Application of these osteotomies on human cadaver or amputated

tibiae and plastic tibial models were also diffucult than other classic osteotomy techniques. It must remember that tibial tubercle may be broken during the application of the technique.

Key Words: Proximal Tibial Osteotomy, High Tibial Osteotomy, Retrotubercle Osteotomy, Patella İnfera, Patella Baja, Anatomic Experiment







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