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High tibial osteotomy is an orthopaedic surgical procedure which aims to correct a varus deformation with compartmental osteoarthritis.Since the inception of the procedure, advancements to technique, fixation devices, and a better understanding of patient selection has allowed HTO to become more popular in younger, more active patients hoping to combat arthritis. [1]
The tibial plateau leveling osteotomy and tibial tuberosity advancement are two of the most common osteotomy procedures performed in the United States. Recovery is often 6–8 weeks and the osteotomy can be filled with autologous bone grafts, scaffolds (hydroxyapatite, TR Matrix, etc.) or ceramics. [14]
In a TPLO procedure, the tibial plateau, the portion of the tibia adjoining the stifle, is cut and rotated so that its slope changes to approximately 5 degrees from the horizontal plane. [4] This prevents the femur from sliding down the slope of the tibial plateau when the dog puts weight on its knee. This surgery generally results in faster ...
The triple tibial osteotomy has been developed as a hybrid of two previously available orthopaedic procedures, the tibial tuberosity advancement and the tibial plateau leveling osteotomy. The tibial tuberosity advancement neutralises shear force within the stifle by advancing the tibial tuberosity until the tibial plateau is at right angles to ...
Type IV = Medial tibial plateau fracture, with or without depression; may involve tibial spines; associated soft tissue injuries. This is a medial tibial plateau fracture with a split or depressed component. It is usually the result of a high energy injury and involves a varus force with axial loading at the knee.
Surgical treatment is typically indicated for high-energy trauma fractures. [ 1 ] Intramedullary nailing is a common technique, but external fixation may have equivalent outcomes and be preferred under certain patient conditions that may preclude intramedullary nailing, such as the presence of a total knee arthroplasty.
Originally described by Dr. Paul Segond in 1879 [6] [7] after a series of cadaveric experiments, the Segond fracture occurs in association with tears of the anterior cruciate ligament (ACL) (75–100%) and injury to the medial meniscus (66–75%), lateral capsular ligament (now known as the Anterolateral ligament, or ALL), as well as injury to the structures behind the knee.
The symptoms usually resolve with treatment but may recur for 12–24 months before complete resolution at skeletal maturity, when the tibial epiphysis fuses. In some cases the symptoms do not resolve until the patient is fully grown. In approximately 10% of patients the symptoms continue unabated into adulthood, despite all conservative measures.