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Functional bracing
1%
28/3779
Reconstruction of the PCL
6%
216/3779
Reconstruction of the ACL and PCL
37/3779
High tibial osteotomy to decrease tibial slope and correct varus malalignment; reconstruction of the PCL & PLC
40%
1504/3779
High tibial osteotomy to increase tibial slope and correct varus malalignment; reconstruction of the PCL & PLC
52%
1949/3779
Select Answer to see Preferred Response
This patient sustained a combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) injury. The most appropriate treatment would be high tibial osteotomy to increase tibial slope and correct varus malalignment and reconstruction of the PCL & PLC. Altering the tibial slope is an important concept in the management of chronic PCL and ACL deficient knees with functional instability. For PCL deficiency, the slope should be INCREASED. Increasing the tibial slope will shift the tibia more anterior relative to the femur. The increased slope will also prevent posterior tibia translation as the femur is more inclined to slide down the tibial slope, therefore keeping the tibia in a more anterior position. Giffin et al states that increasing tibial slope in a PCL-deficient knee reduces tibial sag by shifting the resting position of the tibia more anterior to the femur. This sag is even further reduced when the knee is subjected to axial compressive loads. Petrigliano et al. examined the effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament and posterolateral corner-deficient knee. They concluded that increasing posterior tibial slope diminished static posterior instability of the PCL/PLC-deficient knee as measured by the posterior drawer test. Illustration A shows the effects of increasing and decreasing the tibia slope. Incorrect Answers: Answer 1: Functional bracing will not definitively address the chronic instability. Answers 2,3: Coronal alignment must be addressed. There are high failure rates with knee ligament reconstruction when this is not addressed. Answer 4: Decreasing the tibial slope would be considered in chronic ACL deficiency.
3.8
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