High Tibia Osteotomy and Knee Anatomic Changes

Hihg tibia osteotomy has its own position even with successful total knee replacement. A high tibial osteotomy affects not only the joint function as a whole، but also the dyferent sections of the knee joint. The biomechanical changes affect the patella inedial collateral ligament، quadriceps alignment and Q-angle and tibial plateau slope. The goal of high tibia osteotomy is more normal load distribution in nonarthritic knee in young persons، and slowing degeneration in arthritic knee in adults. All the high tibia osteotomies cause patellofemoral biomechanical changes، through tubercle displacement، or patellar tendon fibrosis or calcification. Q angle also increase with lateral displacement of tibial tuberosity when osteotomy is done proximal to the tibial tuberosity. The medial collateral ligament needs to be released in open wedge high tibia osteotiomy. If intact medial ligament is necessary، osteotomy should be done distal to medial collateral attachment. The proximal tibia configuration is roughly similar to a rectangle. Lateral cortex is in right angle to the posterior one. The posteromedial corner opens three times the anterior one in open wedge osteotomy otherwise there would be tibial slope change.