S Robert Rozbruch1, Kira Segal, Svetlana Ilizarov, Austin T Fragomen, Gabriel Ilizarov. 1. Institute for Limb Lengthening and Reconstruction, Limb Lengthening and Deformity Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA. Rozbruchsr@hss.edu
Abstract
BACKGROUND: Optimal leg alignment is the goal of tibial osteotomy. The Taylor Spatial Frame (TSF) and the Ilizarov method enable gradual realignment of angulation and translation in the coronal, sagittal, and axial planes, therefore, the term six-axis correction. QUESTIONS/PURPOSES: We asked whether this approach would allow precise correction of tibial deformities. METHODS: We retrospectively reviewed 102 patients (122 tibiae) with tibial deformities treated with percutaneous osteotomy and gradual correction with the TSF. The proximal osteotomy group was subdivided into two subgroups to distinguish those with an intentional overcorrection of the mechanical axis deviation (MAD). The minimum followup after frame removal was 10 months (average, 48 months; range, 10-98 months). RESULTS: In the proximal osteotomy group, patients with varus and valgus deformities for whom the goal of alignment was neutral or overcorrection experienced accurate correction of MAD. In the proximal tibia, the medial proximal tibial angle improved from 80 degrees to 89 degrees in patients with a varus deformity and from 96 degrees to 85 degrees in patients with a valgus deformity. In the middle osteotomy group, all patients had less than 5 degrees coronal plane deformity and 15 of 17 patients had less that 5 degrees sagittal plane deformity. In the distal osteotomy group, the lateral distal tibial angle improved from 77 degrees to 86 degrees in patients with a valgus deformity and from 101 degrees to 90 degrees for patients with a varus deformity. CONCLUSIONS: Gradual correction of all tibial deformities with the TSF was accurate and with few complications. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
BACKGROUND: Optimal leg alignment is the goal of tibial osteotomy. The Taylor Spatial Frame (TSF) and the Ilizarov method enable gradual realignment of angulation and translation in the coronal, sagittal, and axial planes, therefore, the term six-axis correction. QUESTIONS/PURPOSES: We asked whether this approach would allow precise correction of tibial deformities. METHODS: We retrospectively reviewed 102 patients (122 tibiae) with tibial deformities treated with percutaneous osteotomy and gradual correction with the TSF. The proximal osteotomy group was subdivided into two subgroups to distinguish those with an intentional overcorrection of the mechanical axis deviation (MAD). The minimum followup after frame removal was 10 months (average, 48 months; range, 10-98 months). RESULTS: In the proximal osteotomy group, patients with varus and valgus deformities for whom the goal of alignment was neutral or overcorrection experienced accurate correction of MAD. In the proximal tibia, the medial proximal tibial angle improved from 80 degrees to 89 degrees in patients with a varus deformity and from 96 degrees to 85 degrees in patients with a valgus deformity. In the middle osteotomy group, all patients had less than 5 degrees coronal plane deformity and 15 of 17 patients had less that 5 degrees sagittal plane deformity. In the distal osteotomy group, the lateral distal tibial angle improved from 77 degrees to 86 degrees in patients with a valgus deformity and from 101 degrees to 90 degrees for patients with a varus deformity. CONCLUSIONS: Gradual correction of all tibial deformities with the TSF was accurate and with few complications. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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