Osteotomy is for knee instability, and this is my whiskey. Some other people are going to talk about whiskey, but this is what I've been doing my whole career, osteotomies, and I need to thank Pete Fowler there who really taught me about osteotomies 35 years ago, and that's him on crutches after I did his osteotomy. So that's quite a tribute to have your mentor ask you to do an osteotomy on him. We started doing osteotomies a long time ago in London, Ontario, and initially the indications for osteotomy did not include instability. As you can see here, Coventry's paper, and here's one of our cases in 1992 of a person with hyperextension, valgus instability, and we didn't even use hardware. We just used a tibial wedge to correct the deformity in the tibia. This is Dr. Fowler's osteotomy, and you can see the staple on the front to make sure that the slope was not altered with the osteotomy. So slope has been a very important part of osteotomies. We published a whole bunch of papers and really spread the word about the importance of osteotomy for knee instability and the various conditions around the knee, not just arthritis. And I've been involved in developing all these plates. These are, you know, this is a conflict I'm disclosing. I get royalties on all these plates that I help design to do osteotomies around the knee. Now, one of the turning points was on this traveling fellowship, and they were doing routinely closing wedge osteotomies for revision ACL surgery, and you can see us there sitting with Philippe Noret in Lyon, France. And so we came back to London, Ontario, and did this study looking at the effect of changing the slope, and the slope really changes the stability of the knee in normal knees, but also in ACL unstable knees. So changing the slope has really kind of changed the use of osteotomies for instability. And so in these cases of revision ACL, changing the slope and doing a closing wedge osteotomy or correcting the coronal plane at the same time, I think has been a really huge advance in the treatment of knee instability and tibial malalignment and knee malalignment at the same time. So you can see these cases that you augment the ACL reconstruction with the alteration of the tibial anatomy with a closing wedge of the proximal tibia. And this was an ACL revision, a third-time revision where we changed the slope. So there's been a huge interest in tibial slope and correcting the tibial slope over the years that you can see here with publications. The risk of ACL revision is much less when the slope is corrected, as you can see in this review paper by Liu. And so I think that we've done a good job of spreading the word about osteotomies around the knee, and in particular for knee instability and slope correction. And I think we helped advance the understanding techniques and indications for osteotomy. Thanks for your attention. Thank you. Yeah, so questions for Dr. Amendola. Judges, Dr. Miller. It's not too difficult. You just got to plan ahead of time. And I think using a plate that gives you that flexibility. So I like using a T-plate where if one of the screws is in the way, you can remove the screw, do your ACL tunnel, plastigraft, and then you can just change the direction of the screw after the completion of passing the graft. It's not a huge... So right now, for me, it's mostly revision surgery. We're considering the slope and a slope of greater than 12 or 13 degrees. And I would say in terms of revision surgeries, we're probably doing a slope correction maybe 10% of the time. Now, the Europeans, I think, are doing a lot more of that. Yeah, you can change. I had a case on here. So, he asked about reversing the slope and increasing the slope if necessary. Is that right? So, there are some conditions where there's actually the slope is too low, especially if they've had a growth plate injury, you know, where they have a hyperextension deformity, you can do an opening wedge and change the slope. Also, for chronic PCL deficiency, you can increase the slope slightly to help with the PCL reconstruction as well. Ed, thanks a lot. We're going to move on to our next one.

osteotomies

knee instability

slope correction

Dr. Pete Fowler

plates for osteotomies