EP1.15 Three-Dimensional Correction in Periacetabular Osteotomy: How the Plane of Rotation Influences Construct Stability and Articular Cartilage Loading

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ID: 331104
2026
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Abstract
Abstract Background Periacetabular osteotomy (PAO) outcomes are commonly assessed by final radiographic parameters. However, identical postoperative lateral coverage values can be achieved through fundamentally different three-dimensional fragment movements with distinct implications for cartilage loading. The Bernese technique corrects primarily through direct lateral rotation with minimal flexion, reducing bony apposition at the iliac cut and placing commonly damaged anterosuperior cartilage over the superolateral weight-bearing zone. The purpose of this study is to describe how the CU PAO’s plane of fragment rotation differs from the Bernese technique and to discuss its implications for bony apposition and cartilage loading. Methods The CU PAO is a dual-incision, interlocking PAO that achieves correction primarily through rotation in an approximately 45-degree plane between the sagittal and coronal planes, aligned with the inner table of the ilium. This produces fragment flexion in direct proportion to the magnitude of lateral correction, with version subsequently addressed through fragment internal or external rotation. In contrast, the Bernese technique corrects primarily through direct lateral rotation in the coronal plane with minimal flexion in the sagittal plane. Radiographic findings from over 1,000 consecutive CU PAOs were reviewed. Degree of fragment flexion was evidenced by the “empty ischial cut sign” and anterior inferior iliac spine (AIIS) position. Contact stress implications were derived from previous studies which used discrete element analysis to demonstrate that mechanically optimal acetabular reorientations require significantly greater anterior coverage than typically achieved surgically. Results The CU PAO’s oblique plane of correction produced significant fragment flexion, evidenced by a consistently visible empty ischial cut sign and low-hanging AIIS on postoperative radiographs. This repositions healthy posterior cartilage into the superolateral weight-bearing zone rather than advancing pathologic anterosuperior cartilage over the femoral head. The interlocking step-cut design, combined with fragment rotation in the plane of the ilium, improved bony apposition at the supra-acetabular ilium enabling immediate weight bearing. AIIS reduction was infrequently required, as version correction brought the AIIS medial and out of the femoral neck’s path during deep flexion. Conclusion Correcting acetabular dysplasia is not just about achieving target radiographic parameters – the three-dimensional path of correction matters. The CU PAO’s oblique plane of rotation produces fragment flexion in direct proportion to the magnitude of lateral correction that positions healthy cartilage at the weight-bearing zone and enhances bony apposition, offering a biomechanically favorable alternative to the predominantly direct lateral rotation of the Bernese technique.
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Authors Kyle Jamar, Erel Ben-Ari, Christopher Orear, Jessica Lee, Omer Mei-Dan, Tigran Garabekyan
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.199
URL
https://doi.org/10.1093/jhps/hnag043.199
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