Abstract
Background The wedge opened during high tibial osteotomy defines the alignment correction in different body planes and alters soft tissue insertions. Although multiple complications of the surgery can be correlated to this, there is still a lack of consensus on the occurrence of those complications and their cause. The current study is aimed at clarifying this problem using a combined medical and biomechanical perspective. Methods We conducted a systematic review of the literature on selective complications of the surgery correlated with the angles of the opened wedge. Search topics covered tibial slope alteration, patellar height alteration, medial collateral ligament release, and model-based biomechanical simulations related to surgical planning or complications. Findings. The selection process with the defined inclusion/exclusion criteria led to the collection of qualitative and quantitative data from 38 articles. Medial collateral ligament tightness can be a valid complication of this surgery; however, further information about its preoperative condition seems required for better interpreting the results. The posterior tibial slope significantly increases, and the patellar height (using the Blackburne-Peel ratio) significantly decreases in the majority of the selected studies. Model-based biomechanical studies targeting surgical planning are mostly focused on the lower-limb alignment principles and tibiofemoral contact balancing rather than surgical complications. Interpretation. Increased posterior tibial slope, patellar height decrease, and medial collateral ligament tightness can occur due to alterations in different body planes and in soft tissue insertions after wedge opening. This study clarified that information about preoperative alignment in all body planes and soft-tissue conditions should be considered in order to avoid and anticipate these complications and to improve per surgery wedge adaptation. The findings and perspective of this review can contribute to improving the design of future clinical and biomechanical studies.
Highlights
Open-wedge high tibial osteotomy (OWHTO) is a joint preserving treatment for medial knee osteoarthritis used especially for young and active patients with a varus deformity [1,2,3]
The defined categories, as well as the number of articles included in each category, are as follows: medial collateral ligament (MCL) release (6 articles), posterior tibial slope (14 articles), patellar position (12 articles), and biomechanical simulations (6 articles)
Six articles studying the effect of MCL release on tibiofemoral contact and valgus laxity (Table 1) were included
Summary
Open-wedge high tibial osteotomy (OWHTO) is a joint preserving treatment for medial knee osteoarthritis used especially for young and active patients with a varus deformity [1,2,3] The purpose of this surgery is to transfer the excessive axial loads applied on the medial compartment of the knee to the lateral compartment. The wedge opened during high tibial osteotomy defines the alignment correction in different body planes and alters soft tissue insertions. Patellar height decrease, and medial collateral ligament tightness can occur due to alterations in different body planes and in soft tissue insertions after wedge opening. The findings and perspective of this review can contribute to improving the design of future clinical and biomechanical studies
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