Revisiting High Tibial Osteotomy: Fifty Years of Experience with the Opening-Wedge Technique

Abstract

Since the first description by Debeyre of medial opening-wedge high tibial osteotomy proximal to the tibial tuberosity in 1951 and with the publication of our results in the English-language literature in 19871, our orthopaedic department has performed this osteotomy in 3756 patients over a period of more than fifty years. Although the opening-wedge osteotomy is not new, the advantages of the opening-wedge as compared with a closing-wedge technique have been discussed only recently, particularly in the English-language literature2-9. The aim of the present report is to describe (1) the key steps in the surgical technique, (2) the determination of the size of the wedge, (3) the improvements in the technique during the past twenty years, (4) the specific problem of posterior slope and patella baja, and (5) the technique of concomitant total knee arthroplasty and opening-wedge tibial osteotomy to avoid the need for soft-tissue release in knees with severe varus deformity. ### Source of Funding No funds were received in support of this study. ### Initial Exposure A longitudinal incision is made from the medial border of the patellar tendon distally along the medial aspect of the tibia for 10 cm. The insertions of the sartorius, gracilis, and semitendinosus muscles are divided, and the tendons are separated from bone as described previously1. The pes anserinus is incised longitudinally, 0.5 cm medial to its attachment to the tibia; if only moderate valgus is required, the incision can be incomplete. The distal portion of the superficial medial collateral ligament is exposed and is separated from bone proximally as far as the level of the osteotomy, which should be started at least 3.5 cm distal to the medial joint line and directed laterally and proximally toward the tip of the fibula. The posterior compartment is opened at the level of the osteotomy …