Closing Wedge High Tibial Osteotomy Research Articles

Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis

This meta-analysis was designed to compare the longevity of the survivorship of opening versus closing wedge high tibial osteotomy (HTO). All studies reporting survival rates in patients who underwent open or closed wedge HTO with more than 5-year follow-up duration were included in the meta-analysis. Survival time was considered as time to conversion to TKA. Twenty three studies were included in meta-analysis, 20 of which were of level IV evidence. The pooled 5-year survival rates were 95.1% (95% CI: 93.1 to 97.1%) in open wedge HTO and 93.9% (95% CI: 93.1 to 94.6%) in closed wedge HTO. Although there was 1.2% greater survival rate in open wedge HTO than in closed wedge HTO, this difference did not reach statistical significance (P = 0.419). Pooled 10-year survival rates were 91.6% (95% CI: 88.5 to 94.8%) in open wedge HTO and 85.4% (95% CI: 84.0 to 86.7%) in closed wedge HTO, indicating that open wedge HTO had 6.2% greater survival rate 10 years after surgery than did closed wedge HTO (P = 0.002). No difference in 5-year survivorship was found between open- and closed-wedge HTO. However, the survival rate was higher in open-wedge HTOs than in closed wedge HTO at 10 years.

Leg length change after opening wedge and closing wedge high tibial osteotomy: A meta-analysis

BackgroundTheoretical considerations suggest that leg length increases after opening wedge high tibial osteotomy (HTO) and decreases after closing wedge HTO; however, in vivo studies have yielded conflicting results. This meta-analysis therefore assessed changes in leg length after opening wedge and closing wedge HTO.MethodsAll studies comparing pre- and postoperative leg length in patients who underwent opening and/or closing wedge HTO were included. Two reviewers independently recorded data from each study in terms of sample size as well as preoperative and postoperative leg length of open wedge and/or closed wedge HTO groups.ResultsFour studies were included in the meta-analysis. Although pooled results showed leg length changes from before to after surgery were –6.93 mm (95% confidence interval [CI]: –17.53 to 3.67 mm; P = 0.20) in opening wedge HTO and 1.97 mm (95% CI: –7.13 to 11.07 mm; P = 0.67) in closing wedge HTO, respectively, these values were statistically not significant. However, the difference in the pooled mean leg length change from before to after surgery between opening wedge and closing wedge HTO was 8 mm, a difference that was significant (95% CI: 6.53 to 9.46 mm; P<0.001).ConclusionThe change in leg length was not statistically significant for either opening or closing wedge HTO. However, leg length change from before to after surgery was 8 mm greater for opening wedge HTO than for closing wedge HTO.

Comparison of rotational alignment change between closing-wedge and opening-wedge high tibial osteotomy: Its possible implication on patellofemoral joint

Comparison of rotational alignment change between closing-wedge and opening-wedge high tibial osteotomy: Its possible implication on patellofemoral joint

Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: A comprehensive meta-analysis

High tibial osteotomy (HTO) has been widely used for clinical treatment of osteoarthritis of the medial compartment of the knee, and both opening-wedge and closing-wedge HTO are the most commonly used methods. However, it remains unclear which technique has better clinical and radiological outcomes in practice. To systematically evaluate this issue, we conducted a comprehensive meta-analysis by pooling all available data for the opening-wedge HTO and closing-wedge HTO techniques from the electronic databases including PubMed, Embase, Wed of Science and Cochrane Library. A total of 22 studies encompassing 2582 cases were finally enrolled in the meta-analysis. There was no significant difference regarding surgery time, duration of hospitalization, knee pain VAS, Lysholm score and HSS knee score (clinical outcomes) between the opening-wedge and closing-wedge HTO groups (P > 0.05). However, the opening-wedge HTO group showed wider range of motion than the closing-wedge HTO group (P = 0.003). Moreover, as for Hip-Knee-Ankle angle and mean angle of correction, no significant difference was observed between the opening-wedge and closing-wedge HTO groups (P > 0.05), while the opening-wedge HTO group showed greater posterior tibial slope angle (P < 0.001) and lesser patellar height than the closing-wedge HTO group (P < 0.001). On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient.

Return to Work and Sport Following High Tibial Osteotomy: A Systematic Review.

The purpose of this study was to examine (1) timelines for return to sport and work following high tibial osteotomy (HTO), and (2) whether patients return to sport and work at levels similar to preoperative levels. A systematic search was conducted across 3 databases (MEDLINE, Embase, and PubMed). Two reviewers independently screened the results for relevant articles. Data regarding patient demographics, indications, surgical technique, return to work and sport, and complication and failure rates were abstracted from eligible studies. Nineteen studies were included, involving 1,189 patients (64% male, 21% female, 15% unspecified) and 1,224 knees. Mean age was 46.2 years (range, 16 to 80 years). Opening-wedge HTO was most commonly used, followed by closing-wedge HTO and hemicallotasis. Mean follow-up was 65.4 months (range, 8 to 253 months). Overall, 87.2% of patients returned to sport postoperatively, and 78.6% returned at an equal or greater level. Among competitive athletes, 54% returned to competition. Overall, 84.5% of patients returned to work postoperatively, and 65.5% returned at an equal or greater level. Approximately 90% of patients who returned to work or sport did so within 1 year. The complication rate was 5.8%, with infection being the most common complication; 7.0% of patients progressed to a total knee arthroplasty at a mean of 6.7 years (range, 0.8 to 15 years) following HTO. The majority of patients undergoing HTO return to sport and work, and most return within 1 year of the operation. Most patients return to sport at a level equal to or greater than the preoperative level. Approximately two-thirds of patients return to an equal or greater level of physical work. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Erratum: Comparison between Closing-Wedge and Opening-Wedge High Tibial Osteotomy in Patients with Medial Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Young active patients with medial knee osteoarthritis (OA) combined with varus leg alignment can be treated with high tibial osteotomy (HTO) to stop the progression of OA and avoid or postpone total knee arthroplasty (TKA). Closing-wedge osteotomy (CWO) and opening-wedge osteotomy (OWO) are the most commonly used osteotomy techniques. The purpose of this study was to compare the clinical and radiologic outcomes and complications between OWO and CWO. We retrospectively evaluated 23 studies including 17 clinical trials from published databases from their inception to May 2015. We evaluated the clinical outcomes including operation time, visual analog scale (VAS), maximal flexion, and hospital for special surgery knee (HSS) score. The radiologic outcomes included patellar height measured by posterior tibial slope angle, hip-knee-ankle (HKA) angle, femorotibial (FT) axis, and limb length. Complications recorded included the incidence of deep vein thrombosis (DVT), common peroneal nerve injury, opposite cortical fracture, etc. There were no differences in most of the clinical outcomes except the operation time. OWO increased the posterior slope angle and limb length, decreased the patellar height, and provided higher accuracy of correction. CWO led to a higher incidence of opposite cortical fracture.

Changes in Patellar Height After Opening Wedge and Closing Wedge High Tibial Osteotomy: A Meta-analysis

To test that patellar height decreases (patellar baja) after opening wedge high tibial osteotomy (HTO) and increases (patellar alta) after closing wedge HTO. In addition, this meta-analysis evaluated whether the method of measuring patellar height affected the change in patellar height after opening and closing HTO. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, all studies comparing pre- and postoperative patellar height using various indices, including the Insall-Salvati index (ISI), Blackburne-Peel index, and Caton Deschamps index, in patients who underwent opening or closing wedge HTO were included. The main outcome of this meta-analysis, mean change in patellar height from before to after surgery, was analyzed with a random effects model. Publication bias was evaluated using funnel plots and Egger's test. Twenty-three studies were included in the meta-analysis. Pooled data, including subgroups of the 3 measurement methods, showed that patellar height decreased 7% after opening wedge HTO (95% confidence interval [CI]: 0.05 to 0.10; P < .001), except when patellar height was assessed by ISI (95% CI:-0.02 to 0.06; P= .34), but that there was no change in patellar height after closing HTO (95% CI:-0.01 to 0.04; P= .29). The patellar height decreased after opening wedge HTO, except when assessed by ISI. In contrast, patellar height was unchanged after closing wedge HTO, regardless of the measurement method. Level II, meta-analysis of Level I and II studies.

Lower Limb Length Discrepancy After High Tibial Osteotomy

Background: High tibial osteotomy (HTO) produces valgus limb alignment, and this change can affect lower limb length. Purpose: To compare the change in lower limb length and the discrepancy compared with the contralateral limb after unilateral lateral closing wedge HTO (CWHTO) and medial opening wedge HTO (OWHTO). Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In this study, 30 knees undergoing unilateral CWHTO and 30 knees undergoing unilateral OWHTO for medial compartmental osteoarthritis were analyzed with 1-year follow-up. The tibial length, lower limb length, and lower limb length discrepancy were measured preoperatively and 1 year postoperatively. The patients’ subjective sensation of, and discomfort due to, the lower limb length discrepancy were recorded 1 year postoperatively. Univariate and multivariate linear regression analyses were conducted to identify predictors related to the change in lower limb length. Results: The mean lengths of the tibia and lower limb increased significantly after OWHTO (5.2 ± 3.7 and 7.6 ± 2.1 mm, respectively; P < .001). The mean tibial length decreased significantly after CWHTO (−6.0 ± 2.1 mm; P < .001); however, the mean lower limb length change was not significant (−0.8 ± 2.5 mm; P = .073). The mean lower limb length discrepancy increased significantly after OWHTO (−0.5 ± 0.7 to 7.2 ± 2.1 mm; P < .001) but not after CWHTO (−0.7 ± 0.6 to −1.0 ± 2.5 mm; P = .539). A significantly greater proportion of patients in the OWHTO group were aware of (70% vs 20%, respectively; P = .002), and uncomfortable because of (37% vs 7%, respectively; P = .010), the lower limb length discrepancy compared with those in the CWHTO group. The strongest predictor of a change in lower limb length was the wedge length in the OWHTO group and the preoperative hip-knee-ankle angle in the CWHTO group. Conclusion: The lower limb length change and discrepancy were significant after unilateral OWHTO, whereas they were negligible after unilateral CWHTO. CWHTO was more beneficial in cases of unilateral HTO to minimize the discrepancy of lower limb length rather than OWHTO, particularly in knees requiring a large correction. Registration: Clinical Trials Registry Platform (protocol number KCT00001684).

Length, thickness, and elasticity of the patellar tendon after closed wedge high tibial osteotomy: a shear wave elastographic study.

To compare the length, thickness, and elasticity of the patellar tendon between operated and non-operated knees following closed wedge high tibial osteotomy (CWHTO). Three men and 17 women aged 52 to 75 (mean, 64.8) years who underwent unilateral CWHTO by a single surgeon and were followed up for a mean of 11 (range, 5-22) years were included, as were 3 male and 17 female healthy controls aged 35 to 61 (mean, 47.9) years. The length, thickness, and elasticity of the bilateral patellar tendons in the patients and healthy controls were measured using shear wave elastography. In the CWHTO patients, the patellar tendon on the operated side was thicker (4.4 vs. 3.3 mm, p=0.001) and stiffer (74.1 vs. 47.7 kPa, p<0.001) than on the non-operated side. Patellar tendon contracture (thickening and stiffening) is associated with CWHTO.

Change in Posterior Tibial Slope After Open-Wedge and Closed-Wedge High Tibial Osteotomy

Background: It is unclear whether open- or closed-wedge high tibial osteotomy (HTO) results in significant changes in posterior tibial slope, with no consensus on the magnitude of such changes. Furthermore, methods of measuring posterior tibial slope differ among studies. This meta-analysis was therefore designed to evaluate whether posterior tibial slope increases after open-wedge HTO and decreases after closed-wedge HTO and to quantify the magnitudes of the slope changes after open- and closed-wedge HTO using various methods of measuring posterior tibial slope. Hypothesis: Posterior tibial slope increases after open-wedge and decreases after closed-wedge HTO. The magnitude of change is similar for the 2 methods, and the value obtained for posterior tibial slope change is affected by the method of measurement. Study Design: Meta-analysis. Methods: Multiple comprehensive databases, including MEDLINE, EMBASE, the Cochrane Library, and KoreaMed, were searched for studies that evaluated the posterior slope of the proximal tibia in patients who had undergone open- and/or closed-wedge HTO. Studies were included that compared pre- and postoperative posterior tibial slopes, regardless of measurement method, including anterior and posterior tibial cortex or tibial shaft axis as a reference line, in patients who underwent open- or closed-wedge HTO. The quality of each included study was appraised with the Newcastle-Ottawa Scale. Results: Twenty-seven studies were included in the meta-analysis. Pooled data, which included subgroups of 3 methods, showed that posterior tibial slope increased 2.02° (95% CI, 2.66° to 1.38°; P = .005) after open-wedge HTO and decreased 2.35° (95% CI, 1.38° to 3.32°; P < .001) after closed-wedge HTO. Conclusion: This meta-analysis confirmed that posterior tibial slope increased after open-wedge HTO and decreased after closed-wedge HTO when the results of a variety of measurement methods were pooled. The magnitude of change after open- and closed-wedge HTO was similar and small (approximately 2°), suggesting that both osteotomy techniques may have little effect on the biomechanics of the cruciate ligaments.

Management of combined knee medial compartmental and patellofemoral osteoarthritis with lateral closing wedge osteotomy with anterior translation of the distal tibial fragment: Does the degree of anteriorization affect the functional outcome and posterior tibial slope?

BackgroundThe aim of this study was to assess the effect of degree of anterior translation of the distal tibial fragment after lateral closing wedge high tibial osteotomy in patients having combined knee medial compartmental and patellofemoral osteoarthritis. MethodsA retrospective study was conducted on 64 patients who were operated on for combined knee medial compartmental and patellofemoral osteoarthritis, by lateral closing wedge high tibial osteotomy with anterior translation of the distal tibial fragment. They were divided into two groups; Group I comprising 32 patients (34 knees, mean age of 51.4±7years) whose degree of anterior translation was <1cm and Group II comprising 32 patients (33 knees, mean age of 52.2±8.3years) whose degree of anterior translation was >1.5cm. The final assessment was performed via: visual analog scale, postoperative Knee Society clinical rating system function score, active range of motion, time to union, degree of correction of mechanical axis, posterior tibial slope, and Insall–Salvati ratio. ResultsGroup II patients exhibited statistically superior mean postoperative score and better return to their work than Group I (P=0.013, 0.076, respectively). Both groups showed statistically significant differences between the preoperative and postoperative evaluation parameters (P<0.001). The posterior tibial slope was decreased in both groups but with no significant difference (P=0.527). ConclusionsLateral closing wedge high tibial osteotomy combined with anterior translation of the distal tibial fragment more than 1.5cm achieved significantly better postoperative functional knee score. Both groups exhibited comparatively decreased posterior tibial slope.

Progression of medial compartmental osteoarthritis 2-8years after lateral closing-wedge high tibial osteotomy.

The primary purpose of this study is to investigate the progression of medial osteoarthritis (OA) following lateral closing-wedge high tibial osteotomy (HTO). Secondary outcomes included functional and pain scores. This prospective cohort study analysed 298 patients treated with lateral closing-wedge HTO surgery for medial compartmental OA. OA progression was measured by comparing the minimum joint space width (mJSW) and Kellgren-Lawrence (KL) score on radiographs preoperatively and postoperatively. The WOMAC score and NRS score for pain were obtained preoperatively and postoperatively to assess secondary outcomes. Failure was defined as revision surgery; survival was estimated. Mean follow-up was 5.2±1.8years (range 2-8.5). Mean preoperative mJSW was 3.4±1.6mm, which changed nonsignificantly (p=0.51) to 3.4±1.7mm postoperatively. Mean annual joint space narrowing was 0.02±0.34mm/year. Progression to 1 KL grade or more was seen in 132 (44%) patients, and annual risk of KL progression was 8.6%. No KL progression was seen in 56% of patients. Mean NRS decreased from 7.3±1.5 to 3.5±2.5 (p<0.001). WOMAC scores decreased from 48.0±17.2 to 23.6±19.7 (p<0.001). Failure was seen in 21 patients. Compared to demographic data in the literature, valgus high tibial osteotomy seems to reduce the progression of OA, reduces pain and improves knee function in patients with medial compartment OA and a varus alignment. III.

High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis

High tibial osteotomy (HTO) has traditionally been used to treat varus gonarthrosis in younger, active patients. Varus malalignment increases the risk of progression of medial compartment osteoarthritis and an HTO can be performed to realign the mechanical axis of the lower limb towards the lateral compartment, thereby decreasing contact pressures in the medial compartment. Anterior cruciate ligament (ACL) insufficiency may lead to post-traumatic arthritis due to altered joint loading and associated injuries to the menisci and articular cartilage. Understanding the importance of posterior tibial slope and its role in sagittal knee stability has led to the development of biplane osteotomies designed to flatten the posterior tibial slope in the ACL deficient knee. Altering the alignment in both the sagittal and coronal planes helps improve stability as well as alter the load in the medial compartment. Detailed history, physical exam and radiographic analysis guide treatment decisions in this high demand patient population. Lateral closing wedge (LCW) and medial opening wedge (MOW) HTOs have been performed and their potential advantages and disadvantages have been well described. Given the triangular shape of the proximal tibia, it is imperative that the surgeon pay close attention to the geometry of the osteotomy “gap” when performing MOW HTO to avoid inadvertently increasing the posterior tibial slope. Simultaneous ACL reconstruction may require technique modifications depending on the type of HTO and ACL graft chosen. With appropriate patient selection and good surgical technique, it is reasonable to expect patients to return to activities of daily living and recreational sports without debilitating pain or instability.

Comparison of closing-wedge and opening-wedge high tibial osteotomies for medial compartment osteoarthritis of knee in Asian population: Mid-term follow-up.

Valgus high tibial osteotomy (HTO) is a well-established treatment option for patients with early osteoarthritis of the medial compartment of the knee. It is achievable with either open-wedge or closed-wedge technique. The aim of the study was to compare the radiological and clinical outcomes following HTO done with open- and closed-wedge techniques. Two groups of patients undergoing HTO and fixation with locking plates were compared. Twenty-five patients were operated using medial open-wedge technique and 23 using closed-wedge technique between January 2000 and June 2014. They were compared on the basis of Hospital for Special Surgery (HSS), knee score, preoperative and postoperative range of motion, femoro-tibial angle and duration required for full-weight bearing. Early and late postoperative complications were noted. Median HSS score at 6 months and 1 year post-surgery was better in the open-wedge technique group. The range of motion was also higher at early follow-up in the open-wedge technique group, with shorter duration for full-weight bearing. Delayed union was seen in two patients in the open-wedge technique group and four patients in closed-wedge group. Peroneal nerve palsy was noted in two patients in the closed-wedge group. Both open-wedge and closed-wedge HTO lead to good and comparable results. However, the technique of open-wedge osteotomy provided better outcome in terms of functional scores in early as well as late follow-up with decreased duration required for full-weight bearing.

L’altezza della rotula dopo osteotomia tibiale prossimale: confronto fra tecnica di addizione mediale e sottrazione laterale

The clinical and radiographic results of patients with unicompartmental osteoarthritis or axial malalignment of the knee surgically treated with two different techniques of osteotomy of the proximal tibia were analysed. The patients, matched for age, sex and deformities, were divided into two groups: 47 cases treated with closed-wedge high tibial osteotomy and 40 cases with open-wedge high tibial osteotomy. For each case the height of the patella was measured by the Caton Method before surgery and at the last follow-up (at least 1 year after surgery). The purpose of this study was to analyse and search for any possible correlation between the variation of the patella and the degree of correction of the mechanical axis. It was concluded that patellar height after final osteotomy of the proximal tibia is modified and depends on the surgical technique used. Our study has shown a more frequent loss of patellar height with open-wedge high tibial osteotomy rather than closed-wedge high tibial osteotomy, the latter followed by a rather high rate of patellar elevation.

High tibial osteotomy in varus knees: indications and limits.

Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. Conventional indications for OWHTO are medial compartment osteoarthritis and varus malalignment of the knee; recently OWHTO has been used successfully in the treatment of double and triple varus. OWHTO, in contrast to closing wedge high tibial osteotomy, does not require fibular osteotomy or peroneal nerve dissection, or lead to disruption of the proximal tibiofibular joint and bone stock loss. For these reasons, interest in this procedure has grown in recent years. The aim of this study is to review the literature on OWHTO, considering indications and prognostic factors (body mass index, grade of osteoarthritis, instability, range of movement and age), outcomes at mid-term follow-up, and limits of the procedure (slope modifications, patellar height changes and difficulties in conversion to a total knee arthroplasty).

Proximal tibiofibular joint pain versus peroneal nerve dysfunction: clinical results of closed-wedge high tibial osteotomy performed with proximal tibiofibular joint disruption.

Closed-wedge high tibial osteotomy (CW-HTO) requires shortening of the fibula or the fibular head or disruption of the proximal tibiofibular joint (PTFJ). However, no study has evaluated the proximal tibiofibular joint after the osteotomy. The aim of this study was to investigate the fate of the PTFJ after CW-HTO applied with using PTFJ disruption method. This prospective study included 22 knees of 20 patients who underwent CW-HTO. The mean age of the patients was 50±4years, and the mean follow-up period was 27.5±14.3months (12-46months). The grade of gonarthrosis (Ahlbäck's classification), tibiofemoral alignment and tibial slope angles were measured on radiographs pre- and post-operatively. During the surgery, the PTFJ capsule was released meticulously so as not to injure the peroneal nerve. Tenderness over the PTFJ was recorded preoperatively and at the last follow-up. No patient had tenderness or pain over PTFJ preoperatively. On the follow-up examinations, tenderness with compression was detected in nine knees with dorsiflexion, in ten with plantar flexion and in nine with neutral position of the ankle, respectively. None of the patients had peroneal nerve injury (including hypesthesia and mild weakness) post-operatively. However, while 11 knees were pain free in all positions of the ankle, seven knees had tenderness over PTFJ both in dorsiflexion and in plantar flexion. CW-HTO using PTFJ disruption provides good clinical results in terms of medial knee pain and corrects the alignment sufficiently while avoiding peroneal nerve injury. However, the results of this study indicated that this technique might result in painful PTFJs. Thus, the surgeon should consider a possibly painful PTFJ, which can be a cause of chronic lateral knee pain when performing this technique. III.

Computer-assisted navigation decreases the change in the tibial posterior slope angle after closed-wedge high tibial osteotomy.

The purpose of the present study was to compare the change in tibial posterior slope angle (PSA) between patients treated via computer-assisted and conventional closed-wedge high tibial osteotomy (CWHTO). It was hypothesized that a decrease in the PSA would be less in the computer-assisted group than in the conventional group. Data on a total of 75 computer-assisted CWHTOs (60 patients) and 75 conventional CWHTOs (49 patients) were retrospectively compared using matched pair analysis. The pre- and postoperative mechanical axis (MA) and the PSA were radiographically evaluated. The parallel angle was defined as the angle between the joint line and the osteotomy surface. The data were compared between the two groups. The postoperative radiographic MA averaged 1.3°±2.6° valgus in the computer-assisted group and 0.3°±3.1° varus in the conventional group. The change in PSA averaged -0.8°±0.9° in the computer-assisted group and -4.0°±2.2° in the conventional group. The parallel angle averaged 0.2°±3.0° in the computer-assisted group and 6.2°±5.3° in the conventional group. Computer-assisted CWHTO using four guide pins could avoid inadvertent change in the PSA. The navigation can be used in anticipation of decreasing the risk of change in the PSA in CWHTO, especially in patients whose preoperative PSA is small. The special attention should be paid to locate the hinge axis acutely and to make the parallel proximal and distal osteotomy surfaces during CWHTO. III.

Medial cortical fractures in computer-assisted closing-wedge high tibial osteotomy

BackgroundWe evaluated the incidence of medial cortical fracture and influence on the loss of the correction angle in computer-assisted closing-wedge high tibial osteotomy. MethodsUsing a navigation system, 200 closing-wedge high tibial osteotomies were performed. The correction angle was defined as the difference between the pre- and postoperative medial proximal tibial angles. The change in the medial proximal tibial angle was calculated as the difference between the medial proximal tibial angles two weeks and one year postoperatively. The medial cortical fractures of the osteotomy site were evaluated. Their incidence, risk factors, and influence on the loss of correction angle were analyzed. ResultsThe incidence of non-displaced cortical breakage and displaced cortical fracture was 28.0% and 6.5%, respectively. Medial cortical fracture was more frequent in younger patients and patients with severe preoperative varus deformity. The average correction angle was significantly larger in the displaced cortical fracture group (9.6° vs. 12.7°, p<0.001). The average change in the medial proximal tibial angle in the no fracture, non-displaced cortical breakage, and displaced cortical fracture groups was 0.7°, 1.8°, and 4.4°, respectively (p<0.001). ConclusionsMedial cortical fracture could not be prevented in all knees, even using the navigation system. The risk of medial cortical fracture and loss of the correction angle was increased, particularly when a greater correction angle is required in young patients. Level of evidenceIV

High tibial osteotomy in knee laxities: Concepts review and results.

Patients with unstable, malaligned knees often present a challenging management scenario, and careful attention must be paid to the clinical history and examination to determine the priorities of treatment.Isolated knee instability treated with ligament reconstruction and isolated knee malalignment treated with periarticular osteotomy have both been well studied in the past. More recently, the effects of high tibial osteotomy on knee instability have been studied.Lateral closing-wedge high tibial osteotomy tends to reduce the posterior tibial slope, which has a stabilising effect on anterior tibial instability that occurs with ACL deficiency.Medial opening-wedge high tibial osteotomy tends to increase the posterior tibia slope, which has a stabilising effect in posterior tibial instability that occurs with PCL deficiency.Overall results from recent studies indicate that there is a role for combined ligament reconstruction and periarticular knee osteotomy.The use of high tibial osteotomy has been able to extend the indication for ligament reconstruction which, when combined, may ultimately halt the evolution of arthritis and preserve their natural knee joint for a longer period of time.Cite this article: Robin JG, Neyret P. High tibial osteotomy in knee laxities: Concepts review and results. EFORT Open Rev 2016;1:3-11. doi: 10.1302/2058-5241.1.000001.