Closing Wedge High Tibial Osteotomy Research Articles

Ankle-Angle-Adjusting Fibular Osteotomy in Closed Wedge High Tibial Osteotomy

Closed-wedge high tibial osteotomy (CWHTO) may be carried out to realign the knee in patients with knee osteoarthritis who do not meet the criteria for open-wedge high tibial osteotomy or total knee arthroplasty. The procedure involves both fibular and tibial osteotomy, and care is needed to prevent peroneal nerve and vessel injury during fibular osteotomy. Notably, use of a tourniquet may mask the development of hematomas or aneurysms until after surgery. We developed a 3-step ankle-angle-adjusting (triple-A) technique to relax the muscles, allowing easy retraction of the peroneal vessels. Crucially, the procedure does not require a tourniquet, thus allowing bleeding to be detected and stopped during surgery. The process involves adjusting the ankle angle by plantar-flexion and applying varus stress to highlight the tension difference between the lateral and posterior compartments; plantar-flexion of the great toe to loosen the flexor hallucis longus muscle, thus exposing the fibular posterior aspect; and valgus stress to loosen the peroneus longus muscle. The muscles can then be retracted sufficiently to allow distal and proximal osteotomies to be performed, and any bleeding can be detected and resolved before wound closure. This technique may improve the ease and safety of fibular osteotomy in patients undergoing CWHTO.

Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis.

This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR. A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant. Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found. ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL. Level IV.

Simultaneous Correction of Varus Deformity and Posterior Tibial Slope by Modified Hybrid Closed-Wedge High Tibial Osteotomy

A large posterior tibial slope has been proven to be a risk factor for anterior cruciate ligament (ACL) injuries, ACL graft failure, and medial meniscus posterior root tear. In addition, such pathologies often are accompanied by varus alignment. Thus, simultaneous varus and slope-correction osteotomy is required in such cases. High tibial osteotomy (HTO) is a well-established treatment for medial compartment knee osteoarthritis. Several HTO surgical techniques have been proposed, and hybrid closed-wedge HTO has been found to correct both varus deformity and a large posterior tibial slope via modification of the transverse osteotomy procedure. This Technical Note describes a modified hybrid closed-wedge HTO for simultaneous varus and slope correction in patients with ACL deficiency and/or medial meniscus posterior root tear involving both varus deformity and a large posterior tibial slope. This technique may reduce the risk of failure of the ACL graft and/or repaired medial meniscus posterior root.

Anterior Closing-Wedge High Tibial Slope-Correcting Osteotomy Using Patient-Specific Preoperative Planning Software for Failed Anterior Cruciate Ligament Reconstruction

Failure of anterior cruciate ligament reconstruction (ACLR) remains a challenging problem. Recently, the effect of increased posterior tibial slope has been identified as a risk factor for ACLR failure. In cases with increased posterior tibial slope, an anterior closing wedge, slope-correcting high tibial osteotomy can be used as a robust adjunct to revision ACLR. In this Technical Note, we demonstrate our preferred method for isolated sagittal plane correction following multiple failed ACLRs with an anterior closing-wedge high tibial osteotomy technique using 3-dimensional patient-specific instrumentation. Through correction of the angular deformity and restoration of the defined sagittal slope via the use of advanced 3-dimensional patient-specific instrumentation, this technique fosters an accurate, favorable mechanical environment to prevent recurrent instability of the knee joint.

Clinical outcomes of hybrid closed wedge high tibial osteotomy for advanced osteoarthritis of the knee compared with total knee arthroplasty.

To evaluate clinical outcomes between hybrid closed wedge high tibial osteotomy (HCWHTO) and total knee arthroplasty (TKA) for advanced medial compartmental osteoarthritis of the knee (advanced knee OA). In more than grade 3 OA based on the Kellgren-Lawrence classification, when patients' age was less than 60years or activity level was more than level 5 based on the UCLA activity score, 22 knees (18 patients) underwent HCWHTO. The other 22 knees (18 patients) that underwent TKA were evaluated retrospectively. Muscle strength was evaluated preoperatively and at 1 year postoperatively. The visual analogue scale (VAS) and Japanese version of the Knee injury and Osteoarthritis Outcome Score (J-KOOS) were used to evaluate clinical outcomes preoperatively and at a mean 66-months follow-up. All postoperative muscle strength measures improved to preoperative equivalent levels in the HCWHTO group; they were significantly higher in the HCWHTO group than in the TKA group (p < .05). The VAS score and total J-KOOS significantly improved in both groups (HCWHTO, p = .001; TKA, p = .040); there were no significant differences in the scores between the groups at the final follow-up. Hybrid closed wedge HTO significantly improved the activities of daily living and sport/recreation scores, whereas TKA did not at the final follow-up. In advanced knee OA, HCWHTO led to improved muscle strength, and its midterm clinical outcomes were equivalent to those of TKA. To postpone or even to avoid TKA, HCWHTO is considered an appropriate treatment for young and high-activity patients with advanced knee OA. Therapeutic Level III.

Alignment prior to total knee arthroplasty in high tibial osteotomy patients has no effect on subsequent functional outcomes.

The influence of prior high tibial osteotomy (HTO) on total knee arthroplasty (TKA) functional outcomes remains widely debated. Alignment of failed HTO can pose technical challenges with subsequent TKA. The primary aim of this study was to evaluate the influence of HTO alignment on the clinical outcomes of subsequent TKA. The secondary aim was to compare the time to TKA for each HTO alignment type. Patients who underwent TKA post lateral closing-wedge HTO for symptomatic medial compartment osteoarthritis between 2001 and 2014 were prospectively followed up for 2years. A total of 159 patients were assigned to three groups based on their pre-TKA femora tibia angles using long lower limb radiographs: varus alignment (VrA) ≤ 3o valgus, neutral alignment (NA) 3-9o valgus alignment, valgus alignment (VlA) ≥ 9o valgus. Functional outcomes were quantified using Knee Society Function Score and Knee Scores (KSFS and KSKS respectively), modified Oxford Knee Score (OKS), Short Form 36 Physical Component Score (SF-36 PCS), and SF-36 Mental Component Score (SF-36 MCS). Pre-operative and post-operative knee range of motion were also measured. Mean pre-TKA KSKS in VrA patients (35 ± 18) was significantly lower than both NA (51 ± 19) and VlA (40 ± 21) patients (p < .05). Otherwise, there was no significant difference in functional outcome scores (KSFS, KSKS, OKS, SF-36 PCS and SF-36 MCS) or range of motion at 6months and 2years post-TKA. The mean duration from HTO to TKA was 12 ± 7years with no significant differences between VrA, NA, and VlA HTO to TKA (13 ± 7 years, 13 ± 6years and12 ± 8years respectively, p > .05). HTO alignment did not influence time to subsequent TKA. HTO alignment did not influence early outcomes as well as radiological outcomes of subsequent TKA. III.

Less risk of conversion to total knee arthroplasty without significant clinical and survivorship difference for opening-wedge high tibial osteotomies in varus knee deformities at 10-year minimum follow-up compared to closing-wedge high tibial osteotomies.

The purpose of this study was to evaluate the clinical outcomes and survivorship at minimum 10-year follow-up of patients undergoing primary valgisation high tibial osteotomy (HTO) for medial osteoarthritis (OA), treated by Opening-Wedge HTO (OW-HTO) or Closing-Wedge HTO (CW-HTO). This was a retrospective cohort study of consecutive patients presenting to a single institution undergoing HTO for isolated medial compartment OA. Two hundred and twenty three HTOs for isolated medial tibio-femoral OA were performed between January 2002 and December 2010. Patients were eligible if they had minimum 10-year follow-up and received either a CW or OW-HTO. Fifteen (6.7%) patients died and twenty-five (11.2%) were lost to follow-up. One hundred and eighty three (82.1%) patients were included in the final analysis and divided into two groups: OW-HTO (96/183; 52.4%) and CW-HTO (87/183; 47.6%). Range of motion, KSS, KOOS scores, and conversion to TKA rate were analyzed between groups. Both groups were comparable regarding age, arthrosis stage, gender, ASA score and BMI at the time of HTO. Survival analysis was conducted with re-intervention for TKA as the end point. At the time of HTO, mean age was 55years ± 7.9 (27-73.9) with 72.7% of patients being male. The mean follow-up was 13.3years ± 2.7 (10-19). Sixty-four (34.9%) patients underwent TKA at a mean delay of 9.3years ± 3 (3-16). The conversion to TKA rate was significantly higher in the CW-HTO group versus the OW-HTO group: 42.5% (37/87) versus 28.1% (27/96) (p = 0.04). The survival at 15-year follow-up was 59.2% in the OW-HTO group versus 54.6% in the CW-HTO group (n.s.). At 13-year follow-up, KSS Function score was significantly better in the OW-HTO (90.9 versus 82.4; p = 0.007). No significant difference was observed between the two groups regarding the KOOS score, KSS Knee Score and complication rate. At mean follow-up of 13years, no significant clinical and survivorship difference was observed between the two groups. The conversion to TKA was significantly lower following OW-HTO. Minor correction was associated with risk of requiring subsequent TKA. Retrospective case series, IV.

High Rate of Radiographic Union at the Fibular Osteotomy Site With No Complications After an Acute Oblique Osteotomy and Ligation Procedure to Shorten the Fibula in High Tibial Osteotomy.

Background:A fibular shortening osteotomy is needed to perform lateral closing-wedge high tibial osteotomy (LCW-HTO). To achieve this shortening, we have recently developed an acute oblique osteotomy and ligation (AO/L) procedure for the center of the fibular shaft, based on the AO procedure.Purpose:To compare the 2-year follow-up outcomes between the AO/L procedure and the AO procedure.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective comparative cohort study was conducted involving 83 patients (83 knees) who underwent shortening osteotomy of the fibula in LCW-HTO between April 2017 and March 2019. The first consecutive 41 knees (AO group) underwent fibular osteotomy with the AO procedure. The remaining 42 knees (AO/L group) underwent fibular osteotomy with the AO/L procedure. All of the patients were evaluated for at least 2 years postoperatively via clinical and radiological assessments. To determine the time needed for complete union at the osteotomy site, we evaluated the radiographs using a radiographic union score for tibial fractures, which was modified for fibular osteotomy. Comparison of outcomes between the 2 groups was performed using the Student t test for continuous variables and the Mann-Whitney U test or Fisher exact test for discrete variables.Results:Around the fibular osteotomy site, no perioperative complications were found in either group. The radiographic union score was significantly higher in the AO/L group than in the AO group (P < .0001 at 2, 3, and 6 months; P = .0290 at 12 and 24 months). The union rate at the fibular osteotomy site was significantly higher in the AO/L group (97.6%) than in the AO group (82.9%) at 12 months (P = .0290).Conclusion:The AO/L procedure significantly accelerated the formation of bridging callus at the fibular osteotomy site and provided a significantly higher union rate compared with the AO procedure. Both AO/L and AO procedures were free from perioperative complications. These results suggest that the AO/L procedure is clinically useful as an osteotomy procedure to shorten the fibula in LCW-HTO.

Mid-Term Results of High Tibial Osteotomy Regarding From Grades of Knee Osteoarthritis

Objectives: The number of high tibial osteotomy (HTO) has significantly increased in Mongolia, however, researchers are still debating about the impact of severity of knee osteoarthritis on the outcome of high tibial osteotomy. The purpose of our study is to report the mid-term results of HTO for knee osteoarthritis according to the Kellgren Lawrence classification. Methods: A total of 100 patients who underwent high tibial osteotomy for knee osteoarthritis from October 2019 to June 2020 at the Joint Center of the First Central Hospital of Mongolia participated in this study. Outcome evaluation of the participants was accomplished at baseline, at 2 months, 6 months, 8 months and 18 months post-operatively. Results: Lateral closing wedge HTO was performed in 54.2 % of patients who had 1st grade deformity and 55.9 % of patients who had 2nd grade deformity. On the other hand, medial opening wedge HTO was performed in 3rd grade patients compared to other grades. WBL was 11.43 ± 8.22 at preoperative, and increased to 56.31 ± 4.52 after 12 months of the surgery in 3rd grade. The total WBL was improved from 20.54 ± 12.57 to 57.24 ± 3.69 after two months of surgery and 57.89 ± 4.17 after 12 months. Conclusion: Our study showed that the severity of knee osteoarthritis had impact on outcome of high tibial osteotomy.

Basics of Coronal Plane Deformity Correction

High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are utilized to correct knee malalignment in patients with coronal plane deformities. Identifying the deformity of the lower extremity using a standardized, reproducible approach is critical prior to correction of lower limb malalignment with an osteotomy procedure. Appropriate radiographs, including bilateral long-leg standing films, are critical to measure the anatomical and/or mechanical axes and calculate the required degree of correction. The femoral and tibial mechanical axes, malalignment (varus or valgus), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) should be measured during coronal plane deformity analysis and accounted for during surgical planning. This paper focuses on the surgical technique for medial opening and lateral closing wedge HTO, as well as medial closing and lateral opening wedge DFO.

The influence of different hinge position on PTS during HTO: comparison between open-wedge and closed-wedge HTO

PurposeThe purpose of this study was to determine the significance of hinge position through comparison between open-wedge and closed-wedge high tibial osteotomy (HTO) and to determine the ideal hinge position to minimize the effect of HTO on the posterior tibial slope (PTS) and medial proximal tibial angle (MPTA).MethodsProcedures were performed on 32 cadaveric knees using open-wedge HTO with the standard hinge position or a low hinge position or closed-wedge HTO with the standard hinge position or a low hinge position. To define the standard hinge position in open wedge HTO, we drew a line 3-cm inferior to the medial tibial plateau toward the fibular head and located the intersection of this line with a longitudinal line 1-cm medial to fibular shaft. The low hinge position was then defined as the point 1-cm inferior to the standard position. For the standard hinge position for closed-wedge HTO, we drew a line parallel with joint line from 2-cm inferior to the lateral tibial plateau. The low hinge position was then defined as the point 1-cm inferior to the standard position.ResultsFor the open-wedge procedure, osteotomy through the low hinge position resulted in a significantly greater PTS compared to osteotomy through the standard hinge position. MPTA was also significantly greater for the low hinge position compared to standard hinge position. In the closed-wedge HTO, neither the PTS nor MPTA was significantly different for the low and standard hinge positions.ConclusionsHinge position significantly affects changes in the PTS and MPTA following open-wedge but not closed-wedge HTO. Understanding how to hinge position affects the PTS and MPTA is critical for surgeons performing open-wedge HTO procedures. Adopting an accurate hinge position is crucial for preventing complications, especially in open-wedge osteotomy, due to postoperative changes in the PTS and MPTA.

Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients.

To compare the incidence of correction loss and survival rate between closed-wedge and open-wedge high tibial osteotomies (CWHTO and OWHTO, respectively) in patients with osteopenic and normal bone. Retrospective review was conducted for 115 CWHTOs and 119 OWHTOs performed in osteopenic patients [-2.5 < Bone mineral density (BMD) T scores ≤ -1] and 136 CWHTOs and 138 OWHTOs performed in normal patients (BMD T score > -1) from 2012 to 2019. Demographics were not different between CW- and OWHTOs in osteopenic and normal patients (n.s., respectively). Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated pre- and postoperatively (2weeks after HTO). The occurrence of hinge fractures was investigated using radiographs taken on the operation day. The correction change was calculated as the last follow-up value minus postoperative MPTA. Correction loss was defined when the correction change was ≥ 3°. The survival rate (failure: correction loss) was investigated. There were no significant differences in the pre and postoperative MA, MPTA, PTS, and value changes between CW- and OWHTOs in osteopenic and normal patients (n.s., respectively); the incidence of unstable hinge fractures also did not differ significantly (CWHTO vs. OWHTO = 7 vs. 7.6% in osteopenic patients; 2.9 vs. 3.6% in normal patients; n.s., respectively). The average correction change (CWHTO = -0.6°, OWHTO = -1.3°, p = 0.007), incidence of correction loss (CWHTO = 1.7%, OWHTO = 9.2%, p = 0.019), and 5-year survival rates (CWHTO = 98.3%, OWHTO = 90.8%, p = 0.013) differed significantly in osteopenic patients; there were no significant differences in these results in normal patients (n.s., respectively). CWHTO was more advantageous than OWHTO regarding the correction loss in osteopenic patients. Intra- and postoperative care that consider poor bone quality will be required when performing OWHTOs in osteopenic patients. III.

Analysis of popliteal artery location for high tibial and distal tuberosity osteotomy using contrast-enhanced computed tomography

BackgroundOur objective was to evaluate the location of popliteal artery (PA) in osteotomy planes during high tibial osteotomy (HTO) and to determine a safer angle for screw drilling to the tibial tuberosity during distal tuberosity osteotomy (DTO).MethodsTwenty knees in 20 patients who underwent contrast-enhanced computed tomography for cardiovascular diseases were examined. Osteotomy planes for open-wedge HTO (OWHTO) and hybrid closed-wedge HTO (hybrid CWHTO) were created using three-dimensional bone models. The distance from the posterior cortex of the tibia to the PA (dPC-PA) in the osteotomy planes was measured in the virtual osteotomy planes. The dangerous point (Point D1) was defined as the point 17.5 mm away from PA, setting the working length of the bone saw as 35 mm. The distance between the most medial point of the tibial cortex (Point M) and Point D1 in OWHTO and the most lateral point (Point L) and Point D1 in hybrid CWHTO were examined (dM-D1 and dL-D1, respectively). The location of Point D1 to the osteotomy line (%D1) was expressed as percentage, setting the start and end of the osteotomy line as 0% and 100%, respectively. To determine the safe angle for screw drilling in DTO, the angle between the line tangential to the medial cortex of the tibia and that passing through the center of the tibial tuberosity and PA were measured.ResultsIn OWHTO and hybrid CWHTO, the mean dPC-PA was 10.6 mm (6.9–16.5 mm) and 10.2 mm (7.3–15.4 mm), respectively. The mean dM-D1 in OWHTO was 25.9 mm (24.6–27.2 mm) and dL-D1 in hybrid CWHTO was 5.1 mm (2.9–7.4 mm). The mean %D1 was 47.6 ± 3.7% in OWHTO and 9.3 ± 4.1% in hybrid CWHTO, respectively. The minimal angle between the two lines in DTO was 35.2°.ConclusionPAs could run within 10 mm from the posterior cortex in the osteotomy planes of HTO. Therefore, proper posterior protection is necessary when cutting posterior cortex. An angle of less than 35° against the medial cortex line would be safe for screw fixation to avoid vascular injury in DTO.

Significant slope reduction in ACL deficiency can be achieved both by anterior closing-wedge and medial open-wedge high tibial osteotomies: early experiences in 76 cases.

It has been proven that a steep tibial slope (TS) is a risk factor for anterior cruciate ligament (ACL) injury and graft insufficiency after ACL reconstruction (ACLR). Recently, there is an increasing number of case series on slope decreasing osteotomies after failed ACLR utilizing different techniques and strategies. Goal of the present study is to report on early experiences with slope decreasing osteotomies in ACL deficient knees with special emphasis on the amount of slope correction, technical details, and complications; and to further analyze differences of slope corrections between sole sagittal as well as combined coronal and sagittal realignment procedures. In addition, we wanted to study if sole sagittal corrections change the coronal alignment. Seventy-six patients with a minimum follow-up of 6 months were identified, who underwent a sole sagittal correction (anterior closed-wedge high tibial osteotomy (ACW-HTO)) or a combined procedure with an additional coronal realignment (medial open-wedge high tibial osteotomy (MOW-HTO)). In ACW-HTO, either infratuberosity or supratuberosity approaches were used. The medial TS was measured on lateral radiographs and the anatomical medial proximal tibial angle (aMPTA) was measured on anterior-posterior radiographs. Technical details and specific complications were recorded. Fifty-eight ACW-HTO and 18 MOW-HTO were performed. Regarding ACW-HTO, an infratuberosity (N = 48) or a supratuberosity (N = 10) approach was chosen. Sixty-seven patients had at least 1 previous ACLR. Mean TS changed from 14.5 ± 2.2° to 6.8 ± 1.9° (P < 0.0001). Mean TS of ACW-HTO was significantly reduced (14.6 ± 2.3° vs. 6.5 ± 1.9°; P < 0.0001), whereas in combined coronal and sagittal realignments, from 14.1 ± 1.9° to 7.6 ± 1.9° (P < 0.0001). The TS reduction in sole sagittal corrections was significantly higher compared to combined procedures (8.1 ± 1.6 vs. 6.4 ± 1.6°; P = 0.0002). Mean aMPTA in ACW-HTO changed from 87.1 ± 2.1° to 87.4 ± 2.8 (n.s.). However, there was a significant inverse correlation between the amount of sagittal correction and coronal alteration (r = -0.29; P = 0.028). There was one late implant infection, which occurred 5.5months after the index surgery. ACW-HTO and MOW-HTO facilitate significant slope reduction with a low-risk profile in patients with ACL insufficiency and a high tibial slope. AOW-HTO does not significantly alter coronal alignment in the majority of patients. IV.

Iatrogenic ischiofemoral impingement due to high tibial osteotomy with overvalgization: a case report

BackgroundOpen wedge high tibial osteotomy is a standard procedure for frontal realignment. It is indicated in varus knee with reduced mechanical medial proximal tibia angle. Overcorrection producing a mechanical medial proximal tibia angle out of the normal range (85–90°) is not recommended because this would lead to unphysiological joint-line orientation. Osteotomies around the knee also influence the adjacent ankle and hip joints. For the hip, it is known that frontal alignment of the leg influences the ischiofemoral space. A decreased ischiofemoral space can lead to painful impingement between the ischial bone and the lesser trochanter.Case presentationA 53-year-old German woman presented with severe ischiofemoral impingement symptoms and valgus malalignment of the left leg after open wedge high tibial osteotomy, which was indicated and performed by an orthopedic surgeon with intention to treat medial knee pain due to degenerative arthritis of the medial compartment years after medial meniscectomy. The mechanical medial proximal tibia angle was 100.5°. We performed closed wedge high tibial osteotomy producing a mechanical medial proximal tibia angle of 90.0° and normal joint-line orientation. The hip pain was gone immediately after the surgery, and the patient had no signs of ischiofemoral impingement or hip pain at last follow-up 12 months after closed wedge high tibial osteotomy.ConclusionsFrontal realignment osteotomy around the knee can create problems at adjacent joints. Overvalgization of the proximal tibia made the patient compensate by hyperadduction of the hip to enable full foot sole contact with the floor. Hyperadduction of the hip decreased the ischiofemoral space, leading to severe impingement. Therefore, meticulous planning of osteotomies is important not to produce unphysiological situations or unwanted negative effects at the level of an adjacent joint.

Research progress of osteotomy around knee in the treatment of valgus knee osteoarthritis

To review the research progress of surgical methods of osteotomy around the knee in the treatment of valgus knee osteoarthritis. The relevant literature on the surgical treatment of valgus knee osteoarthritis at home and abroad in recent years was reviewed, and the advantages, disadvantages, and effectiveness of different surgical methods of osteotomy around the knee were summarized. For young and active patients with symptomatic valgus knee osteoarthritis, osteotomy around the knee is a safe and reliable treatment option. At present, the main surgical methods include medial closing wedge distal femoral osteotomy, lateral opening wedge distal femoral osteotomy, medial closing wedge high tibial osteotomy, and lateral opening wedge high tibial osteotomy. The indications, advantages, and disadvantages of different osteotomies are different, and the selection of appropriate surgical method is the key to achieve good effectiveness. There are many osteotomies in the treatment of valgus knee osteoarthritis. In order to achieve good results, improve survival rate, and reduce postoperative complications, the most reasonable surgical strategy needs to be developed according to different situations.

High Tibial Osteotomies for the Treatment of Osteoarthritis of the Knee.

A high tibial osteotomy (HTO) is a joint-preserving procedure that can be used to treat symptomatic unicompartmental cartilage disorders in the presence of limb malalignment. Appropriate patient selection and careful preoperative planning are vital for optimizing outcomes. Based on past literature, correction of varus malalignment to 3° to 8° of valgus appears to lead to favorable results. Recently, there has been growing awareness that it is important to consider soft-tissue laxity during preoperative planning. Although there has been a recent trend toward performing opening-wedge rather than closing-wedge or dome HTOs for unicompartmental osteoarthritis, current data suggest that all 3 are acceptable techniques with varying complication profiles. Based on current evidence, an HTO provides pain relief, functional improvement, and a high rate of return to sport, with reported survivorship ranging from 74.7% to 97.6% and 66.0% to 90.4% at 10 and 15 years, respectively.

Three-Dimensional Patient Specific Instrumentation and Cutting Guide for Medial Closing Wedge High Tibial Osteotomy to Correct Valgus Malalignment

Achievement of appropriate mechanical knee alignment is crucial to ensure optimal clinical outcomes following osteotomy procedures about the knee. The use of patient-specific instrumentation (PSI) to assist in preoperative planning and intraoperative realignment has gained increasing popularity. The purpose of this article is to describe a surgical technique involving a medial closing wedge high tibial osteotomy performed using three-dimensional (3D) PSI and cutting guide to revise residual valgus deformity following failed distal femoral osteotomy. The correction angle, 3D position of the hinge and wedge, as well as final plate and screw position are planned preoperatively using virtual software and computed tomography imaging to allow precise surgical execution.

Discrepancy in the Distribution Patterns of Subchondral Bone Density Across the Ankle Joint After Medial Opening-Wedge and Lateral Closing-Wedge High Tibial Osteotomy

Background: High tibial osteotomy (HTO) changes the alignment and dynamics of the ankle joint; however, differences in the stress distribution of the ankle joint after opening-wedge HTO (OWHTO) and closing-wedge HTO (CWHTO) are not understood. It is believed that subchondral bone density of the articular surface reflects the pattern of cumulative stress distribution across the joint surface. Purpose: To clarify the effects of OWHTO and CWHTO on the distribution patterns of subchondral bone density across the ankle joint using computed tomography (CT)–osteoabsorptiometry. Study Design: Cohort study; Level of evidence, 4. Methods: Radiographic and CT data of 18 cases who underwent OWHTO (OW group), 12 cases who underwent CWHTO (CW group), and 11 cases with unilateral anterior cruciate ligament injury serving as controls were retrospectively reviewed. The subchondral bone density of the distal tibia was assessed in the 3 groups using CT-osteoabsorptiometry. The distal tibial surface of the ankle joint was divided into 4 parts in the coronal direction, and the percentage of the high-density area (%HDA) to each subregion was compared before and after HTO. Results: Preoperatively, comparing %HDA among the 3 groups, there were no significant differences in any regions. In the OW group, postoperative %HDA in the most medial region was significantly increased compared with preoperative %HDA (49.3% to 53.0%; P = .011), and postoperative %HDA in the most lateral region was significantly decreased (21.4% to 17.2%; P = .003). On the other hand, in the CW group, postoperative %HDA in the most medial region was significantly decreased (55.7% to 35.7%; P = .001), and %HDA in the second lateral region was significantly increased (23.6% to 29.2%; P = .002). Conclusion: The ankle distribution pattern of subchondral bone density shifted significantly medially after OWHTO without fibular osteotomy, whereas the distribution pattern shifted laterally after CWHTO with fibular osteotomy. When the OWHTO is performed for patients with medial ankle osteoarthritis, surgeons should pay attention to potential postoperative progression of ankle osteoarthritis due to medial shift of the stress distribution in the ankle joint.

Inverted V-Shaped High Tibial Osteotomy Decreases the Posterior Tibial Slope More but Shortens the Tibia Less Than Closed-Wedge High Tibial Osteotomy

To assess the postoperative anatomical changes in the lower extremity after inverted V-shaped high tibial osteotomy (IVHTO) using 3-dimensional (3D) computed tomography (CT) bone models and compare those changes after closed-wedge high tibial osteotomy (CWHTO). Preoperative and 3-week postoperative CT scanning of the lower extremity were obtained from patients who underwent IVHTO and CWHTO between October 2019 and March 2021. 3D CT bone models were reconstructed using ZedKnee software. The postoperative changes (Δ) in (1) posterior tibial slope (PTS), (2) knee rotation angle (KRA), (3) tibial torsional angle (TTA), (4) patella tilt (PT), (5) Insall-Salvati ratio (ISR), and (6) tibial length (TL) were compared between IVHTO and CWHTO. Thirty-seven knees (18 IVHTO and 19 CWHTO) in 34 patients were retrospectively enrolled in this study. ΔPTS at the medial and lateral tibial plateau in the IVHTO group (-6.5° and -5.0°) was larger compared with that in the CWHTO group (-3.3° and -2.0°; P=.024 and P= .002, respectively). No significant differences exist between the IVHTO and CWHTO groups in ΔKRA (0.8± 4.5° and -1.5 ± 6.5°; P= 0.631), ΔTTA (-3.9 ± 6.2° and -4.1 ± 7.3°; P= .951), ΔPT (-2.0 ± 4.8° and -0.6 ± 4.1°; P=.353), and ΔISR (0.0 and 0.0; P= .829). ΔTL in the IVHTO group (-1.6 ± 2.3 mm) was smaller compared with that in the CWHTO group (-4.1 ± 1.6 mm; P < .001). (1) The postoperative PTS in the IVHTO group was further decreased compared to the CWHTO group; (2) no significant differences in ΔKRA, ΔTTA, ΔPT, and ΔISR exist between the 2 groups; and (3) the ΔTL in the IVHTO group was significantly smaller compared with the CWHTO group. Level III, retrospective cohort study.