Tag Archive for: Osteotomy

Osteotomy: The Final Frontier in Knee Preservation

Volume 6 | Issue 2 | July-December 2021 | Page 01-02 | Anshu Shekhar, Sachin Tapasvi

DOI:10.13107/aja.2021.v06i02.026

Author: Anshu Shekhar [1], Sachin Tapasvi [2]

[1] Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
[2] The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Address of Correspondence:

Dr. Anshu Shekhar,
Consultant, Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
E-mail: dr.anshushekhar@gmail.com

Editorial

Asian Journal of Arthroscopy completes 5 years of publication with this issue. This feat could only be achieved because of the unflinching support from all our authors, reviewers and above all, the readers. In all our previous issues, we have dealt with specific areas and pathologies which can be treated by arthroscopy. The knee joint has received most attention because it the most common joint to be injured and be treated as well. However, any
talk of knee preservation is incomplete without acknowledging the art and science of osteotomy. This issue is dedicated to discussing the various aspects of a modern knee osteotomy for preserving the knee joint because it is indeed the final frontier.

Osteotomy surgery is a proven method of knee joint preservation by correcting mal-alignment in the coronal and sagittal planes [1]. It has been used to treat knee osteoarthritis by correcting varus or valgus mal-alignment since a very long time and with good results [2]. However, the science and art of osteotomy has evolved significantly over the last decade or so and everything is not so simple about a high tibial osteotomy (HTO) anymore. This has made osteotomy more predictable and safer, while expanding the indications and applications. One major ‘expanded’ indication has been to use osteotomy to treat ligament instabilities of the knee. This has been a force multiplier for ligament surgeons, who can achieve greater success with their soft-tissue reconstruction [3]. Perhaps the most remarkable progress has been made in planning an osteotomy. The use of digital planning techniques and specialized software for defining the deformity and correction has made osteotomy planning more reproducible and accurate [4, 5]. However, clinical examination cannot be given a miss in spite of any sophisticated radiological planning tool. Assessment of the soft-tissue laxity has to be considered in the surgical plan because this is an important cause of over-correction [6].

Medial open wedge high tibial osteotomy (MOWHTO) remains by far the most commonly performed surgery to correct malalignment around the knee for any indication. A close wedge or dome osteotomy are less frequently performed but have their place. Techniques of these surgeries are also evolving, the most important of which are performing a biplanar osteotomy and use of angle-stable locked plates for fixation. Both these provide definite benefits in terms of biology and biomechanics, thus permitting early mobilization and weight bearing [7, 8]. Another simple but remarkable innovation has been use of a K wire as a hinge protection tool. This has reduced the incidence of lateral hinge fractures by increasing the stiffness of hinge by about 880% and allowing early healing of the osteotomy [9, 10]. Even in cases of varus osteoarthritis with severe deformity, the utility of a double-level osteotomy to prevent joint line obliquity and provide good results has been demonstrated [11]. Another area of interest now are sagittal tibial osteotomies, especially the anterior closing wedge to reduce the posterior tibial slope in the setting of repeated failures of anterior cruciate ligament reconstruction [12].

As regards the use of technology for performing osteotomies, navigation has been used for quite some time. Although navigated HTO has yielded better precision and accuracy of alignment correction, it has not translated to better clinical outcomes [13]. The newest technological marvel in osteotomy surgery is the use of patient-specific cutting jigs and implants. This is a promising new avenue with good clinical results reported in the short-term without an increased risk of specific or non-specific complications [14]. In spite of everything, some patients will eventually require a total knee arthroplasty (TKA) for end-stage disease. The long-term survivorship of a TKA after HTO has been reported as 97% with a 3% revision rate for instability [15]. The survival drops to 88% after a distal femoral osteotomy when 6% revisions are due to instability [16]. These numbers are for patients who underwent osteotomies when the philosophy was still not refined. With better osteotomy technique and respect to ligament balancing, the TKA survivorship should also improve in future.

All these issues related to planning, execution and performance of a knee osteotomy have been dealt with in great detail and up to date information in this issue. We do hope that the wealth of knowledge contributed by the stalwarts of osteotomy surgery will be loved and appreciated by all our readers. The bone always wins and anybody willing to preserve a knee joint must have the weapon of osteotomy in their armamentarium.

References

1. Zampogna B, Vasta S, Papalia R. Patient Evaluation and Indications for Osteotomy Around the Knee. Clin Sports Med. 2019;38(3):305-315. doi:10.1016/j.csm.2019.02.011
2. Peng H, Ou A, Huang X, et al. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg. 2021;13(5):1465-1473. doi:10.1111/os.13021
3. Tischer T, Paul J, Pape D, et al. The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence. Orthop J Sports Med. 2017;5(3):2325967117697287. doi:10.1177/2325967117697287
4. Elson DW, Petheram TG, Dawson MJ. High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2041-2048. doi:10.1007/s00167-014-2920-x.
5. Schröter S, Ihle C, Mueller J, Lobenhoffer P, Stöckle U, van Heerwaarden R. Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):189-196. doi:10.1007/s00167-012-2114-3
6. Park JG, Kim JM, Lee BS, Lee SM, Kwon OJ, Bin SI. Increased preoperative medial and lateral laxity is a predictor of overcorrection in open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28(10):3164-3172. doi:10.1007/s00167-019-05805-8.
7. Pape D, Lorbach O, Schmitz C, et al. Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):204-211. doi:10.1007/s00167-009-0929-3
8. Koh, YG., Lee, JA., Lee, HY. et al. Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J Orthop Surg Res 14, 219 (2019). doi.org/10.1186/s13018-019-1269-8.
9. Gulagaci F, Jacquet C, Ehlinger M, et al. A protective hinge wire, intersecting the osteotomy plane, can reduce the occurrence of perioperative hinge fractures in medial opening wedge osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28(10):3173-3182. doi:10.1007/s00167-019-05806-7
10. Dessyn E, Sharma A, Donnez M, et al. Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture. Knee Surg Sports Traumatol Arthrosc. 2020;28(3):751-758. doi:10.1007/s00167-019-05404-7
11. Schröter S, Nakayama H, Yoshiya S, Stöckle U, Ateschrang A, Gruhn J. Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg. 2019;139(4):519-527. doi:10.1007/s00402-018-3068-9
12. Vadhera AS, Knapik DM, Gursoy S, et al. Current Concepts in Anterior Tibial Closing Wedge Osteotomies for Anterior Cruciate Ligament Deficient Knees. Curr Rev Musculoskelet Med. 2021;14(6):485-492. doi:10.1007/s12178-021-09729-0
13. Wu ZP, Zhang P, Bai JZ, et al. Comparison of navigated and conventional high tibial osteotomy for the treatment of osteoarthritic knees with varus deformity: A meta-analysis. Int J Surg. 2018;55:211-219. doi:10.1016/j.ijsu.2018.03.024
14. Chaouche S, Jacquet C, Fabre-Aubrespy M, et al. Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort. Int Orthop. 2019;43(12):2757-2765. doi:10.1007/s00264-019-04372-4
15. Chalmers BP, Limberg AK, Tibbo ME, Perry KI, Pagnano MW, Abdel MP. Total Knee Arthroplasty After High Tibial Osteotomy Results in Excellent Long-Term Survivorship and Clinical Outcomes. J Bone Joint Surg Am. 2019;101(11):970-978. doi:10.2106/JBJS.18.01060
16. Chalmers BP, Limberg AK, Athey AG, Perry KI, Pagnano MW, Abdel MP. Total knee arthroplasty after distal femoral osteotomy long-term survivorship and clinical outcomes. Bone Joint J. 2019;101-B(6):660-666. doi:10.1302/0301-620X.101B6.BJJ-2018-1334.R2

How to Cite this article: Shekhar A, Tapasvi S | Osteotomy: The Final Frontier in Knee Preservation | Asian Journal of Arthroscopy | July-December 2021; 6(2): 01-02.

(Abstract Text HTML)      (Download PDF)

Sagittal Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 39-45 | Anshu Shekhar, Puneeth K, Sachin Tapasvi

DOI:10.13107/aja.2021.v06i02.033

Author: Anshu Shekhar [1], Puneeth K [2], Sachin Tapasvi [2]

[1] Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
[2] The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Address of Correspondence:

Dr. Anshu Shekhar,
Consultant, Sushrut OrthoPlastic Clinic, Raipur, Chhattisgarh, India.
E-mail: dr.anshushekhar@gmail.com

Abstract

The anatomy proximal tibia is such that the anterior part is higher than the posterior, both medially and laterally, which causes a natural posterior tibial slope (PTS). The ‘normal range’ of this slope is variable across geography, ethnicity and gender. The morphology of the slope has profound impact on knee biomechanics, especially with respect to the anterior and posterior cruciate ligaments. A high slope increases forces across the anterior cruciate ligament (ACL), while the posterior cruciate ligament (PCL) function is compromised when the slope is flat or reversed (sloping anteriorly). A flat or reversed slope also contributes to the ‘bony’ component of a genu recurvatum deformity, which can become symptomatic. A sagittal tibial osteotomy (STO) is one in which the PTS is altered without changing the coronal plane alignment. When the slope is reduced, it is known as an extension STO and when the slope is increased, it is known as a flexion STO. This review describes the biomechanics of the PTS; the planning, indications, technique and complications of a STO and discusses some case examples.

Keywords: Posterior tibial slope, Osteotomy, Sagittal plane deformity, Revision anterior cruciate ligament reconstruction, Genu recurvatum

References

1. Hashemi J, Chandrashekar N, Gill B, et al. The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Joint Surg Am. 2008;90(12):2724-2734. doi:10.2106/JBJS.G.01358

2. Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br. 1994;76(5):745-749.

3. Genin P, Weill G, Julliard R. La pente tibiale. Proposition pour une méthode de mesure [The tibial slope. Proposal for a measurement method]. J Radiol. 1993;74(1):27-33.

4. Pangaud C, Laumonerie P, Dagneaux L, LiArno S, Wellings P, Faizan A, Sharma A, Ollivier M. Measurement of the Posterior Tibial Slope Depends on Ethnicity, Sex, and Lower Limb Alignment: A Computed Tomography Analysis of 378 Healthy Participants. Orthop J Sports Med. 2020 Jan 24;8(1):2325967119895258.

5. Weinberg DS, Williamson DF, Gebhart JJ, Knapik DM, Voos JE. Differences in Medial and Lateral Posterior Tibial Slope: An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race. Am J Sports Med. 2017 Jan;45(1):106-113. doi: 10.1177/0363546516662449. Epub 2016 Oct 1. PMID: 27587744.

6. Aljuhani WS, Qasim SS, Alrasheed A, Altwalah J, Alsalman MJ. The effect of gender, age, and body mass index on the medial and lateral posterior tibial slopes: a magnetic resonance imaging study. Knee Surg Relat Res. 2021 Apr 8;33(1):12.

7. Zhang K, Han Q, Wang H, Yang K, Chen B, Zhang Y, Zhang S, Wang J, Chu H. Measurement of proximal tibial morphology in northeast Chinese population based on three-dimensional reconstruction computer tomography. Medicine (Baltimore). 2019 Nov;98(45):e17508.

8. Matsuda S, Miura H, Nagamine R, et al. Posterior tibial slope in the normal and varus knee. Am J Knee Surg. 1999;12(3):165-168.

9. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P. Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg. 2004;124(9):575-584. doi:10.1007/s00402-004-0728-8

10. Pandy MG, Shelburne KB. Dependence of cruciate-ligament loading on muscle forces and external load. J Biomech. 1997;30(10):1015-1024. doi:10.1016/s0021-9290(97)00070-5

11. Shelburne KB, Pandy MG. A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions. J Biomech. 1997;30(2):163-176. doi:10.1016/s0021-9290(96)00119-4

12. Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med. 2004;32(2):376-382. doi:10.1177/0363546503258880

13. Giffin JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD. Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med. 2007;35(9):1443-1449. doi:10.1177/0363546507304665

14. Bernhardson AS, Aman ZS, Dornan GJ, Kemler BR, Storaci HW, Brady AW, Nakama GY, LaPrade RF. Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases. Am J Sports Med. 2019 Feb;47(2):296-302.

15. McLean SG, Oh YK, Palmer ML, Lucey SM, Lucarelli DG, Ashton-Miller JA, Wojtys EM. The relationship between anterior tibial acceleration, tibial slope, and ACL strain during a simulated jump landing task. J Bone Joint Surg Am. 2011 Jul 20;93(14):1310-7.

16. Yamaguchi KT, Cheung EC, Markolf KL, Boguszewski DV, Mathew J, Lama CJ, McAllister DR, Petrigliano FA. Effects of Anterior Closing Wedge Tibial Osteotomy on Anterior Cruciate Ligament Force and Knee Kinematics. Am J Sports Med. 2018 Feb;46(2):370-377.

17. Imhoff FB, Mehl J, Comer BJ, Obopilwe E, Cote MP, Feucht MJ, Wylie JD, Imhoff AB, Arciero RA, Beitzel K. Slope-reducing tibial osteotomy decreases ACL-graft forces and anterior tibial translation under axial load. Knee Surg Sports Traumatol Arthrosc. 2019 Oct;27(10):3381-3389.

18. Bowen JR, Morley DC, McInerny V, MacEwen GD. Treatment of genu recurvatum by proximal tibial closing-wedge/anterior displacement osteotomy. Clin Orthop Relat Res. 1983;(179):194-199.

19. Moroni A, Pezzuto V, Pompili M, Zinghi G. Proximal osteotomy of the tibia for the treatment of genu recurvatum in adults. J Bone Joint Surg Am. 1992;74(4):577-586.

20. Utzschneider S, Goettinger M, Weber P, et al. Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 2011;19:1643-1648.

21. Hudek R, Schmutz S, Regenfelder F, Fuchs B, Koch PP. Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res. 2009 Aug;467(8):2066-72.

22. Luceri F, Basilico M, Batailler C, et al. Effects of sagittal tibial osteotomy on frontal alignment of the knee and patellar height. Int Orthop. 2020;44(11):2291-2298. doi:10.1007/s00264-020-04580-3

23. Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med. 2013 Dec;41(12):2800-4.

24. Salmon LJ, Heath E, Akrawi H, Roe JP, Linklater J, Pinczewski LA. 20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope. Am J Sports Med. 2018 Mar;46(3):531-543.

25. Lee CC, Youm YS, Cho SD, Jung SH, Bae MH, Park SJ, Kim HW. Does Posterior Tibial Slope Affect Graft Rupture Following Anterior Cruciate Ligament Reconstruction? Arthroscopy. 2018 Jul;34(7):2152-2155. doi: 10.1016/j.arthro.2018.01.058. Epub 2018 Mar 9. PMID: 29530354.

26. Ahmed I, Salmon L, Roe J, Pinczewski L. The long-term clinical and radiological outcomes in patients who suffer recurrent injuries to the anterior cruciate ligament after reconstruction. Bone Joint J. 2017 Mar;99-B(3):337-343. doi: 10.1302/0301-620X.99B3.37863. PMID: 28249973.

27. Friedmann, S., Agneskirchner, J. & Lobenhoffer, P. Extendierende und flektierende Tibiakopfosteotomien. Arthroskopie 21, 30–38 (2008).

How to Cite this article: Shekhar A, Puneeth K, Tapasvi S | Sagittal tibial osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 39-45.

(Abstract Text HTML)      (Download PDF)

Opening Wedge High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 20-26 | Parag Sancheti, Sunny Gugale, Kailash Patil, Ashok Shaym

DOI:10.13107/aja.2021.v06i02.030

Author: Parag Sancheti [1], Sunny Gugale [1], Kailash Patil [1], Ashok Shaym [1, 2]

[1] Department of Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation & PG College, Pune, Maharashtra, India.
[2] Indian Orthopaedic Research Group, Thane, Maharashtra, India.

Address of Correspondence:

Dr. Parag Sancheti,
Dean, Professor & Chairman, Sancheti Institute for Orthopaedics & Rehabilitation & PG College, Pune, Maharashtra, India.
E-mail: sanchetipk@gmail.com

Abstract

In the era of Joint replacement surgery, Medial High Tibial Osteotomy is a time tested and successful surgical procedure for treatment of mild to moderate knee osteoarthritis. The success of this procedure lies in proper patient selection, an excellent surgical technique, a rigid internal fixation and early rehabilitation. There are a lots of research articles published in literature, many systematic reviews and meta-analysis on this specific topic. In this review article we discuss mainly the recent trends in the medial open wedge osteotomy for treatment of knee osteoarthritis.

Keywords: MOWHTO, Osteoarthritis, Osteotomy, Surgical treatment

References

1. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. NUMBER. 2016;4(3):9.
2. Murray R, Winkler PW, Shaikh HS, Musahl V. High Tibial Osteotomy for Varus Deformity of the Knee. JAAOS Glob Res Rev [Internet]. 2021 Jul [cited 2022 Jan 26];5(7). Available from: https://journals.lww.com/10.5435/JAAOSGlobal-D-21-00141
3. Choi HG, Kang YS, Kim JS, Lee HS, Lee YS. Meniscal and Cartilage Changes on Serial MRI After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med. 2021 Dec 1;9(12):232596712110479.
4. Lee DC, Byun SJ. High Tibial Osteotomy. Knee Surg Relat Res. 2012 Jun;24(2):61–9.
5. Ahmed El-Nahas WE-D. Comparison of Open Wedge High Tibial Osteotomy versus Unicondylar Knee Replacement for Medial Knee Osteoarthritis. Orthop Rheumatol Open Access J [Internet]. 2017 Feb 23 [cited 2022 Jan 26];5(1). Available from: https://juniperpublishers.com/oroaj/OROAJ.MS.ID.555651.php
6. Elyasi E, Cavalié G, Perrier A, Graff W, Payan Y. A Systematic Review on Selected Complications of Open-Wedge High Tibial Osteotomy from Clinical and Biomechanical Perspectives. Saarakkala S, editor. Appl Bionics Biomech. 2021 Oct 31;2021:1–14.
7. Duan D, Cao Y, Li R, Wang G, Zhang Y, Xiang K, et al. Opening Wedge High Tibial Osteotomy with Combined Use of Patient-Specific 3D-Printed Plates and Taylor Spatial Frame for the Treatment of Knee Osteoarthritis. Zou J, editor. Pain Res Manag. 2021 Dec 1;2021:1–6.
8. Brinkman J-M, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br. 2008 Dec;90(12):1548–57.
9. Elyasi E, Cavalié G, Perrier A, Graff W, Payan Y. A Systematic Review on Selected Complications of Open-Wedge High Tibial Osteotomy from Clinical and Biomechanical Perspectives. Saarakkala S, editor. Appl Bionics Biomech. 2021 Oct 31;2021:1–14.
10. Herbst M, Ahrend M-D, Grünwald L, Fischer C, Schröter S, Ihle C. Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results. Knee Surg Sports Traumatol Arthrosc [Internet]. 2021 Feb 11 [cited 2022 Jan 26]; Available from: http://link.springer.com/10.1007/s00167-021-06457-3
11. Chiba K, Yonekura A, Miyamoto T, Osaki M, Chiba G. Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results. Arch Orthop Trauma Surg. 2017 Mar;137(3):303–10.
12. Caton-Deschamps index (knee) | Radiology Reference Article | Radiopaedia.org [Internet]. [cited 2022 Jan 26]. Available from: https://radiopaedia.org/articles/caton-deschamps-index-knee
13. Atamaz F, Aydogdu, Hepguler S, Sur H. Evaluation of the knee with magnetic resonance imaging prior to high tibial osteotomy: is it useful? is it necessary in routine practice? Orthop Proc. 2006 Mar 1;88-B(SUPP_I):102–102.
14. Vaishya R, Bijukchhe AR, Agarwal AK, Vijay V. A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis. J Clin Orthop Trauma. 2018 Oct;9(4):300–6.
15. Yin Y, Li S, Zhang R, Guo J, Hou Z, Zhang Y. What is the relationship between the “Fujisawa point” and postoperative knee valgus angle? A theoretical, computer-based study. The Knee. 2020 Jan 1;27(1):183–91.
16. Peng H, Ou A, Huang X, Wang C, Wang L, Yu T, et al. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg. 2021 Jul;13(5):1465–73.
17. Chung JH, Choi CH, Kim S-H, Kim S-J, Lee S-K, Jung M. Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis. J Clin Med. 2021 Sep 21;10(18):4272.
18. Elson DW, Petheram TG, Dawson MJ. High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method. Knee Surg Sports Traumatol Arthrosc. 2015 Jul 1;23(7):2041–8.
19. Yoon S-D, Zhang G, Kim H-J, Lee B-J, Kyung H-S. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy. Knee Surg Relat Res. 2016 Dec;28(4):283–8.
20. Yoo M-J, Shin Y-E. Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results. Knee Surg Relat Res. 2016 Dec;28(4):270–6.
21. Heinz T, Reppenhagen S, Wagenbrenner M, Horas K, Ohlmeier M, Schäfer T, et al. Focal cartilage defects of the lateral compartment do influence the outcome after high tibial valgus osteotomy. SICOT-J. 2021;7:44.
22. Lee S-J, Kim J-H, Baek E, Ryu H-S, Han D, Choi W. Incidence and Factors Affecting the Occurrence of Lateral Hinge Fracture After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med. 2021 Oct 1;9(10):232596712110353.
23. Staubli AE, Jacob HAC. Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. Int Orthop. 2010 Feb;34(2):167–72.
24. Onodera J, Kondo E, Omizu N, Ueda D, Yagi T, Yasuda K. Beta-tricalcium phosphate shows superior absorption rate and osteoconductivity compared to hydroxyapatite in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2014 Nov 1;22(11):2763–70.
25. Gaasbeek RDA, Sonneveld H, van Heerwaarden RJ, Jacobs WCH, Wymenga AB. Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. The Knee. 2004 Dec 1;11(6):457–61.
26. Song SJ, Bae DK, Kim KI, Lee CH. Conversion Total Knee Arthroplasty after Failed High Tibial Osteotomy. Knee Surg Relat Res. 2016 Jun 30;28(2):89–98.
27. Han JH, Kim HJ, Song JG, Yang JH, Bhandare NN, Fernandez AR, et al. Is Bone Grafting Necessary in Opening Wedge High Tibial Osteotomy? A Meta-Analysis of Radiological Outcomes. Knee Surg Relat Res. 2015 Dec 30;27(4):207–20.
28. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P. The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2007 Aug;23(8):852–61.
29. Hartz C, Wischatta R, Klostermeier E, Paetzold M, Gerlach K, Pries F. Plate-related results of opening wedge high tibial osteotomy with a carbon fiber reinforced poly-ether-ether-ketone (CF-PEEK) plate fixation: a retrospective case series of 346 knees. J Orthop Surg. 2019 Dec 27;14(1):466.
30. Roberson TA, Momaya AM, Adams K, Long CD, Tokish JM, Wyland DJ. High Tibial Osteotomy Performed With All-PEEK Implants Demonstrates Similar Outcomes but Less Hardware Removal at Minimum 2-Year Follow-up Compared With Metal Plates. Orthop J Sports Med. 2018 Mar 12;6(3):2325967117749584.
31. Kyun-Ho S, Hyun-Jae R, Ki-Mo J, Seung-Beom H. Effect of concurrent repair of medial meniscal posterior root tears during high tibial osteotomy for medial osteoarthritis during short-term follow-up: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021 Dec;22(1):623.
32. Koshino T, Yoshida T, Ara Y, Saito I, Saito T. Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. The Knee. 2004 Dec;11(6):439–44.
33. Coventry MB. Upper Tibial Osteotomy. Clin Orthop Relat Res. 1984 Feb;182:46–52.
34. Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP. High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13-21 years. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2011 Jan;19(1):122–7.
35. Giuseffi SA, Replogle WH, Shelton WR. Opening-Wedge High Tibial Osteotomy: Review of 100 Consecutive Cases. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2015 Nov;31(11):2128–37.
36. Han JH, Kim HJ, Song JG, Yang JH, Nakamura R, Shah D, et al. Locking plate versus non-locking plate in open-wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017 Mar;25(3):808–16.
37. Lee S-H, Seo H-Y, Kim H-R, Song E-K, Seon J-K. Older age increases the risk of revision and perioperative complications after high tibial osteotomy for unicompartmental knee osteoarthritis. Sci Rep. 2021 Dec;11(1):24340.
38. Bonasia D, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial Opening Wedge High Tibial Osteotomy for Medial Compartment Overload/Arthritis in the Varus Knee. Am J Sports Med. 2014 Jan 21;42.
39. LOIA MC, VANNI S, ROSSO F, BONASIA DE, BRUZZONE M, DETTONI F, et al. High tibial osteotomy in varus knees: indications and limits. Joints. 2016 Aug 18;4(2):98–110.
40. Bode G, Heyden J, Pestka J, Schmal H, Salzmann G, Südkamp N, et al. Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2013 Nov 19;23.

How to Cite this article: Sancheti P, Gugale S, Patil K, Shaym A | Opening wedge high tibial osteotomy | Asian Journal Arthroscopy | July-December 2021; 6(2): 20-26.

(Abstract Text HTML)      (Download PDF)