Medial open wedge vs. lateral closed wedge high tibial osteotomy - Indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases

The purpose of this study was to investigate the change in patellar position after open wedge high tibial osteotomy (OWHTO) with distal tubercle osteotomy (DTO), comparing outcomes of conventional OWHTO in young adults with proximal tibia varus deformity but no arthritic manifestations. Thirty-three patients (mean age, 31.8 years) subjected to OWHTO/DTO were matched with 30 patients (mean age, 33.5 years) undergoing conventional OWHTO. Patellar position, as measured in pre- and postoperative standing lateral radiographs, was compared. Patellar height was assessed via Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel (BP) index, Caton-Deschamps (CD) index, and modified Miura-Kawamura index. Computed tomography was used to measure lateral patellar tilt and shift. In the OWHTO group, all patellar height indices decreased significantly following surgery. Although mean values of BP and CD indices decreased significantly in the OWHTO/DTO group, other determinants of patellar height showed no significant postoperative differences. Significant postoperative declines in average lateral patellar tilt were also evident in both groups, but pre- and postoperative lateral patellar shift did not differ significantly. OWHTO/DTO can be performed without significant changes in patellar height. The results obtained support that OWHTO/DTO is suitable for relatively young patients with proximal tibia vara but no arthritic change.

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Patellar Height and Posterior Tibial Slope after Open- and Closed-Wedge High Tibial Osteotomy

The American Journal of Sports Medicine ◽

10.1177/0363546509348050 ◽

2010 ◽

Vol 38 (2) ◽

pp. 323-329 ◽

Cited By ~ 109

Author(s):

Hosam El-Azab ◽

Parpakorn Glabgly ◽

Jochen Paul ◽

Andreas B. Imhoff ◽

Stefan Hinterwimmer

Keyword(s):

High Tibial Osteotomy ◽

Tibial Slope ◽

Patellar Height ◽

Posterior Tibial Slope ◽

Tibial Osteotomy ◽

Posterior Tibial ◽

Closed Wedge ◽

Wedge High Tibial Osteotomy

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Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03703-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Takahiro Ogino ◽

Ken Kumagai ◽

Shunsuke Yamada ◽

Tomotaka Akamatsu ◽

Shuntaro Nejima ◽

...

Keyword(s):

Soft Tissue ◽

High Tibial Osteotomy ◽

Mechanical Axis ◽

Tibial Osteotomy ◽

Axis Deviation ◽

Open Wedge ◽

Correction Angle ◽

Closed Wedge ◽

Wedge High Tibial Osteotomy

Abstract Background The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). Methods A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. Results CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P < 0.05), and a greater soft tissue correction than OWHTO (P < 0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P < 0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. Conclusions The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.

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Change in leg length after open-wedge high tibial osteotomy can be predicted from the opening width: A three-dimensional analysis

The Knee ◽

10.1016/j.knee.2021.04.010 ◽

2021 ◽

Vol 30 ◽

pp. 185-194

Author(s):

Yuki Yamamuro ◽

Tamon Kabata ◽

Kenichi Goshima ◽

Yoshitomo Kajino ◽

Daisuke Inoue ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Dimensional Analysis ◽

Three Dimensional ◽

Tibial Osteotomy ◽

Open Wedge ◽

Leg Length ◽

Wedge High Tibial Osteotomy ◽

Opening Width

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Clinical outcome of a novel fixation system for open-wedge high tibial osteotomy: Comparison with tomofix

Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology ◽

10.1016/j.asmart.2016.07.104 ◽

2016 ◽

Vol 6 ◽

pp. 40

Author(s):

Koji Yabuuchi ◽

Eiji Kondo ◽

Jun Onodera ◽

Tomohiro Onodera ◽

Toshiaki Kameda ◽

...

Keyword(s):

Clinical Outcome ◽

High Tibial Osteotomy ◽

Tibial Osteotomy ◽

Open Wedge ◽

Wedge High Tibial Osteotomy ◽

Fixation System

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Return to sport and work after medial open wedge high tibial osteotomy : a case series

Acta Orthopaedica Belgica ◽

10.52628/87.1.15 ◽

2021 ◽

Vol 87 (1) ◽

pp. 117-124

Author(s):

Francis De Neve ◽

Brecht Braems ◽

Milan Holvoet ◽

Marie-Angélique De Scheerder ◽

Nele Arnout ◽

...

Keyword(s):

Clinical Outcome ◽

High Tibial Osteotomy ◽

Mechanical Axis ◽

Case Series ◽

Return To Sport ◽

Tibial Osteotomy ◽

Open Wedge ◽

Work Activity ◽

Wedge High Tibial Osteotomy ◽

Open Wedge Hto

Data on return to work and sport following open wedge high tibial osteotomy (HTO) have been underreported. Furthermore, there is no clear consensus in literature about the postoperative alignment goals following HTO. A retrospective case series was performed to evaluate return to sport and work following open wedge HTO. The University of California, Los Angeles scale, the German classification system according to the Reichsausschuß für Arbeitszeitermittlung, the Tegner score and the Knee injury and Osteoarthritis Outcome Score were used to asses the employment status, sport status and clinical outcome at the time of surgery and at final follow-up, minimum 2 years after surgery. The pre- and postoperative hip knee ankle angle (HKA) were documented. The desired postoperative alignment target was 0°-2° valgus mechanical axis. 30 open wedge HTOs were performed of which 27 patients were retrospectively included in the study. 25 out of 26 patients returned to work and 15 out of 17 patients returned to sport following surgery. Outcome scores were significantly higher after surgery. The mean postoperative HKA was 0,9° of valgus mechanical axis. This study shows excellent outcome in sport and work activity and clinical outcome after open wedge HTO. We furthermore suggest that these outcomes can be obtained with a postoperative alignment of 0°-2° of valgus mechanical axis.

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