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Understanding Osteotomy: A narrative review

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020 | page: 21-30 | Domenico Alesi, Vito Gaetano Rinaldi, Amit Meena, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini


Author: Domenico Alesi [1], Vito Gaetano Rinaldi [1], Amit Meena [2], Giulio Maria Marcheggiani Muccioli [1,3], Stefano Zaffagnini [1,3]

[1] 2nd Orthopaedic and Traumatology Clinic – IRCCS – Istituto Ortopedico Rizzoli – Via G.B. Pupilli 1, 40136, Bologna, Italy.
[2] Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
[3] DIBINEM, University of Bologna, Bologna, Italy.

Address of Correspondence
Dr. Domenico Alesi,
Resident in Orthopedics and Traumatology, IRCCS – Istituto Ortopedico Rizzoli Via di Barbiano, 1/13, Bologna
E-mail: domenico.alesi@ior.it


Abstract

Osteotomy around the knee is an effective surgical procedure for active, physiologically young patients with symptomatic unicompartmental osteoarthritis (OA) and malalignment. It restores the correct lower limb mechanical alignment, redistributing weight-bearing from a damaged joint surface area to an undamaged one. Hence, it consistently provides relief in knee pain, improves knee function, and delay the need for TKA. Despite all these advantages its popularity was decreasing in the past but improved meniscal and cartilage restoration techniques renewed interest in knee osteotomies in young patients with knee pain and joint surface defects. Hence, in the last decade, the majority of osteotomies have been performed in combined with cartilage repair, meniscal transplantation, and ligament reconstruction. Understanding the rationale of an osteotomy and the possibility to combine it with other procedures allows us to obtain the most clinical benefit for the patient. This review article provides an overview of the basic osteotomy planning for knee axes malalignment, describing the different techniques based on the location of the deformity and the presence of associated lesions, thus presenting the main results of isolated and combined procedures, to provide useful updates to guide the surgeon in the choice of possible variants or associated gestures.
Keywords: Deformities around the knee, High tibial osteotomy, Clinical outcome.


References

1. Jackson J. Osteotomy for osteoarthritis of the knee. J Bone Jt Surg Br 1958:40:826.
2. Wardle EN. Osteotomy of the tibia and fibula. Surg Gynecol Obstet 1962;115:61–4.
3. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 1965;47:984–90.
4. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Distal femoral varus osteotomy. J Bone Joint Surg Am 1988;70:102–9.
5. Pape D, Adam F, Rupp S, Seil R, Kohn D. [Stability, bone healing and loss of correction after valgus realignment of the tibial head. A roentgen stereometry analysis]. Orthopade 2004;33:208–17.
https://doi.org/10.1007/s00132-003-0591-2.
6. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop 1992:248–64.
7. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979;10:585–608.
8. Dejour H, Walch G, Deschamps G, Chambat P. Arthrosis of the knee in chronic anterior laxity. Orthop Traumatol Surg Res OTSR 2014;100:49–58. https://doi.org/10.1016/j.otsr.2013.12.010.
9. Lee DK, Wang JH, Won Y, Min YK, Jaiswal S, Lee BH, et al. Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:1411–8. https://doi.org/10.1007/s00167-019-05502-6.
10. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 1993;75:196–201.
11. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 1987;69:332–54.
12. Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC, et al. Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2012;20:468–86. https://doi.org/10.1007/s00167-011-1714-7.
13. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop 1989:250–9.
14. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5 Years. Clin Orthop Relat Res 2015;473:2009–15. https://doi.org/10.1007/s11999-014-4106-8.
15. Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. Int Orthop 2010;34:271–81. https://doi.org/10.1007/s00264-009-0924-9.
16. Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C. Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 2006;30:403–8. https://doi.org/10.1007/s00264-006-0098-7.
17. Flecher X, Parratte S, Aubaniac J-M, Argenson J-NA. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop 2006;452:91–6. https://doi.org/10.1097/01.blo.0000229362.12244.f6.
18. Gstöttner M, Michaela G, Pedross F, Florian P, Liebensteiner M, Michael L, et al. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 2008;128:111–5. https://doi.org/10.1007/s00402-007-0438-0.
19. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 2008;90:592–6. https://doi.org/10.1302/0301-620X.90B5.20386.
20. Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, et al. Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 2011;39:64–70. https://doi.org/10.1177/0363546510377445.
21. Laprade RF, Spiridonov SI, Nystrom LM, Jansson KS. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2012;28:354–64. https://doi.org/10.1016/j.arthro.2011.08.310.
22. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:170–80. https://doi.org/10.1007/s00167-012-2087-2.
23. Liu JN, Agarwalla A, Garcia GH, Christian DR, Redondo ML, Yanke AB, et al. Return to sport following isolated opening wedge high tibial osteotomy. The Knee 2019;26:1306–12.
https://doi.org/10.1016/j.knee.2019.08.002.
24. Bonnin MP, Laurent J-R, Zadegan F, Badet R, Pooler Archbold HA, Servien E. Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:64–73. https://doi.org/10.1007/s00167-011-1461-9.
25. Berruto M, Maione A, Tradati D, Ferrua P, Uboldi FM, Usellini E. Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020. https://doi.org/10.1007/s00167-020-05890-0.
26. Liu JN, Agarwalla A, Gomoll AH. High Tibial Osteotomy and Medial Meniscus Transplant. Clin Sports Med 2019;38:401–16. https://doi.org/10.1016/j.csm.2019.02.006.
27. Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE. High tibial osteotomy. J Am Acad Orthop Surg 2005;13:279–89. https://doi.org/10.5435/00124635-200507000-00007.
28. Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 2011;19:590–9.
https://doi.org/10.5435/00124635-201110000-00003.
29. Schuster P, Schulz M, Mayer P, Schlumberger M, Immendoerfer M, Richter J. Open-Wedge High Tibial Osteotomy and Combined Abrasion/Microfracture in Severe Medial Osteoarthritis and Varus Malalignment: 5-Year Results and Arthroscopic Findings After 2 Years. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2015;31:1279–88. https://doi.org/10.1016/j.arthro.2015.02.010.
30. Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, et al. Advances in modern osteotomies around the knee : Report on the Association of Sports Traumatology, Arthroscopy, Orthopaedic surgery, Rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017. J Exp Orthop 2019;6:9. https://doi.org/10.1186/s40634-019-0177-5.
31. Kahlenberg CA, Nwachukwu BU, Hamid KS, Steinhaus ME, Williams RJ. Analysis of Outcomes for High Tibial Osteotomies Performed With Cartilage Restoration Techniques. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2017;33:486–92. https://doi.org/10.1016/j.arthro.2016.08.010.
32. Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK. Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 2010;38:1420–4.
https://doi.org/10.1177/0363546509360403.
33. Bode G, Ogon P, Pestka J, Zwingmann J, Feucht M, Südkamp N, et al. Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. Int Orthop 2015;39:689–96. https://doi.org/10.1007/s00264-014-2547-z.
34. Agarwalla A, Christian DR, Liu JN, Garcia GH, Redondo ML, Gowd AK, et al. Return to Work Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2020;36:808–15. https://doi.org/10.1016/j.arthro.2019.08.046.
35. Hsu AC, Tirico LEP, Lin AG, Pulido PA, Bugbee WD. Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure. Cartilage 2018;9:248–54. https://doi.org/10.1177/1947603517710307.
36. Koh Y-G, Kwon O-R, Kim Y-S, Choi Y-J. Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2014;30:1453–60. https://doi.org/10.1016/j.arthro.2014.05.036.
37. Barber-Westin SD, Noyes FR. Low-impact sports activities are feasible after meniscus transplantation: a systematic review. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2018;26:1950–8.
https://doi.org/10.1007/s00167-017-4658-8.
38. Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Surgical technique. J Bone Joint Surg Am 2006;88 Suppl 1 Pt 1:109–18.
https://doi.org/10.2106/JBJS.E.00875.
39. Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg Am 2005;87:715–24. https://doi.org/10.2106/JBJS.C.01344.
40. Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, Di Martino A, Di Matteo B, et al. Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:2509–17. https://doi.org/10.1007/s00167-013-2388-0.
41. Zaffagnini S, Bonanzinga T, Grassi A, Marcheggiani Muccioli GM, Musiani C, Raggi F, et al. Combined ACL reconstruction and closing-wedge HTO for varus angulated ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:934–41.
https://doi.org/10.1007/s00167-013-2400-8.
42. Bonin N, Ait Si Selmi T, Donell ST, Dejour H, Neyret P. Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. The Knee 2004;11:431–7.
https://doi.org/10.1016/j.knee.2004.02.001.
43. Trojani C, Elhor H, Carles M, Boileau P. Anterior cruciate ligament reconstruction combined with valgus high tibial osteotomy allows return to sports. Orthop Traumatol Surg Res OTSR 2014;100:209–12. https://doi.org/10.1016/j.otsr.2013.11.012.
44. Schneider A, Gaillard R, Gunst S, Batailler C, Neyret P, Lustig S, et al. Combined ACL reconstruction and opening wedge high tibial osteotomy at 10-year follow-up: excellent laxity control but uncertain return to high level sport. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:960–8. https://doi.org/10.1007/s00167-019-05592-2.
45. Mehl J, Paul J, Feucht MJ, Bode G, Imhoff AB, Südkamp NP, et al. ACL deficiency and varus osteoarthritis: high tibial osteotomy alone or combined with ACL reconstruction? Arch Orthop Trauma Surg 2017;137:233–40. https://doi.org/10.1007/s00402-016-2604-8.
46. Schuster P, Schlumberger M, Mayer P, Eichinger M, Geßlein M, Schulz-Jahrsdörfer M, et al. Excellent long-term results in combined high tibial osteotomy, anterior cruciate ligament reconstruction and chondral resurfacing in patients with severe osteoarthritis and varus alignment. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:1085–91. https://doi.org/10.1007/s00167-019-05671-4.
47. Dejour D, Saffarini M, Demey G, Baverel L. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2015;23:2846–52. https://doi.org/10.1007/s00167-015-3758-6.
48. van de Pol GJ, Arnold MP, Verdonschot N, van Kampen A. Varus alignment leads to increased forces in the anterior cruciate ligament. Am J Sports Med 2009;37:481–7. https://doi.org/10.1177/0363546508326715.
49. Walker J, Hartigan D, Stuart M, Krych A. Anterior Closing Wedge Tibial Osteotomy for Failed Anterior Cruciate Ligament Reconstruction. J Knee Surg Rep 2015;1:051–6. https://doi.org/10.1055/s-0035-1551548.
50. Gupta A, Tejpal T, Shanmugaraj A, Horner NS, Simunovic N, Duong A, et al. Surgical Techniques, Outcomes, Indications, and Complications of Simultaneous High Tibial Osteotomy and Anterior Cruciate Ligament Revision Surgery: A Systematic Review. HSS J Musculoskelet J Hosp Spec Surg 2019;15:176–84. https://doi.org/10.1007/s11420-018-9630-8..


How to Cite this article: Alesi D, Rinaldi VG, Meena A, Muccioli GMM, Zaffagnini S | Understanding osteotomy: a narrative review | Journal of Clinical Orthopaedics | January-June 2020; 5(1):21-30.

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Understanding Osteotomy: A narrative review

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020 | page: 21-30 | Domenico Alesi, Vito Gaetano Rinaldi, Amit Meena, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini


Author: Domenico Alesi [1], Vito Gaetano Rinaldi [1], Amit Meena [2], Giulio Maria Marcheggiani Muccioli [1,3], Stefano Zaffagnini [1,3]

[1] 2nd Orthopaedic and Traumatology Clinic – IRCCS – Istituto Ortopedico Rizzoli – Via G.B. Pupilli 1, 40136, Bologna, Italy.
[2] Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
[3] DIBINEM, University of Bologna, Bologna, Italy.

Address of Correspondence
Dr. Domenico Alesi,
Resident in Orthopedics and Traumatology, IRCCS – Istituto Ortopedico Rizzoli Via di Barbiano, 1/13, Bologna
E-mail: domenico.alesi@ior.it


Abstract

Osteotomy around the knee is an effective surgical procedure for active, physiologically young patients with symptomatic unicompartmental osteoarthritis (OA) and malalignment. It restores the correct lower limb mechanical alignment, redistributing weight-bearing from a damaged joint surface area to an undamaged one. Hence, it consistently provides relief in knee pain, improves knee function, and delay the need for TKA. Despite all these advantages its popularity was decreasing in the past but improved meniscal and cartilage restoration techniques renewed interest in knee osteotomies in young patients with knee pain and joint surface defects. Hence, in the last decade, the majority of osteotomies have been performed in combined with cartilage repair, meniscal transplantation, and ligament reconstruction. Understanding the rationale of an osteotomy and the possibility to combine it with other procedures allows us to obtain the most clinical benefit for the patient. This review article provides an overview of the basic osteotomy planning for knee axes malalignment, describing the different techniques based on the location of the deformity and the presence of associated lesions, thus presenting the main results of isolated and combined procedures, to provide useful updates to guide the surgeon in the choice of possible variants or associated gestures.
Keywords: Deformities around the knee, High tibial osteotomy, Clinical outcome.


References

1. Jackson J. Osteotomy for osteoarthritis of the knee. J Bone Jt Surg Br 1958:40:826.
2. Wardle EN. Osteotomy of the tibia and fibula. Surg Gynecol Obstet 1962;115:61–4.
3. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 1965;47:984–90.
4. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Distal femoral varus osteotomy. J Bone Joint Surg Am 1988;70:102–9.
5. Pape D, Adam F, Rupp S, Seil R, Kohn D. [Stability, bone healing and loss of correction after valgus realignment of the tibial head. A roentgen stereometry analysis]. Orthopade 2004;33:208–17.
https://doi.org/10.1007/s00132-003-0591-2.
6. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop 1992:248–64.
7. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979;10:585–608.
8. Dejour H, Walch G, Deschamps G, Chambat P. Arthrosis of the knee in chronic anterior laxity. Orthop Traumatol Surg Res OTSR 2014;100:49–58. https://doi.org/10.1016/j.otsr.2013.12.010.
9. Lee DK, Wang JH, Won Y, Min YK, Jaiswal S, Lee BH, et al. Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:1411–8. https://doi.org/10.1007/s00167-019-05502-6.
10. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 1993;75:196–201.
11. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 1987;69:332–54.
12. Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC, et al. Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2012;20:468–86. https://doi.org/10.1007/s00167-011-1714-7.
13. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop 1989:250–9.
14. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5 Years. Clin Orthop Relat Res 2015;473:2009–15. https://doi.org/10.1007/s11999-014-4106-8.
15. Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. Int Orthop 2010;34:271–81. https://doi.org/10.1007/s00264-009-0924-9.
16. Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C. Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 2006;30:403–8. https://doi.org/10.1007/s00264-006-0098-7.
17. Flecher X, Parratte S, Aubaniac J-M, Argenson J-NA. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop 2006;452:91–6. https://doi.org/10.1097/01.blo.0000229362.12244.f6.
18. Gstöttner M, Michaela G, Pedross F, Florian P, Liebensteiner M, Michael L, et al. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 2008;128:111–5. https://doi.org/10.1007/s00402-007-0438-0.
19. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 2008;90:592–6. https://doi.org/10.1302/0301-620X.90B5.20386.
20. Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, et al. Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 2011;39:64–70. https://doi.org/10.1177/0363546510377445.
21. Laprade RF, Spiridonov SI, Nystrom LM, Jansson KS. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2012;28:354–64. https://doi.org/10.1016/j.arthro.2011.08.310.
22. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:170–80. https://doi.org/10.1007/s00167-012-2087-2.
23. Liu JN, Agarwalla A, Garcia GH, Christian DR, Redondo ML, Yanke AB, et al. Return to sport following isolated opening wedge high tibial osteotomy. The Knee 2019;26:1306–12.
https://doi.org/10.1016/j.knee.2019.08.002.
24. Bonnin MP, Laurent J-R, Zadegan F, Badet R, Pooler Archbold HA, Servien E. Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:64–73. https://doi.org/10.1007/s00167-011-1461-9.
25. Berruto M, Maione A, Tradati D, Ferrua P, Uboldi FM, Usellini E. Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020. https://doi.org/10.1007/s00167-020-05890-0.
26. Liu JN, Agarwalla A, Gomoll AH. High Tibial Osteotomy and Medial Meniscus Transplant. Clin Sports Med 2019;38:401–16. https://doi.org/10.1016/j.csm.2019.02.006.
27. Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE. High tibial osteotomy. J Am Acad Orthop Surg 2005;13:279–89. https://doi.org/10.5435/00124635-200507000-00007.
28. Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 2011;19:590–9.
https://doi.org/10.5435/00124635-201110000-00003.
29. Schuster P, Schulz M, Mayer P, Schlumberger M, Immendoerfer M, Richter J. Open-Wedge High Tibial Osteotomy and Combined Abrasion/Microfracture in Severe Medial Osteoarthritis and Varus Malalignment: 5-Year Results and Arthroscopic Findings After 2 Years. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2015;31:1279–88. https://doi.org/10.1016/j.arthro.2015.02.010.
30. Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, et al. Advances in modern osteotomies around the knee : Report on the Association of Sports Traumatology, Arthroscopy, Orthopaedic surgery, Rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017. J Exp Orthop 2019;6:9. https://doi.org/10.1186/s40634-019-0177-5.
31. Kahlenberg CA, Nwachukwu BU, Hamid KS, Steinhaus ME, Williams RJ. Analysis of Outcomes for High Tibial Osteotomies Performed With Cartilage Restoration Techniques. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2017;33:486–92. https://doi.org/10.1016/j.arthro.2016.08.010.
32. Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK. Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 2010;38:1420–4.
https://doi.org/10.1177/0363546509360403.
33. Bode G, Ogon P, Pestka J, Zwingmann J, Feucht M, Südkamp N, et al. Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. Int Orthop 2015;39:689–96. https://doi.org/10.1007/s00264-014-2547-z.
34. Agarwalla A, Christian DR, Liu JN, Garcia GH, Redondo ML, Gowd AK, et al. Return to Work Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2020;36:808–15. https://doi.org/10.1016/j.arthro.2019.08.046.
35. Hsu AC, Tirico LEP, Lin AG, Pulido PA, Bugbee WD. Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure. Cartilage 2018;9:248–54. https://doi.org/10.1177/1947603517710307.
36. Koh Y-G, Kwon O-R, Kim Y-S, Choi Y-J. Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2014;30:1453–60. https://doi.org/10.1016/j.arthro.2014.05.036.
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How to Cite this article: Alesi D, Rinaldi VG, Meena A, Muccioli GMM, Zaffagnini S | Understanding osteotomy: a narrative review | Journal of Clinical Orthopaedics | January-June 2020; 5(1):21-30.

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