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The Efficacy of High Tibial Osteotomy with or without Post-root Medial Meniscus Repair: A Systematic Review

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 80-84 | Aishwarya Roy, Kiran Kumari, Miten Sheth

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.610


Authors: Aishwarya Roy [1], Kiran Kumari [2], Miten Sheth [1]

[1] Third Year Junior Resident in Seth GS Medical College & KEM Hospital, Mumbai, India,

[2] Postgraduate student, Msc Public Health, University of Bristol, United Kingdom.

Address of Correspondence
Dr. Aishwarya Roy,
16/2 P. majumder Road Kolkata -700078, India.
E-mail: ash46roy@gmail.com


Abstract

Background: High tibial osteotomy (HTO) is a knee joint treatment modality for medial compartment arthritis, aiming to improve articular cartilage healing by shifting the lower limb’s axis. It is commonly used in younger patients with pain and active lifestyles, preventing advanced cartilage deterioration. Varus malalignment may often be accompanied with medial meniscus root tears. In recent years, meniscus root tears are often been repaired. However, the efficacy of medial meniscus repairs with high tibial in varus malalignment with medial meniscal tears remains a controversy.
Purpose: The purpose is to study the functional outcomes of concurrent medial meniscus root repair with HTO versus HTO alone.
Study design: Systematic review.
Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of medial meniscus posterior root tear (MMPRT) repair with HTO versus HTO alone and extracted data about characteristics of patients, clinical functional scores, and radiologic outcomes. One reviewer extracted data and 1 reviewer assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the functional outcome of HTO alone or HTO and MMPRT repair in patients of varus malalignment and medial meniscus root tears.
Results: 6 studies with 264 patients were identified. Data from these studies were segregated in HTO only and HTO with medial meniscus repair group. The findings of this systematic review suggest that the outcomes of HTO with MMPHRR and of only HTO are not statistically significant, meaning that doing valgus osteotomy only in patients with varus knee and MMPHRT can give good results regardless of not repairing the meniscus.
Conclusion: HTO with medial meniscus posterior horn root repair seems to have no significant improvement in the functional outcomes of the patient. However, long-term studies need to be performed.
Keywords: High tibial osteotomy, medial meniscus, root repair, arthroscopy, varus malalignment, meniscus, root tear


References

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6. Omae, Hiroaki et al. “Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy.” The Knee vol. 45 (2023): 117-127. doi:10.1016/j.knee.2023.10.011
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12. Lee HI, Park D, Cho J. Clinical and radiological results with second-look arthroscopic findings after open wedge high tibial osteotomy without arthroscopic procedures for medial meniscal root tears. Knee Surg Relat Res 2018;30:34-41.
13. Suh DW, Yeo WJ, Han SB, So SY, Kyung BS. Simple medial meniscus posterior horn root repair using an all-inside meniscal repair device combined with high tibial osteotomy to maintain joint-space width in a patient with a repairable tear. Indian J Orthop 2020;55:397-404.
14. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy 2004;20:373-8.
15. Lee OS, Ahn S, Lee YS. Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: A systematic review and meta-analysis. Arch Orthop Trauma Surg 2017;137:903-11.

How to Cite this article: Roy A, Kumari K. The Efficacy of High Tibial Osteotomy with or without Post-root Medial Meniscus Repair: A Systematic Review. Journal of Clinical Orthopaedics 2023;8(2):80-84.

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Current Concepts in High Tibial Osteotomy

Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page:24-31 | Vikram Arun Mhaskar, Yogesh Jain, Jitendra Maheshwari


Author: Vikram Arun Mhaskar [1], Yogesh Jain [1], Jitendra Maheshwari [1]

[1] Knee & Shoulder Clinic, New Delhi, Max Superspecilaity Hospital Saket, New Delhi, India

Address of Correspondence
Dr. Vikram Arun Mhaskar,
Knee & Shoulder Clinic, New Delhi, Max Superspecilaity Hospital Saket, New Delhi, India
E-mail: drvikrammhaskar@gmail.com


Abstract

Background: High tibial osteotomy is an effective procedure for the management of medial compartment osteoarthritis. This paper intends to analyze the current indications, contra indications, technique, complications, survival, and recent advances of this procedure.

Method: Literature review was done by searching journals with “High tibial osteotomy,” “Indications of HTO,” “Alignment in HTO,” “Survival and clinical outcomes of HTO,” and “Recent advances in HTO.” A total of 12 articles were found suitable for this study and reviewed.

Outcomes: Indications have largely remained the same except for thrust, which was earlier, a contra indication, Biplanar osteotomy, patient specific instrumentation; 3D printing and computer navigation are the recent technical modifications. The rate of complications is variable in different studies and the 5-year survival is still over 90% in most studies. Rate of serious complications is low but minor complications are high.

Conclusion: HTO is a successful procedure in treating medial compartment OA in isolation or with ligament deficiencies with a good 5 and 10-year survival. Recent advances have focused on improving planning, rehabilitation, and accuracy of alignment.

Keywords: High Tibial Osteotomy, osteotomy, deformity, gene varum, osteoarthritis, knee preservation, deformity correction


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  89. Picardo NE, Khan W, Johnstone D. Suppl 2: Computer[1]Assisted Navigation in High Tibial Osteotomy: A Systematic Review of the Literature. The Open Orthopaedics Journal. 2012;6:305.
  90. Victor J, Premanathan A. Virtual 3D planning and patient specific surgical guides for osteotomies around the knee: a feasibility and proof-of-concept study. The bone & joint journal. 2013 Nov;95(11_Supple_A):153-8.
  91. Jones GG, Jaere M, Clarke S, Cobb J. 3D printing and high tibial osteotomy. EFORT open reviews. 2018 May;3(5):254-9.
  92. Henckel J, Richards R, Lozhkin K, Harris S, Baena FR, Barrett AR, Cobb JP. Very low-dose computed tomography for planning and outcome measurement in knee replacement: the imperial knee protocol. The Journal of bone and joint surgery. British volume. 2006 Nov;88(11):1513-8.
  93. Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M, Toms A. Complications associated with opening wedge high tibial osteotomy—A review of the literature and of 15 years of experience. The Knee. 2016 Mar 1;23(2):276-82.
  94. Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GR. Complications after tomofix medial opening wedge high tibial osteotomy. Journal of Knee Surgery. 2009 Jul 1;22(3):218.
  95. Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. International Orthopaedics 2010;34(2):155-60.
  96. Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA. Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. The American journal of sports medicine. 2011 Jan;39(1):64-70.
  97. Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. The bone & joint journal. 2014 Nov;96(11):1491-7.
  98. Niinimäki TT, Eskelinen A, Mann BS, Junnila M, Ohtonen P, Leppilahti J. Survivorship of high tibial osteotomy in the treatment of osteoarthritis of the knee: Finnish registry-based study of 3195 knees. The Journal of bone and joint surgery. British volume. 2012 Nov;94(11):1517-21.
  99. Darden CN, Katsman A, Alaia MJ, Strauss EJ, Jazrawi LM. Short-Term Clinical Outcomes of High Tibial Osteotomy with the iBalance HTO System. Bulletin of the NYU Hospital for Joint Diseases. 2019 Oct 1;77(4):256-62.

How to Cite this article: Mhaskar VA, Jain Y, Maheshwari J. Current Concepts in High Tibial Osteotomy. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):24-31.

 (Abstract    Full Text HTML)   (Download PDF)


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.

(Abstract    Full Text HTML)   (Download PDF)


 

 

 

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.
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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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