- surgical descision making:
- Limb Alignment After Open-wedge High Tibial Osteotomy and Its Effect on the Clinical Outcome
- Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust.
- The effect of a proximal tibial medial opening wedge osteotomy on posterolateral knee instability: a biomechanical study.
- Osteotomy Options:
- sartorius fascia is incised and the pes anserinus retracted distally with a blunt retractor, exposing the superficial MCL;
- release of MCL:
- long fibers of MCL are mobilized and partially released distally to allow a blunt Hohmann retractor to be placed behind the
posteromedial aspect of the tibia to protect the neurovascular bundle;
- release of distal fibers also prevents excessive medial compartment loading as the tibia is hinged into valgus;
- protection of N/V bundle:
- blunt retractor is passed deep to the MCL to protect the posterior neurovascular structures;
- ref: The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study.
- standard osteotomy:
- two 2.5-mm threaded Kirschner wires mark the oblique osteotomy 5 cm distal to the joint line, starting proximal to the pes
anserinus and extending to the level of the tip of the fibula at the lateral cortex
- saggital plane (lateral view on flouro)
- osteotomy is performed parallel to the posterior tibial slope
- 2.5-mm K wire marks oblique osteotomy 5 cm distal to joint line, starting proximal to pes anserinus and extending to level
of tip of fibula at lateral cortex;
- starting point for opening the osteotomy is posterior to the superficial medial collateral ligament
- start at anteromedial tibia at the level of the superior border of the tibial tubercle (approximately 4 cm distal from the joint
line) and aiming the tip of the fibular head (approximately 1 cm below the lateral articular surface)
- medial border of the patellar tendon was identified, retracted, and protected throughout the whole procedure.
- latearl cortex: careful not to disrupt the lateral cortex;
- mobility of the osteotomy is checked by gentle manipulation of the leg with valgus force.
- The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy.
- Open-wedge high tibial osteotomy: a technical trick to avoid loss of reduction of the opposite cortex
- The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy
- V shaped osteotomy:
- oblique osteotomy is performed in the posterior two-thirds of the medial aspect of the tibia distal to the Kirschner wires and
parallel to tibial slope extending to the tip of the fibula, leaving a 10-mm lateral bone bridge intact;
- second osteotomy starts in the anterior one-third of the tibia at an angle of 135°, leaving the tibial tuberosity intact
- Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique
- Patellar height relevance in opening-wedge high tibial osteotomy.
- Modified Retro-Tubercle Opening-Wedge Versus Conventional High Tibial Osteotomy
- Opening-Wedge High Tibial Osteotomy with a Locked Low-Profile Plate: Surgical Technique
- Opening-Wedge High Tibial Osteotomy: Review of 100 Consecutive Cases.
- Bone Grafting:
- Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft.
- Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee
- Adverse Event Rates and Classifications in Medial Opening Wedge High Tibial Osteotomy
- Post Operative Care:
- Early full weight bearing is safe in open-wedge high tibial osteotomy.
- Medial Opening Wedge High Tibial Osteotomy With Early Full Weight Bearing
Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies.
Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function.