6 High-tibial closed-wedge osteotomy
The classical valgization closed-wedge high-tibial osteotomy (HTO) technique performed proximal to the tuberosity was inaugurated and propagated by Coventry in 1965 . For a long time the closed-wedge procedure was a common and widespread method in treatment of medial gonarthritis, until the open-wedge technique gained new popularity. This development was favored by the introduction of new implant designs, especially plate fixators with angular stable locking head screws during the last years [2–6]. The medial open-wedge technique with these implants offers many advantages: the surgical technique is faster, the correction is more precise, and the risk of peroneal nerve lesion during fibula osteotomy is avoided. Open-wedge and closed-wedge osteotomies have similar indications [7, 8] and have demonstrated good results [9–13], although currently no long-term results with modern angular locked plates are available.
Despite the advantages of open-wedge HTO there are still certain indications for the closed-wedge osteotomy.
Patella baja is a relative contraindication for open-wedge HTO since this procedure significantly lowers the patella and can cause problems especially in patients with preexisting femoropatellar symptoms .
If a lateral arthrotomy is planned or scars exist at the lateral aspect of the knee, it might be wise to use a lateral approach again instead of performing a second medial incision.
Table 6-1 summarizes the differences between open- and closed-wedge valgization HTO with its indications, advantages, and disadvantages.
Bone graft necessary in case of high correction
No graft necessary
Risk of saphenus nerve lesion
Risk of peroneus nerve lesion