6 High-tibial closed-wedge osteotomy



10.1055/b-0034-9886

6 High-tibial closed-wedge osteotomy

Jacobi, Matthias, Jakob, Roland P


1 Introduction


The classical valgization closed-wedge high-tibial osteotomy (HTO) technique performed proximal to the tuberosity was inaugurated and propagated by Coventry in 1965 [1]. 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 [26]. 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 [913], 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.




  1. 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 [14].



  2. 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.


























Table 6.1 Summary of the differences between open- and closed-wedge valgization HTO with its indications, advantages, and disadvantages.

Indications



Open-wedge HTO


Closed-wedge HTO


Patella alta


Patella baja


Insufficient medial collateral ligament (open-wedge technique allows tensioning)


Intact medial collateral ligament


Associated anterior cruciate ligament (ACL) reconstruction


Associated anterior cruciate ligament (ACL) reconstruction


Simultaneous medial arthrotomy


Simultaneous lateral arthrotomy


Advantages/disadvantages

























Advantages/disadvantages


Open-wedge HTO


Closed-wedge HTO


Faster surgery


Longer surgery


Bone graft necessary in case of high correction


No graft necessary


Higher precision


Lower precision


Risk of saphenus nerve lesion


Risk of peroneus nerve lesion

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Jun 30, 2020 | Posted by in ORTHOPEDIC | Comments Off on 6 High-tibial closed-wedge osteotomy
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