6 High-tibial closed-wedge osteotomy


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.


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



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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