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Background: Although many studies have reported successful functional outcomes after proximal tibial osteotomy (PTO), a paucity of literature has sought to quantify outcomes and current rates of return to sport (RTS) and return to work (RTW) after PTO. Purpose: To (1) determine current rates of RTS and RTW after PTO and (2) quantify the incidence of complications and conversion to total knee arthroplasty (TKA) after PTO for all patients as well as those undergoing opening and closing wedge PTO. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), EMBASE (2008-2019), and MEDLINE (2008-2019) databases were queried. Data pertaining to article information, patient demographics, surgical techniques, rates of complication and conversion to TKA, patient-reported outcome scores, RTS, and RTW were extracted. Data were synthesized, and a random effects meta-analysis of proportions using continuity correction methods was performed to determine the proportion of patients receiving opening and closing wedge PTO who experienced adverse events. Results: The review and meta-analysis included 33 studies involving 1914 patients who underwent PTO with a weighted mean ± SD age of 50.3 ± 9.9 years and body mass index of 26.9 ± 2.3 kg/m2. The pooled RTS and RTW rates were 75.7% (range, 55%-100%) in 814 patients and 80.8% (range, 41%-100%) in 505 patients, respectively. The pooled TKA rate was 12.5% (range, 0%-35.7%) at a mean of 70.6 months and the pooled complication rate was 11.1% (range, 0%-28.6%). The overall random pooled summary estimate of the proportion of patients who underwent opening wedge PTO and subsequently converted to TKA was 2.0% (95% CI, 1.0%-4.0%; I2 = 63.65) at a mean of 43.4 ± 31.9 months and who experienced a complication was 6.0% (95% CI, 3.0%-9.0%; I2 = 87.10%). For closing wedge PTO, the proportion of patients who converted to TKA was 5.0% (95% CI, 1.0%-9.0%; I2 = 93.1%) and experienced a complication was 2.0% (95% CI, 1.0%-3.0%; I2 = 90.0%). Only 53.8% of studies that referenced RTS provided postoperative RTS rates, and 80% of studies that referenced RTW provided RTW rates. Only 1 study defined RTS criteria, no studies defined RTW criteria, and 31 different outcome measures were reported across all studies. Conclusion: Patients undergoing PTO for osteoarthritis, cartilage defects, and symptomatic malalignment of the knee experience high rates of RTS and RTW. These patients also experience low rates of complications and conversion to TKA, regardless of opening or closing wedge technique. Significant heterogeneity exists with regard to criteria used to define RTS and RTW and patient-reported outcome measures used to assess clinical and functional improvements after PTO.

Introduction: The purpose of this study was to perform a systematic review and meta-analysis of the effects of training simulators on surgical skill measures across randomized controlled trials. The authors hypothesized that simulated training would (1) result in objective improvements in skill acquisition and (2) be heterogeneous regarding the outcomes and types of validity assessed. Methods: The Cochrane Database of Systematic Reviews, the Central Register of Controlled Trials, PubMed, EMBASE, and MEDLINE databases were queried for Level I studies on training simulators between 2007 and 2019 in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Exclusion criteria were studies without discrete assessment of skills acquisition after surgical simulator training and level of evidence II to V. The Jadad scale was used to assess the methodological quality of all included articles. Data pertaining to patient demographics, validity measures, simulator types, and study-specific outcome measures were extracted. Meta-analyses adjusted for random effects and heterogeneity analyses (I2) were used to compare pooled time-to-completion and performance outcomes among included studies. Results: A total of 24 studies with 494 participants were identified. The most common simulator type involved knee arthroscopy (11 studies, 45.8%). Eight studies reporting time-to-task completion and performance scores were included in the meta-analysis. Virtual reality training was favored in time-to-task completion (mean difference = −82.25 seconds, P = 0.002) and improvement in objective performance scores (mean difference = 1.24, P = 0.02) relative to traditional training. Sensitivity analysis of time-to-task completion based on the length of training interval revealed a mean difference of −45.24 (P = 0.07) and −137.74 (P < 0.001) seconds for the short-term and immediate posttesting subgroups, respectively. Conclusion: Overall, improved task efficiency and performance were observed with the use of orthopaedic simulators. However, simulator type, training protocols, and outcome measures were heterogeneous. Future studies are warranted to evaluate financial cost and longitudinal training programs and to standardize outcomes regarding the use of simulators in orthopaedic education. Level of Evidence: Level I