High tibial osteotomies in the young active patient

Abstract

Unicompartmental changes in the knee of a young athlete remains a difficult and controversial problem in orthopaedics. Excessive premature loading of articular cartilage, most often the result of a knee injury, has been shown to result in increased degenerative changes and pain in the younger patient. Instability may also contribute to the degeneration of cartilage and must therefore be considered in the treatment of osteoarthritis in the young adult. High tibial osteotomy has been described as a treatment option for malalignment in the older, less active adult and has shown promising results in a younger, more active population. Osteotomies for instability are more controversial and should be considered in more complex injury patterns.

Incidence of osteotomies around the knee for the treatment of knee osteoarthritis: A 22-year population-based study

“…Furthermore, at the same time, the number of unicondylar knee arthroplasties (UKA) has grown [2], which may also have contributed to the decreased number of osteotomies performed. However, symptomatic and radiographically mild to moderate knee OA in young and active patients is still commonly regarded as an indication for high tibial osteotomy [3][4][5].…”

Is a high tibial osteotomy (HTO) superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis (OA)? A propensity matched study using 2 randomized controlled trial (RCT) datasets

“…Specifically for varus alignment and symptomatic medial knee OA there are some additional options: non-surgical treatment with a lateral wedge, or valgus bracing, and surgical options like a HTO, or a unicompartmental knee arthroplasty (UKA) 5e8 . Of the surgical options for the relative younger, active patient the HTO remains the procedure of choice 9,10 . The UKA and the TKA are the preferred options for older patients with end-stage OA.…”

Osteotomy around the knee: state of the art and new challenges

“…First, Wolcott et al [1] have stated that "Correction of malalignment in young patients with unicompartmental disease has shown promising results, but more long-term, prospective studies are needed to determine functional results". The review of Sherman and Cabanela (Mayo Clinic) [2] concerns closing osteotomy in femur and tibia.…”