Surgical anatomy of medial open-wedge high tibial osteotomy: crucial steps and pitfalls

Abstract

Expert opinion, Level V.

Three-dimensional analysis of lateral cortical hinge in medial open-wedge high tibial osteotomy: A computational simulation study of adult cadavers

“…We developed and classified the AP projections for MOWHTO: (1) matched AP, (2) nonoverlapping AP, and (3) neutral AP projection in which, during tibial torsion, the tibia was rotated and the lateral cortical margin divided the fibula in half approximately. 19 Compared with the internally rotated projections, 8,16,18,19 the tibia model should be more internally rotated to obtain matched AP projection. Considering that the neutral AP projection in which the overlapping point was lateral to the fibular tip, 19 the overlapping points of matched AP projection were placed within 2 mm of the fibular tip and accurately aligned with the fibular tip.…”

“…In the standard AP projection, 5,9 the lateral exit of virtual cutting plane was placed immediately distal to the fibular tip inside the safe zone. [5][6][7][8][10][11][12][13][14] The starting point of the medial surface was distal to the tibial tubercle considering the Tomofix ® hole D, and the virtual line was parallel to the tibial slope in the sagittal plane to prevent a change in tibial slope 2 (Figure 1). To ensure the width of lateral cortical hinge not less than 10 mm, a round cylinder measuring 30 mm in diameter and 10 mm in height (10-mm cylinder) was used.…”

“…To ensure the width of lateral cortical hinge not less than 10 mm, a round cylinder measuring 30 mm in diameter and 10 mm in height (10-mm cylinder) was used. Based on the well-known landmarks, 5,8,9 a 10-mm cylinder was placed vertically in the nonosteotomized lateral cortex using the following method (Figure 1): (1) The posterior hinge point was marked in the medial end of articular facet inside the safe zone to avoid the injury of PTFJ. (2) The posteromedial border of 10-mm cylinder was exactly aligned to be matched with posterior hinge point.…”

“…To maintain the integrity of lateral cortical hinge from opening osteotomy to completion of gap healing while preventing loss of wedge-distracted correction, most surgeons intend to localize a cutting plane of osteotomy inside the safe zone within the proximal one-third of the fibular head in the anteroposterior (AP) projection of image intensifier. [5][6][7][8] To maintain a safe zone for wedge-distracted correction, the position and direction of anterior and posterior cortical hinge points are crucial for the success of MOWHTO, at least in principle. The anterior and posterior endpoints of osteotomy and cutting plane should be intraoperatively verified by the correct intensifier view and the width of lateral cortical hinge should be adequate to prevent intraoperative lateral hinge fracture.…”

Deep peroneal nerve injury during plate fixation for medial open‐wedge high tibial osteotomy: A case report and cadaveric study

“…In the study by Shin et al, the plate was anteriorly positioned, posing a risk for the screw to penetrate the tibial nerve . It is recommended to medially position the locking plates as much as possible to maximize fixation strength and avoid the risk of injury to the popliteal vessels and tibial nerve . However, the risk of DPN injury by drilling of the distal locking screws has not been recognized.…”