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Consistent indications, targets and techniques for double-level osteotomy of the knee: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To systematically review and critically appraise the literature on double-level osteotomy (DLO) of the knee, and determine the indications, contraindications, targets and outcomes.

Materials and methods

A systematic literature search was performed on PubMed, Embase®, and Cochrane for studies that reported on DLO by any technique or approach, including indications, contraindications, and targets for DLO, as well as patient-reported outcome measures (pROMS) and radiographic angles.

Results

Twelve eligible studies were found: 9 case series and 3 studies that compared DLO to high-tibial osteotomy (HTO). In all studies, DLO was performed by medial opening-wedge tibial osteotomy and lateral closing-wedge femoral osteotomy. Seven specified that DLO was performed if simple HTO would exceed thresholds of postoperative medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and/or predicted wedge size. The targets were 88°–95° for MPTA, 84°–89° for LDFA, and 0°–4° for hip–knee–ankle (HKA) angle. The 3 comparative studies reported lower MPTA after DLO (89.6°–92.5°) than after HTO (91.5°–98.3°). All 3 reported similar postoperative HKA after DLO (0.2°–4.4°) as HTO (0.4°–4.8°); only 2 compared postoperative LDFA, which was lower after DLO (85.4° and 84.9°) than HTO (88.7° and 88.8°). Two comparative studies reported postoperative overall KOOS which was slightly lower after DLO (351–403) than HTO (368–410); only 1 study reported separate items of the KOOS.

Conclusion

There was relative consistency between studies on the indications, targets and techniques for DLO. Furthermore, while the comparative studies reported similar preoperative MPTA, LDFA and HKA, the postoperative MPTA and LDFA were lower after DLO than after HTO, though both treatments achieved equivalent postoperative HKA.

Level of evidence

IV, systematic review.

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Authors and Affiliations

  1. Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland

    Philippe Alves

  2. Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and University of Geneva, Faculty of Medicine, Geneva, Switzerland

    Philippe Alves & Hermes Miozzari

  3. ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland

    Floris van Rooij, Thomas Kuratle & Mo Saffarini

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  1. Philippe Alves
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Correspondence to Floris van Rooij.

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Conflict of interest

PA, FVR, TK, MS, HM have nothing to declare.

Funding

This article was funded by Fondation de la Tour pour la recherche et l’enseignement.

Ethical approval

This study involved no human or animal subjects as it based on published literature; Its protocol including the search strategy was registered on PROSPERO (CRD42021278652).

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Alves, P., van Rooij, F., Kuratle, T. et al. Consistent indications, targets and techniques for double-level osteotomy of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 30, 4078–4087 (2022). https://doi.org/10.1007/s00167-022-06915-6

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