Osteotomies around the knee are rarely indicated to treat knee instability in the acute setting, unless significant deformities are present at the moment of ligament reconstruction. On the other hand, in the chronic setting, osteotomies are essential in treating knee instability, as an isolated procedure or combined with ligamentous reconstruction. Chronic instabilities treated with ligament reconstruction in a malaligned knee are likely to fail if realignment is not performed in advance or concurrently. Malalignment in both coronal and sagittal planes should be evaluated and addressed in these cases.
The goal of this chapter is to review the indications and surgical techniques for proximal tibial and distal femoral osteotomy in the setting of chronic ligament deficiency of the knee. Both opening and closing wedge techniques are discussed together with the technical tips and pearls.
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Bonasia DE, Dettoni F, Palazzolo A, Rossi R. Opening wedge high tibial osteotomy and anterior cruciate ligament reconstruction or revision. Arthrosc Tech. 2017;6(5):e1735–41.CrossRefGoogle Scholar
Naudie DD, Amendola A, Fowler PJ. Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med. 2004;32(1):60–70.CrossRefGoogle Scholar
Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, Birmingham TB, Litchfield RB. A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):152–60.CrossRefGoogle Scholar
Thienpont E, Schwab PE, Cornu O, Bellemans J, Victor J. Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg. 2017;137(3):393–400.CrossRefGoogle Scholar
Eberbach H, Mehl J, Feucht MJ, Bode G, Südkamp NP, Niemeyer P. Geometry of the valgus knee: contradicting the dogma of a femoral-based deformity. Am J Sports Med. 2017;45(4):909–14.CrossRefGoogle Scholar
Matsuda S, Miura H, Nagamine R, Urabe K, Ikenoue T, Okazaki K, Iwamoto Y. Posterior tibial slope in the normal and varus knee. Am J Knee Surg. 1999;12(3):165–8.PubMedGoogle Scholar
Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H. Effect of wedge insertion angle on posterior tibial slope in medial opening wedge high tibial osteotomy. Orthop J Sports Med. 2016;4(2):2325967116630748.CrossRefGoogle Scholar
Amendola A, Bonasia DE. Proximal tibial/distal femoral osteotomy for management of unicompartmental arthritis. In: Johnson DL, editor. Master techniques in orthopaedic surgery: reconstructive knee surgery. Alphen aan den Rijn: Wolters Kluwer Health; 2017.Google Scholar