High Tibial Osteotomy: A Systematic Review and Current Concept

Document Type: CURRENT CONCEPTS REVIEW

Authors

1 1Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburg, USA

2 2Department of Orthopedic Surgery, Shahid Beheshti University of Medical Science, Tehran, Iran

3 3Department of Orthopedic Surgery, Mashhad University of Medical Science, Mashhad, Iran 4Harvard Medical School, Boston, USA

4 Mashhad University Of Medical Sciences, Mashhad, Iran Department of Orthopedic Surgery, Mashhad University of Medical Science, Mashhad, Iran 4Harvard Medical School, Boston, USA

Abstract

High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes.
High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes.

Keywords

Main Subjects


1. Maquet P. The treatment of choice in osteoarthritis of
the knee. Clin Orthop Relat Res. 1985; 192:108-12.
2. Coventry MB. Osteotomy about the knee for
degenerative and rheumatoid arthritis. J Bone Joint
Surg Am. 1973; 55(1):23-48.
3. Akamatsu Y, Koshino T, Saito T, Wada J. Changes
in osteosclerosis of the osteoarthritic knee after
high tibial osteotomy. Clin Orthop Relat Res. 1997;
334:207-14.
4. Takahashi S, Tomihisa K, Saito T. Decrease of
osteosclerosis in subchondral bone of medial
compartmental osteoarthritic knee seven to nineteen
years after high tibial valgus osteotomy. Bull Hosp Jt
Dis. 2002; 61(1-2):58-62.
5. Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH,
et al. Second-look arthroscopic assessment of cartilage

regeneration after medial opening-wedge high tibial
osteotomy. Arthroscopy. 2014; 30(1):72-9.
6. Jackson JP. Osteotomy for Osteoarthritis of the Knee. J
Bone Joint Surg Br. 1958; 40(4):826.
7. Lobenhoffer P, Agneskirchner JD. Improvements in
surgical technique of valgus high tibial osteotomy. Knee
Surg Sports Traumatol Arthrosc. 2003; 11(3):132-8.
8. Niemeyer P, Schmal H, Hauschild O, von Heyden J,
Südkamp NP, Köstler W. Open-wedge osteotomy
using an internal plate fixator in patients with medialcompartment
gonarthritis and varus malalignment:
3-year results with regard to preoperative arthroscopic
and radiographic findings. Arthroscopy. 2010;
26(12):1607-16.
9. Staubli AE, De Simoni C, Babst R, Lobenhoffer
P. TomoFix: a new LCP-concept for open wedge
osteotomy of the medial proximal tibia--early results
in 92 cases. Injury. 2003; 34(Suppl 2):B55-62.
10. Sommer C, Gautier E, Müller M, Helfet DL, Wagner M.
First clinical results of the Locking Compression Plate
(LCP). Injury. 2003; 34(Suppl 2):B43-54.
11. Elson DW, Paweleck JE, Shields DW, Dawson MJ, Ferrier
GM. Stretching the indications: high tibial osteotomy
used successfully to treat isolated ankle symptoms.
BMJ Case Rep. 2013; 2013:1-4.
12. Van Thiel GS, Frank RM, Gupta A, Ghodadra N, Shewman
EF, Wang VM, et al. Biomechanical evaluation of a high
tibial osteotomy with a meniscal transplant. J Knee
Surg. 2011; 24(1):45-53.
13. Mina C, Garrett WE Jr, Pietrobon R, Glisson R, Higgins
L. High tibial osteotomy for unloading osteochondral
defects in the medial compartment of the knee. Am J
Sports Med. 2008; 36(5):949-55.
14. Morrey BF. Upper tibial osteotomy for secondary
osteoarthritis of the knee. J Bone Joint Surg Br. 1989;
71(4):554-9.
15. Li Y, Zhang H, Zhang J, Li X, Song G, Feng H. Clinical
outcome of simultaneous high tibial osteotomy
and anterior cruciate ligament reconstruction for
medial compartment osteoarthritis in young patients
with anterior cruciate ligament-deficient knees: a
systematic review. Arthroscopy. 2015; 31(3):507-19.
16. Noyes FR, Barber SD, Simon R. High tibial osteotomy
and ligament reconstruction in varus angulated,
anterior cruciate ligament-deficient knees. A two- to
seven-year follow-up study. Am J Sports Med. 1993;
21(1):2-12.
17. Zaffagnini S, Bonanzinga T, Grassi A, Marcheggiani
Muccioli GM, Musiani C, Raggi F, et al. Combined ACL
reconstruction and closing-wedge HTO for varus
angulated ACL-deficient knees. Knee Surg Sports
Traumatol Arthrosc. 2013; 21(4):934-41.
18. Preston CF, Fulkerson EW, Meislin R, Di Cesare PE.
Osteotomy about the knee: applications, techniques,
and results. J Knee Surg. 2005; 18(4):258-72.
19. Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli
AE, Wymenga AB, van Heerwaarden RJ. Osteotomies
around the knee: patient selection, stability of fixation
and bone healing in high tibial osteotomies. J Bone
Joint Surg Br. 2008; 90(12):1548-57.
20. Murphy SB. Tibial osteotomy for genu varum.
Indications, preoperative planning, and technique.
Orthop Clin North Am. 1994; 25(3):477-82.
21. Bonnin M, Chambat P.Current status of valgus angle,
tibial head closing wedge osteotomy in media
gonarthrosis. Orthopade. 2004; 33(2):135-42.
22. Jenny JY, Tavan A, Jenny G, Kehr P. Long-term survival
rate of tibial osteotomies for valgus gonarthrosis.
Rev Chir Orthop Reparatrice Appar Mot. 1998;
84(4):350-7.
23. Phillips CL, Silver DA, Schranz PJ, Mandalia V. The
measurement of patellar height: a review of the
methods of imaging. J Bone Joint Surg Br. 2010;
92(8):1045-53.
24. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12-
28-year followup study of closing wedge high tibial
osteotomy. Clin Orthop Relat Res. 2006; 452:91-6.
25. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The
Install Award. Survivorship of the high tibial valgus
osteotomy. A 10- to -22-year followup study. Clin
Orthop Relat Res. 1999; 367:18-27.
26. Gstöttner M, Pedross F, Liebensteiner M, Bach C. Longterm
outcome after high tibial osteotomy. Arch Orthop
Trauma Surg. 2008; 128(1):111-5.
27. Aglietti P, Rinonapoli E, Stringa G, Taviani A. Tibial
osteotomy for the varus osteoarthritic knee. Clin
Orthop Relat Res. 1983; 176:239-51.
28. Ivarsson I, Myrnerts R, Gillquist J. High tibial
osteotomy for medial osteoarthritis of the knee. A 5
to 7 and 11 year follow-up. J Bone Joint Surg Br. 1990;
72(2):238-44.
29. Rudan JF, Simurda MA. High tibial osteotomy. A
prospective clinical and roentgenographic review. Clin
Orthop Relat Res. 1990; 255:251-6.
30. Insall JN, Joseph DM, Msika C. High tibial osteotomy
for varus gonarthrosis. A long-term follow-up study. J
Bone Joint Surg Am. 1984; 66(7):1040-8.
31. Stuchin SA, Johanson NA, Lachiewicz PF, Mont MA.
Surgical management of inflammatory arthritis of the
adult hip and knee. Instr Course Lect. 1999; 48:93-109.
32. Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC.
The role of joint load in knee stability. J Bone Joint Surg

Am. 1981; 63(4):570-85.
33. Babis GC, An KN, Chao EY, Rand JA, Sim FH. Double
level osteotomy of the knee: a method to retain jointline
obliquity. Clinical results. J Bone Joint Surg Am.
2002; 84-A(8):1380-8.
34. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial
osteotomy. A critical long-term study of eighty-seven
cases. J Bone Joint Surg Am. 1993; 75(2):196-201.
35. Odenbring S, Tjörnstrand B, Egund N, Hagstedt B,
Hovelius L, Lindstrand A, et al. Function after tibial
osteotomy for medial gonarthrosis below aged 50
years. Acta Orthop Scand. 1989; 60(5):527-31.
36. Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A,
Bruzzone M, et al. Medial opening wedge high tibial
osteotomy for medial compartment overload/arthritis
in the varus knee: prognostic factors. Am J Sports Med.
2014; 42(3):690-8.
37. Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial
alignment of the lower extremity and load-bearing
distribution at the knee. Clin Orthop Relat Res. 1990;
255:215-27.
38. Moreland JR, Bassett LW, Hanker GJ. Radiographic
analysis of the axial alignment of the lower extremity.
J Bone Joint Surg Am. 1987; 69(5):745-9.
39. Tetsworth K, Paley D. Malalignment and
degenerative arthropathy. Orthop Clin North Am.
1994; 25(3):367-77.
40. Fujisawa Y, Masuhara K, Shiomi S. The effect of high
tibial osteotomy on osteoarthritis of the knee. An
arthroscopic study of 54 knee joints. Orthop Clin North
Am. 1979; 10(3):585-608.
41. Iorio R, Healy WL. Unicompartmental arthritis of the
knee. J Bone Joint Surg Am. 2003; 85-A(7):1351-64.
42. Hernigou P, Medevielle D, Debeyre J, Goutallier D.
Proximal tibial osteotomy for osteoarthritis with varus
deformity. A ten to thirteen-year follow-up study. J
Bone Joint Surg Am. 1987; 69(3):332-54.
43. Coventry MB. Upper tibial osteotomy for osteoarthritis.
J Bone Joint Surg Am. 1985; 67(7):1136-40.
44. Engel GM, Lippert FG 3rd. Valgus tibial osteotomy:
avoiding the pitfalls. Clin Orthop Relat Res. 1981;
160:137-43.
45. Kettelkamp DB, Chao EY. A method for quantitative
analysis of medial and lateral compression forces at
the knee during standing. Clin Orthop Relat Res. 1972;
83:202-13.
46. Koshino T, Morii T, Wada J, Saito H, Ozawa N, Noyori
K. High tibial osteotomy with fixation by a blade plate
for medial compartment osteoarthritis of the knee.
Orthop Clin North Am. 1989; 20(2):227-43.
47. Myrnerts R. Optimal correction in high tibial
osteotomy for varus deformity. Acta Orthop Scand.
1980; 51(4):689-94.
48. Dugdale TW, Noyes FR, Styer D. Preoperative
planning for high tibial osteotomy. The effect of lateral
tibiofemoral separation and tibiofemoral length. Clin
Orthop Relat Res. 1992; 274:248-64.
49. Rossi R, Bonasia DE, Amendola A. The role of high tibial
osteotomy in the varus knee. J Am Acad Orthop Surg.
2011; 19(10):590-9.
50. Müller M, Strecker W. Arthroscopy prior to osteotomy
around the knee? Arch Orthop Trauma Surg. 2008;
128(11):1217-21.
51. Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A. High
tibial valgus osteotomy for medial gonarthrosis: a 10-
to 21-year study. J Knee Surg. 2003; 16(1):21-6.
52. Berman AT, Bosacco SJ, Kirshner S, Avolio A Jr. Factors
influencing long-term results in high tibial osteotomy.
Clin Orthop Relat Res. 1991; 272:192-8.
53. Holden DL, James SL, Larson RL, Slocum DB. Proximal
tibial osteotomy in patients who are fifty years old or
less. A long-term follow-up study. J Bone Joint Surg Am.
1988; 70(7):977-82.
54. Devgan A, Marya KM, Kundu ZS, Sangwan SS, Siwach
RC. Medial opening wedge high tibial osteotomy for
osteoarthritis of knee: long-term results in 50 knees.
Med J Malaysia. 2003; 58(1):62-8.
55. Patond KR, Lokhande AV. Medial open wedge high tibial
osteotomy in medial compartment osteoarthrosis of
the knee. Natl Med J India. 1993; 6(3):104-8.
56. Kettelkamp DB, Leach RE, Nasca R. Pitfalls of
proximal tibial osteotomy. Clin Orthop Relat Res.
1975; 106:232-41.
57. Kirgis A, Albrecht S. Palsy of the deep peroneal nerve
after proximal tibial osteotomy. An anatomical study. J
Bone Joint Surg Am. 1992; 74(8):1180-5.
58. Recommendations for the optimal care of the
traumatized and/or burned patients. Part IV. The
North Carolina Committee on Trauma of the American
College of Surgeons. N C Med J. 1980; 41(12):818-23.
59. Billings A, Scott DF, Camargo MP, Hofmann AA. High
tibial osteotomy with a calibrated osteotomy guide,
rigid internal fixation, and early motion. Long-term
follow-up. J Bone Joint Surg Am. 2000; 82(1):70-9.
60. Coventry, M.B., Upper tibial osteotomy. Clin Orthop
Relat Res, 1984(182): p. 46-52.
61. Grelsamer RP. Unicompartmental osteoarthrosis of the
knee. J Bone Joint Surg Am. 1995; 77(2):278-92.
62. Leutloff D, Tobian F, Perka C. High tibial osteotomy for
valgus and varus deformities of the knee. Int Orthop.
2001; 25(2):93-6.
63. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal

tibial osteotomy. A new fixation device. Clin Orthop
Relat Res. 1989; 246:250-9.
64. Naudie DD, Amendola A, Fowler PJ. Opening wedge
high tibial osteotomy for symptomatic hyperextensionvarus
thrust. Am J Sports Med. 2004; 32(1):60-70.
65. Rinonapoli E, Aglietti P, Mancini GB, Buzzi R. High tibial
osteotomy in the treatment of arthritic varus knee. A
medium term (small) review of 61 cases. Ital J Orthop
Traumatol. 1988; 14(3):283-92.
66. Yasuda K, Majima T, Tsuchida T, Kaneda K. A ten- to 15-
year follow-up observation of high tibial osteotomy in
medial compartment osteoarthrosis. Clin Orthop Relat
Res. 1992; 282:186-95.
67. Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X,
et al. Posterior tibial slope changes after opening- and
closing-wedge high tibial osteotomy: a comparative
prospective multicenter study. Orthop Traumatol Surg
Res. 2012; 98(1):68-74.
68. Javidan P, Adamson GJ, Miller JR, Durand P Jr, Dawson
PA, Pink MM, et al. The effect of medial opening wedge
proximal tibial osteotomy on patellofemoral contact.
Am J Sports Med. 2013; 41(1):80-6.
69. McNamara I, Birmingham TB, Fowler PJ, Giffin JR. High
tibial osteotomy: evolution of research and clinical
applications--a Canadian experience. Knee Surg Sports
Traumatol Arthrosc. 2013; 21(1):23-31.
70. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer
P. The effects of valgus medial opening wedge high
tibial osteotomy on articular cartilage pressure of
the knee: a biomechanical study. Arthroscopy. 2007;
23(8):852-61.
71. Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW. A
“safe zone” in medial open-wedge high tibia osteotomy
to prevent lateral cortex fracture. Knee Surg Sports
Traumatol Arthrosc. 2013; 21(1):90-5.
72. Hernigou P. Open wedge tibial osteotomy: combined
coronal and sagittal correction. Knee. 2002;
9(1):15-20.
73. Noyes FR, Goebel SX, West J. Opening wedge tibial
osteotomy: the 3-triangle method to correct axial
alignment and tibial slope. Am J Sports Med. 2005;
33(3):378-87.
74. Asada S, Akagi M, Mori S, Matsushita T, Hashimoto K,
Hamanishi C. Increase in posterior tibial slope would
result in correction loss in frontal plane after medial
open-wedge high tibial osteotomy. Knee Surg Sports
Traumatol Arthrosc. 2012; 20(3):571-8.
75. El-Azab H, Halawa A, Anetzberger H, Imhoff AB,
Hinterwimmer S. The effect of closed- and open-wedge
high tibial osteotomy on tibial slope: a retrospective
radiological review of 120 cases. J Bone Joint Surg Br.
2008; 90(9):1193-7.
76. Nha KW, Kim HJ, Ahn HS, Lee DH. Change in Posterior
Tibial Slope After Open-Wedge and Closed-Wedge
High Tibial Osteotomy: A Meta-analysis. Am J Sports
Med. 2016.
77. Agneskirchner JD, Hurschler C, Stukenborg-Colsman
C, Imhoff AB, Lobenhoffer P. Effect of high tibial flexion
osteotomy on cartilage pressure and joint kinematics:
a biomechanical study in human cadaveric knees.
Winner of the AGA-DonJoy Award 2004. Arch Orthop
Trauma Surg. 2004; 124(9):575-84.
78. Reising K, Strohm PC, Hauschild O, Schmal H, Khattab
M, Südkamp NP, et al. Computer-assisted navigation for
the intraoperative assessment of lower limb alignment
in high tibial osteotomy can avoid outliers compared
with the conventional technique. Knee Surg Sports
Traumatol Arthrosc. 2013; 21(1):181-8.
79. Iorio R, Pagnottelli M, Vadalà A, Giannetti S, Di Sette P,
Papandrea P, et al. Open-wedge high tibial osteotomy:
comparison between manual and computer-assisted
techniques. Knee Surg Sports Traumatol Arthrosc.
2013; 21(1):113-9.
80. Schröter S, Gonser CE, Konstantinidis L, Helwig P,
Albrecht D. High complication rate after biplanar
open wedge high tibial osteotomy stabilized with a
new spacer plate (Position HTO plate) without bone
substitute. Arthroscopy. 2011; 27(5):644-52.
81. Spahn G. Complications in high tibial (medial opening
wedge) osteotomy. Arch Orthop Trauma Surg. 2004;
124(10):649-53.
82. van den Bekerom MP, Patt TW, Kleinhout MY, van der
Vis HM, Albers GH. Early complications after high tibial
osteotomy: a comparison of two techniques. J Knee
Surg. 2008; 21(1):68-74.
83. Brinkman JM, Luites JW, Wymenga AB, van
Heerwaarden RJ. Early full weight bearing is safe in
open-wedge high tibial osteotomy. Acta Orthop. 2010;
81(2):193-8.
84. Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I,
Kumagai K, et al. Medial opening wedge high tibial
osteotomy with early full weight bearing. Arthroscopy.
2009; 25(1):46-53.
85. Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer
P, et al. Primary stability of four different implants for
opening wedge high tibial osteotomy. Knee Surg Sports
Traumatol Arthrosc. 2006; 14(3):291-300.
86. Pape D, Kohn D, van Giffen N, Hoffmann A, Seil R,
Lorbach O. Differences in fixation stability between
spacer plate and plate fixator following high tibial
osteotomy. Knee Surg Sports Traumatol Arthrosc.
2013; 21(1):82-9.

Kyung HS, Lee BJ, Kim JW, Yoon SD. Biplanar Open Wedge
High Tibial Osteotomy in the Medial Compartment
Osteoarthritis of the Knee Joint: Comparison between
the Aescula and TomoFix Plate. Clin Orthop Surg. 2015;
7(2):185-90.
88. Golovakhа ML, Orljanski W, Benedetto KP, Panchenko
S, Büchler P, Henle P, et al. Comparison of theoretical
fixation stability of three devices employed in medial
opening wedge high tibial osteotomy: a finite element
analysis. BMC Musculoskelet Disord. 2014; 15:230.
89. Samani SS, Kachooei AR, Ebrahimzadeh MH,
Omidi Kashani F, Mahdavian Naghashzargar R,
Razi S. Application of Orthopedic Dual Sliding
Compression Plate (ODSCP) in High Medial Tibial
Open Wedge Osteotomies. Iran Red Crescent Med J.
2013; 15(4):335-9.
90. Staubli AE. Radiologische Heilungsvorgänge nach
öffnender kniegelenknaher Tibiaosteotomie. In:
Lobenhoffer P, Agneskirchner JD, Galla M, eds.
Kniegelenknahe osteotomien: indikation, planung,
operationstechnik mit plattenfixateuren. New
York: Georg Thieme Verlag KG; 2006: p. 65-78.
91. Onodera J, Kondo E, Omizu N, Ueda D, Yagi T, Yasuda K.
Beta-tricalcium phosphate shows superior absorption
rate and osteoconductivity compared to hydroxyapatite
in open-wedge high tibial osteotomy. Knee Surg Sports
Traumatol Arthrosc. 2014; 22(11):2763-70.
92. Gaasbeek RD, Toonen HG, van Heerwaarden RJ, Buma
P. Mechanism of bone incorporation of beta-TCP bone
substitute in open wedge tibial osteotomy in patients.
Biomaterials. 2005; 26(33):6713-9.
93. Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig
M, Hinterwimmer S. May smokers and overweight
patients be treated with a medial open-wedge HTO?
Risk factors for non-union. Knee Surg Sports Traumatol
Arthrosc. 2011; 19(3):333-9.
94. Kuremsky MA, Schaller TM, Hall CC, Roehr BA, Masonis
JL. Comparison of autograft vs allograft in openingwedge
high tibial osteotomy. J Arthroplasty. 2010;
25(6):951-7.
95. Luites JWH, BJ, van Heerwaarden R, Valstar ER,
Wymenga AB. Stability of open vs closed wedge
high tibial osteotomy measured with roentegen
stereophotogrammetric analysis in a randomised
clinical trial. ESSKA Congress; 2006.
96. Koshino T, Yoshida T, Ara Y, Saito I, Saito T. Fifteen to
twenty-eight years’ follow-up results of high tibial
valgus osteotomy for osteoarthritic knee. Knee. 2004.
11(6):439-44.
97. Weale AE, Lee AS, MacEachern AG. MacEachern, High
tibial osteotomy using a dynamic axial external fixator.
Clin Orthop Relat Res. 2001; 382:154-67.
98. Hernigou P, Ma W. Open wedge tibial osteotomy with
acrylic bone cement as bone substitute. Knee. 2001;
8(2):103-10.
99. Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob
RP. High tibial valgus osteotomy in unicompartmental
medial osteoarthritis of the knee: a retrospective
follow-up study over 13-21 years. Knee Surg Sports
Traumatol Arthrosc. 2011; 19(1):122-7.
100. Duivenvoorden T, Brouwer RW, Baan A, Bos PK,
Reijman M, Bierma-Zeinstra SM, et al. Comparison
of closing-wedge and opening-wedge high tibial
osteotomy for medial compartment osteoarthritis
of the knee: a randomized controlled trial with
a six-year follow-up. J Bone Joint Surg Am. 2014;
96(17):1425-32.
101. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I,
Horiuchi H. The long-term outcome of high tibial
osteotomy - A ten- to 20-year follow-up. Journal of Bone
and Joint Surgery-British Volume. 2008; 90B(5):592-6.
102. Billings A, Scott DF, Camargo MP, Hofmann AA. High
tibial osteotomy with a calibrated osteotomy guide,
rigid internal fixation, and early motion - Long-term
follow-up. Journal of Bone and Joint Surgery-American
Volume. 2000; 82A(1):70-9.
103. Brouwer RW, Raaij van TM, Bierma-Zeinstra SM,
Verhagen AP, Jakma TS, Verhaar JA. Osteotomy for
treating knee osteoarthritis. Cochrane Database Syst
Rev. 2007; 3:CD004019.
104. Esenkaya I, Elmali N. Proximal tibia medial open-wedge
osteotomy using plates with wedges: early results in
58 cases. Knee Surg Sports Traumatol Arthrosc. 2006;
14(10):955-61.
105. Miller BS, Downie B, McDonough EB, Wojtys EM.
Complications after medial opening wedge high tibial
osteotomy. Arthroscopy. 2009; 25(6):639-46.
106. Nelissen EM, van Langelaan EJ, Nelissen RG. Stability of
medial opening wedge high tibial osteotomy: a failure
analysis. Int Orthop. 2010; 34(2):217-23.
107. Giuseffi SA, Replogle WH2, Shelton WR. Opening-
Wedge High Tibial Osteotomy: Review of 100
Consecutive Cases. Arthroscopy. 2015; 31(11):
2128-37.
108. Martin R, Birmingham TB, Willits K, Litchfield R, Lebel
ME, Giffin JR. Adverse event rates and classifications
in medial opening wedge high tibial osteotomy. Am J
Sports Med. 2014. 42(5):1118-26.