Combined High Tibial Osteotomy Decreases Biomechanical Changes Radiologically Detectable in the Sagittal Plane Compared With Closing-Wedge Osteotomy

Miklós Papp, László Szabó, István Lázár, István Takács, Zoltán Károlyi, Gergely G. Nagy, György Vereb

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9 Citations (Scopus)


Purpose: The purpose of this randomized, prospective study was to compare radiologic changes in the sagittal plane after closing-wedge and combined high tibial osteotomies (HTOs) performed in patients with medial knee arthrosis associated with a varus deformity and requiring a 10° correction. Methods: The patellar height, determined by the Insall-Salvati index (ISI), and tibial slope (TS) angle, measured by the Dejour-Bonnin method, were compared after 45 closing-wedge osteotomy (CWO) and 46 combined osteotomy (CO) procedures. CO is a relatively new technique effectively being the combination of closing-wedge and opening-wedge HTOs. It involves performing a proximal osteotomy parallel to the tibial plateau, followed by a distal osteotomy extending from the lateral part of the tibia to the line of the proximal osteotomy at the center of the tibial condyle. After closure of the lateral part of the osteotomy and consequent opening of the medial part, the removed lateral bone wedge is transferred to the gap on the medial side. Results: We found that at the end of the study, 12 months after the operation, CO resulted in significantly smaller changes in TS angle (4.7% v 38.2%) and ISI (2.2% v 5.7%) values than CWO. Conclusions: The main conclusion of this study is that based on our radiologic findings, CO results in significantly smaller changes in TS angle and ISI values than CWO; therefore, CO is better at preserving the normal or near normal condition of the knee than CWO. Altogether, when a 10° correction is required during HTO, we recommend choosing CO instead of CWO. Level of Evidence: Level II, prospective comparative study.

Original languageEnglish
Pages (from-to)355-364
Number of pages10
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Issue number4
Publication statusPublished - Apr 1 2009



  • Closing-wedge high tibial osteotomy
  • Combined high tibial osteotomy
  • Dejour-Bonnin method
  • Insall-Salvati index
  • Length of patellar tendon
  • Tibial slope angle

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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