Inverted V–Shaped High Tibial Osteotomy for Medial Osteoarthritic Knees With Severe Varus Deformity

A hemi–closing-wedge and hemi–opening-wedge, inverted V–shaped high tibial osteotomy with local bone graft has been reported to be an effective surgical procedure for medial osteoarthritis of the knee. In this procedure, an inverted V–shaped osteotomy is made and a thin wedged bone block is resected from the lateral side and implanted in the medial opening space created after valgus correction. This procedure can provide sufficient valgus correction of the knee with severe varus deformity more easily than can closing-wedge high tibial osteotomy. The inverted V–shaped osteotomy does not change the posterior tibial slope, the patellar height, or the length of the lower limb at all because the center of tibial alignment correction by the inverted V–shaped osteotomy is located near the center of rotation of angulation of the lower-limb deformity. We recently modified this procedure by performing biplanar osteotomy, developing useful cutting guides, and fixing the tibia with a lateral locking compression plate. The surgical technique is described to enable the reproducible creation of the hemi–closing-wedge and hemi–opening-wedge, inverted V–shaped osteotomy with the locking plate for medial osteoarthritic knees with moderate or severe varus deformity

An Acute Oblique Osteotomy and Suture Ligation Procedure to Shorten the Fibula in Lateral Closing-Wedge High Tibial Osteotomy

The purpose of this description is to report an “acute oblique osteotomy and ligation” (AOOL) procedure to shorten the fibula in high tibial osteotomy (HTO). A 4-cm longitudinal skin incision is made at the lateral aspect of the leg. After the central portion of the fibula is circumferentially isolated from all the periosteal tissues, a simple osteotomy is performed at the mid-portion of the fibular diaphysis in the quasi-frontal plane, which is inclined by 25 to 30° to the long axis of the fibula. Two thin holes are created beside the osteotomy line on the lateral surface of the fibula. A polyester thread is passed through the 2 holes. After the HTO is completed, the surgeon easily reduces the displaced fibular ends using this thread. This thread is securely tied to keep the contact between the 2 osteotomized surfaces. The AOOL procedure is technically easy and safely performed. We believe that the AOOL procedure is clinically useful to shorten the fibular shaft in HTO