New developments in osteotomy techniques and methods of fixation have caused a revival of interest of osteotomies around the knee. The current consensus on the indications, patient selection and the factors influencing the outcome after high tibial osteotomy is presented. This paper highlights recent research aimed at joint pressure redistribution, fixation stability and bone healing that has led to improved surgical techniques and a decrease of post-operative time to full weight-bearing.

Osteotomies around the knee

https://www.knee.ae/wp-content/themes/international_knee_joint/pdf/high-tibial-osteotomy-current-concepts.pdf

Patient selection, stability of fixation and bone healing in high tibial osteotomies

Die Kenntnis der Biomechanik sowie die richtige Patientenauswahl stellen ganz entscheidende Faktoren fur den Erfolg einer Umstellungsosteotomie dar. Ein besseres Verstandnis der Biomechanik unter Berucksichtung von 5 grundlegenden biomechanischen Faktoren kann die Ergebnisse der Umstellungsosteomien deutlich verbessern. Bei der Indikationsstellung ist ein standardisiertes Vorgehen hilfreich. Neuere Erkenntnisse uber Prognosefaktoren bei der Gonarthrose erleichtern die Entscheidungsfindung. Das angestrebte Ziel einer kniegelenknahen Umstellungsosteotomie bei Varus- oder Valgusfehlstellungen sollte eine individuelle Entlastung des betroffenen Kompartments unter Berucksichtigung der biomechanischen Prinzipien sein. In 10–15% der Falle ist dieses Ziel jedoch nur mit einer Doppelosteotomie an Femur und Tibia moglich.

Biomechanische Grundlagen und Indikationen bei der kniegelenknahen Osteotomie

Purpose
Open-wedge high tibial osteotomy using internal plate fixation is a well-established and frequently performed treatment option for the management of medial compartment osteoarthritis (OA) in the young and active patients. The present study provides survival rate and functional outcome preoperatively and after 6, 12, 24, 36 and 60 months following open-wedge high tibial osteotomy. Hypothesis of the authors was high survival rates after 5 years with still remaining satisfying functional results.

Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy

Die Tibiavalgisationsosteotomie ist seit vielen Jahren ein etabliertes Verfahren bei der unikompartimentalen medial betonten Gonarthrose. Nachdem mit der zunehmenden Verbesserung der Knietotalprothesen vor einigen Jahren die Bedeutung beim alten Patienten rucklaufig wurde, tritt die Therapiemoglichkeit der Valgisationsosteotomie mit den neuen knorpelchirurgischen Moglichkeiten wieder vermehrt in den Mittelpunkt des Interesses. Vor allem bei medialen traumatischen oder beginnenden degenerativen Knorpelschaden am Kniegelenk ist ein Kombinationseingriff einer knorpelchirurgischen Masnahme mit einer Tibiavalgisationsosteotomie eine wichtige Therapieoption.

Stellenwert der Tibiavalgisationsosteotomie in der Knorpelchirurgie

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Stellenwert der Tibiavalgisationsosteotomie in der Knorpelchirurgie