Osteotomy about the knee: applications, techniques, and results

Varus or valgus malalignment of the knee may be either a cause or a consequence of unicompartmental knee arthritis in young, active adults. Proximal tibial osteotomy for the varus knee and distal femoral osteotomy for the valgus knee have been used for decades to manage this condition; however, their use has decreased significantly in recent years as the popularity of unicompartmental and total knee arthroplasty has grown. With the advent of biologic resurfacing techniques for focal full-thickness articular cartilage injury, combined or staged high tibial osteotomy is becoming increasingly popular. In addition, in the face of cruciate ligamentous instability with or without posterolateral corner instability coupled with varus malalignment, high tibial osteotomy with and without ligament reconstruction provides a solution to complex orthopedic problems. Recent long-term follow-up studies have concluded osteotomy allows for improved function and pain relief in properly selected young patients.