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Technical tips and tricks for complex biplanar high tibial osteotomies
Tyler M Hauer1,2, Romed P Vieider1,3, David Wasserstein4
1Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Summary
Biplanar high tibial osteotomy (HTO) corrects complex knee deformities in both coronal and sagittal planes. Precise planning and execution are key for successful knee-preserving surgery in patients with cruciate ligament insufficiency.
Area of Science:
- Orthopaedic Surgery
- Biomechanics
- Knee Joint Anatomy
Background:
- Traditional high tibial osteotomy (HTO) primarily corrects coronal plane malalignment.
- Sagittal plane alignment, specifically posterior tibial slope (PTS), is crucial in cruciate ligament insufficiency.
- Combined coronal and sagittal plane deformities present unique surgical challenges.
Purpose of the Study:
- To review literature and provide surgical tips for managing complex biplanar knee deformities.
- To discuss case-based techniques for correcting combined coronal and sagittal plane malalignments.
- To emphasize the importance of addressing both planes for optimal patient outcomes.
Main Methods:
- Narrative review of preoperative planning, surgical techniques, and clinical outcomes.
- Case-based discussion of four distinct biplanar HTO techniques.
- Detailed explanation of surgical rationale and technical nuances for each technique.
Main Results:
- Four techniques for biplanar HTO are presented: Hybrid HTO (POW/ACW), asymmetrical MCW HTO, MOW HTO with anterolateral hinge, and double HTO (ACW/MOW).
- Accurate assessment and correction of biplanar deformities are vital for successful outcomes.
- Biplanar HTO offers a knee-preserving option for specific complex deformities.
Conclusions:
- Biplanar HTO is a viable knee-preserving option for a select group of patients.
- Meticulous preoperative planning and surgical execution are essential for effective biplanar deformity correction.
- This review serves as a guide for surgeons managing complex biplanar knee malalignments.
