ArticleJournal of orthopaedic surgery and research2026
Sagittal alignment and patellofemoral consequences of open wedge high tibial osteotomy: a comparative radiological and gait analysis of supratubercle and distal tibial tuberosity techniques.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe optimal osteotomy configuration in medial open-wedge high tibial osteotomy (OWHTO) remains debated. Descending biplanar and ascending biplanar techniques differ regarding biomechanical stability, risk of patellar height alteration, and hinge-related complications, yet high-quality comparative evidence integrating clinical, radiological, and gait-level functional outcomes is lacking.
methodsIn this retrospective comparative cohort study, we reviewed 96 patients with medial compartment knee osteoarthritis who underwent supratubercle biplanar OWHTO (STB-OWHTO, n = 45) or distal tibial tuberosity osteotomy OWHTO (DTT-OWHTO). Clinical outcomes (Hospital for Special Surgery score), radiological parameters (weight-bearing line ratio, posterior tibial slope, and Caton-Deschamps index [CDI]), and gait biomechanics (spatiotemporal, kinematic, and kinetic variables, including the knee adduction moment) were retrospectively extracted from medical records and an institutional gait-analysis database preoperatively and at an early postoperative follow-up (mean duration, ~ 60 days).
resultsBaseline characteristics were comparable between the two groups. Both techniques yielded significant improvements in the HSS score and gait performance alongside a marked reduction in KAM (all P < 0.001). STB-OWHTO exerted a greater coronal realignment effect on WBLR (group-by-time interaction P = 0.016), while it was associated with an increase in the posterior tibial slope (+ 5.26°, P < 0.001) and a reduction in patellar height (CDI = - 0.17, P < 0.001). Conversely, DTT-OWHTO preserved patellar height (insignificant CDI change, P = 0.169) and reduced the posterior tibial slope (P = 0.003). Spatiotemporal gait improvements were similar between the two groups. Small between-group differences in stance-phase knee flexion were identified.
conclusionBoth STB-OWHTO and DTT-OWHTO provide early clinical improvement and effective medial compartment unloading during gait in varus knee osteoarthritis, while they produce distinct sagittal-plane and patellofemoral consequences. The osteotomy configuration should be individualized according to the patellofemoral status, ligament considerations, and the desired slope modification.
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