Preoperative Planning for High Tibial Osteotomies

Valgus-producing osteotomy of the proximal tibia is a well-established treatment for medial femorotibial osteoarthritis in the varus knee. The ideal patient is active, younger than 55 years of age, has a stable varus deformity of less than 10°, a good bone stock, and an osteoarthritis stage that is restricted to the medial compartment of the knee. There are different preoperative planning methods varying between simple estimates of correction angles and specific radiographic planning tools. These methods can be based on the anatomic axis, the mechanical axis, or the weight-bearing line. Both anterior and posterior cruciate ligament insufficiency may be considered in the preoperative planning process through alterations in the sagittal plane alignment. The reproducibility of operative outcome with regard to a predictable anatomic alignment and functional recovery must have a high priority. This article deals with different preoperative planning methods to improve the reliability of surgical results after tibial osteotomy.