High Tibial Osteotomy: The Italian Experience

Osteotomy is one of the more ancient orthopaedic procedures still used today. Today, new knowledge and technology about bone healing and better fixations to accelerate postoperative management have allowed high tibial osteotomy to become a useful procedure for active patients younger than 60 years of age with symptomatic unicompartmental disease and osseous deformity of the knee. An important advantage of this procedure is the possibility of combining with it the articular cartilage procedure (osteochondral grafts, autologous chondrocyte implantation), meniscus transplantation, or ligament reconstruction. The 2 main techniques to produce valgus realignment of the knee are lateral closing wedge osteotomy and medial opening wedge osteotomy. We also can perform elevation osteotomy in posttraumatic cases and procurvation osteotomy to correct genu recurvatum. Most complications resulting from osteotomy can be avoided by careful patient selection and accurate preoperative planning. Therefore, the role of high tibial osteotomy is not only curative as in treating cartilage damage and posttraumatic axial deviation in patients older than 50 years but also preventive in degenerative joint diseases of young patients with congenital or posttraumatic axial deviation or anatomical deformation of the knee joint.