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Background: Valgus high tibial osteotomy (HTO) may be associated with changes in the patellar height and posterior tibial slope., Hypothesis: Patellar height increases and posterior tibial slope decreases after closed-wedge HTO, whereas patellar height decreases and tibial slope increases after open-wedge osteotomy., Study Design: Cohort study; Level of evidence, 3., Methods: Lateral radiographs of 100 knees were assessed for patellar height (PH) (Insall-Salvati index [ISI], Caton-De Champ index [CDI], and Blackburne-Peel index [BPI]) as well as posterior tibial slope. Measurements were done before HTO (50 closed wedge [CW], 50 open wedge [OW]), direct postoperatively, and before removal of the hardware., Results: In the CW group, all 3 PH indices were increased direct postoperatively and at removal of the hardware, with changes in CDI and BPI being significant (P<.05). The effect size (ES) for the direct postoperative PH increase was medium (ES = 0.48) according to CDI. In the OW group, all 3 indices showed a significant (P <.05) PH decrease direct postoperatively and at hardware removal. The ES for the direct postoperative PH decrease was large according to CDI (ES = 0.92) and BPI (ES = 0.80). There were no significant changes between the 2 follow-up measurements (P > .05) with a small ES each. Posterior tibial slope showed a significant (P <.05) decrease of 3.1 degrees +/- 3.4 degrees after CW HTO and a significant (P <.05) increase of 2.1 degrees +/- 3.6 degrees after OW HTO direct postoperatively. These changes did not change at the second follow-up. In CW HTO, the correlations between frontal plane correction and PH changes were moderate (CDI: r = .57; BPI: r = .64). In OW HTO, these correlations were weak (CDI: r = .44; BPI: r = .46). According to ISI, there was no correlation (CW: r = .11; OW: r = .16). There was no correlation between PH changes and slope changes (CDI) and no correlation between frontal plane HTO correction and slope changes in both CW and OW HTO., Conclusion: The results confirm our hypothesis for PH and posterior tibial slope changes after valgus HTO. However, there is no strong correlation between PH changes and the degree of frontal plane HTO correction. The incidence of patella infera increases after OW HTO, whereas the incidence of patella alta increases after CW HTO. Therefore, we recommend performing CW HTO or OW HTO with the tuberosity left at the proximal tibia in cases of patellofemoral complaints or patella infera. Neither technique leads to patellar lowering. It should be borne in mind that PH and posterior tibial slope may have been altered before planning total knee replacement after HTO.

Background: Isolated varus osteoarthritis of the knee is a common problem in patients engaged in sports and recreational activities., Hypothesis: Patients will be able to resume sporting activity after high tibial osteotomy., Study Design: Case series; Level of evidence, 4., Methods: A total of 65 patients were surveyed by postal questionnaires to determine their sporting and recreational activities at an average of 36 +/- 8.1 months (range, 14-84) after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. The clinical evaluation included the Lysholm score, the Tegner activity scale, the Activity Rating Scale, and a visual analog scale for pain., Results: At the time of survey, 90.9% of patients were engaged in sports and recreational activities, compared with 87.9% before surgery (P = .182). The number of different sporting activities declined from 3.5 preoperatively to 3.0 after surgery (P = .178). The sports frequency per week (2.1 sessions) and the activity duration per week (4.1 hours) did not significantly change from preoperative to postoperative (2.3, P = .211; and 4.2 hours, P = .709, respectively). The Lysholm score (42.4) and the visual analog scale (6.9) illustrated significant improvements (69.6, P = .001; and 2.9, P < .001, respectively). No patient returned to competitive sports after surgery, and declines were noted in the Tegner (4.9 +/- 2.3 to 4.3 +/- 1.5, P < .05) and Activity Rating Scale (5.7 +/- 5.2 to 3.3 +/- 4.6, P = .001) scores. After surgery, many patients continued to engage in high-level activities such as downhill skiing or mountain biking., Conclusion: High tibial osteotomy for the treatment of medial compartment knee osteoarthritis in the active patient demonstrated favorable clinical results and allowed patients to return to sports and recreational activities similar to the preoperative level.

Radiographs of 110 patients who had undergone 120 high tibial osteotomies (60 closed-wedge, 60 open-wedge) were assessed for posterior tibial slope before and after operation, and before removal of the hardware. In the closed-wedge group the mean slope was 5.7 degrees (SD 3.8) before and 2.4 degrees (SD 3.9) immediately after operation, and 2.4 degrees (SD 3.4) before removal of the hardware. In the open-wedge group, these values were 5.0 degrees (SD 3.7), 7.7 degrees (SD 4.3) and 8.1 degrees (SD 3.9) respectively, when stabilised with a non-locking plate, and 7.7 degrees (SD 3.5), 9.4 degrees (SD 4.1) and 9.1 degrees (SD 3.8), when stabilised with a locking plate. The reduction in slope (-2.7 degrees (SD 4.1)) in the closed-wedge group and the increase (+2.5 degrees (SD 3.4), in the open-wedge group was significantly different before and after operation (p = 0.002, p = 0.003). In no group were the changes in slope directly after operation and before removal of the hardware significant (p > 0.05). There was no correlation between the amount of correction in the frontal plane and the post-operative change in slope. Posterior tibial slope decreases after closed-wedge high tibial osteotomy and increases after an open-wedge procedure because of the geometry of the proximal tibia. The changes in the slope are stable over time, emphasising the influence of the operative procedure rather than of the implant.

An abstract of the article "The effect of closed-and open-wedge high tibial osteotomy on tibial slope: A Retrospective Radiological Review of 120 Cases," by H. El-Azab and colleagues is presented.