We hypothesized that patient treated with OWHTO who participate in high-impact sports would attain satisfactory outcome. The purpose of this study was to examine the clinical and radiological outcomes in a consecutive series of opening-wedge high tibial osteotomy (OWHTO) in highly active patients.
Seventy-seven consecutive patients who underwent OWHTO with varus osteoarthritic knees were included in the study. The mean age of the study population was 56.1 years. All patients were followed for a minimum of 2 years. Clinical and radiological evaluations were performed at 12 and 24 months after surgery. The clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) Subjective Score. In regards to radiological assessment, the following parameters were measured in full-length weightbearing radiographs both pre- and postoperatively; mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), and weight bearing line (WBL) ratio.
Fifty-eight patients (75.3%) returned to the same high-impact sports activities as before surgery, with a mean time to return of 8.7 ± 2.7 months (6–14 months). In the clinical assessments, the IKDC subjective score and KOOS both improved from the mean preoperative scores of 38.4 and 217.4 points to the mean postoperative scores of 74.5 and 421.6 points, respectively. The mean pre-symptomatic Tegner activity scale was 5.3 ± 0.6 and significantly decreased to 4.8 ± 1.2 at 2 years postoperative (p < 0.05). In the radiological evaluation, the postoperative mTFA, mMPTA, and WBL ratio values averaged 1.3° ± 2.2° valgus, 90.7° ± 2.9°, and 51.6% ± 8.4°, respectively, at 24 months after surgery.
Clinical outcomes based on postoperative patient-reported outcome measures and rate of return to high-impact sports activities were favorable after OWHTO in patients with knee OA who desired to continue sporting activities with the Tegner activity score of ≥ 5 points.
Level of evidence
Retrospective case series, IV.
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Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861
Akiyama T, Okazaki K, Mawatari T, Ikemura S, Nakamura S (2016) Autologous osteophyte grafting for open-wedge high tibial osteotomy. Arthrosc Tech 5:e989–e999
Bonnin MP, Laurent JR, Zadegan F, Badet R, Pooler Archbold HA, Servien E (2013) Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc 21(1):64–73
Ekhtiari S, Haldane CE, De Sa D, Simunovic N, Musahl V, Ayeni OR (2016) Return to work and sport following high tibial osteotomy: a systematic review. J Bone Jt Surg Am 98(18):1568–1577
Faschingbauer M, Nelitz M, Urlaub S, Reichel H, Dornacher D (2015) Return to work and sporting activities after high tibial osteotomy. Int Orthop 39:1527–1534
Feucht MJ, Minzlaff P, Saier T, Cotic M, Südkamp NP, Niemeyer P, Imhoff AB, Hinterwimmer S (2014) Degree of axis correction in valgus high tibial osteotomy: proposal ofan individualised approach. Int Orthop 38(11):2273–2280
Fibel KH, Hillstrom HJ, Halpern BC (2015) State-of-the-art management of knee osteoarthritis. World J Clin Cases 3(2):89–101
Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21:170–180
Hoorntje A, Witjes S, Kuijer PP, Koenraadt KL, van Geenen RC, Daams JG, Getgood A, Kerkhoffs GM (2017) High rates of return to sports activities and work after osteotomies around the knee: a systematic review and meta-analysis. Sports Med 47(11):1–26
Johnstone SF, Tranovich MJ, Vyas D, Wright VJ (2013) Unicompartmental arthritis in the aging athlete: osteotomy and beyond. Curr Rev Musculoskelet Med 6:264–272
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–502
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Saito T (2017) Radiographic and computed tomographic evaluation of bone union after medial opening wedge high tibia osteotomy with filling gap. Knee 24:1108–1117
Lansdaal JR, Mouton T, Wascher DC, Demey G, Lustig S, Neyret P, Servien E (2016) Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 25(12):3670–3678
Lerat J, Moyen B, Garin C, Besse J, Brunet-Guedj E (1993) Anterior laxity and medial arthritis in varus knee. Reconstruction of the anterior cruciate ligament associated with a high tibial osteotomy. J Orthop Surg 7(3):333–342
Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138
Magyar G, Ahl TL, Vibe P, Toksvig-Larsen S, Lindstrand A (1999) Open-wedge osteotomy by hemicallotasis or the closedwedge technique for osteoarthritis of the knee. A randomised study of 50 operations. J Bone Jt Surg Br 81(3):444–448
Martin R, Birmingham TB, Willits K, Litchfield R, Lebel ME, Giffin JR (2014) Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Am J Sports Med 42:1118–1126
Minzlaff P, Feucht MJ, Saier T, Cotic M, Plath JE, Imhoff AB, Hinterwimmer S (2016) Can young and active patients participate in sports after osteochondral autologous transfer combined with valgus high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc 24(5):1594–1600
Nagel A, Insall J, Scuderi G (1996) Proximal tibial osteotomy: a subjective outcome study. J Bone Jt Surg Am 78:1353–1358
Odenbring S, Tjornstrand B, Egund N, Hagstedt B, Hovelius L, Lindstrand A, Luxhöj T, Svanström A (1989) Function after tibial osteotomy for medial gonarthrosis below age 50 years. Acta Orthop Scand 60:527–531
Paxton EW, Namba RS, Maletis GB, Khatod M, Yue EJ, DaviesM LRB Jr, Wyatt RW, Inacio MC, Funahashi TT (2010) A prospective study of 80,000 total joint and 5000 anterior cruciate ligament reconstruction procedures in a community-based registry in the United States. J Bone Jt Surg Am 92(Suppl 2):117–132
Salzmann GM, Ahrens P, Naal FD, El-Azab H, Spang JT, Imhoff AB, Lorenz S (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37(2):312–318
Saragaglia D, Rouchy RC, Krayan A, Refaie R (2014) Return to sports after valgus osteotomy ofthe knee joint in patients with medial unicompartmental osteoarthritis. Int Orthop 38(10):2109–2114
Schröter S, Ateschrang A, Lowe W, Nakayama H, Stockle U, Ihle C (2015) Early full weight-bearing versus 6-week partial weightbearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 25:325–332
Schröter S, Ihle C, Elson DW, Döbele S, Stöckle U, Ateschrang A (2016) Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 24:3410–3417
Schröter S, Ihle C, Mueller J, Staubli P, Stockle U, van Heerwaarden R (2013) Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc 21:189–196
Smith JO, Wilson AJ, Thomas NP (2013) Osteotomy around the knee: evolution, principles and results. Knee Surg Sports Traumatol Arthrosc 21(1):3–22
Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34:55–62
Takeuchi R, Bito H, Akamatsu Y, Shiraishi T, Mosishita S, Koshino T, Saito T (2010) In vitro stability of open wedge high tibial osteotomy with synthetic bone graft. Knee 17:217–220
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Verbeek J, Mischke C, Robinson R, Ijaz S, Kuijer P, Kievit A, Ojajärvi A, Neuvonen K (2017) Occupational exposure to knee loading and the risk of osteoarthritis of the knee: a systematic review and a dose-response meta-analysis. Saf Health Work 8(2):130–142
Warme B, Aalderink K, Amendola A (2011) Is there a role for high tibial osteotomies in the athlete? Sports Health 3:59–69
Witjes S, Gouttebarge V, Kuijer PP, van Greenen RC, Poolman RW, Kerkhoffs GM (2016) Return to sports and physical activity after total and unicondylar knee arthroplasty: a systematic review and meta-analysis. Sports Med 46:1–24
Witjes S, van Geenen RC, Koenraadt KL, van der Hart CP, Blankevoort L, Kerkhoffs GM, Kuijer PP (2017) Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions? Qual Life Res 26(2):403–417
Yoshimura N, Muraki S, Oka H, Mabuchi A, En-Yo Y, Yoshida M, Saika A, Yoshida H, Suzuki T, Yamamoto S, Ishibashi H, Kawaguchi H, Nakamura K, Akune T (2009) Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study. J Bone Miner Metab 27:620–628
Zeni JA Jr, Axe MJ, Snyder-Mackler L (2010) Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis. BMC Musculoskelet Disord 11:86
The authors would like to acknowledge Rebecca Imaizumi for her assistance in the preparation of this article.
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Kanto, R., Nakayama, H., Iseki, T. et al. Return to sports rate after opening wedge high tibial osteotomy in athletes. Knee Surg Sports Traumatol Arthrosc 29, 381–388 (2021). https://doi.org/10.1007/s00167-020-05967-w
- Medial opening wedge high tibial osteotomy
- High-impact sports