Rocca Michael S, Dias Karina, Hughes Jonathan D
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
Ann Jt. 2025 Apr 15;10:17. doi: 10.21037/aoj-24-68. eCollection 2025.
Osteotomies around the knee are an effective method for preserving the knee joint by correcting overall alignment. Although osteotomies have historically been used in treatment of knee pathology, they have recently regained a renewed interest as a treatment strategy for alignment correction, ligamentous stability, and cartilage preservation. Osteotomies are a powerful way to correct alignment in both the sagittal and coronal plane to preserve and/or protect the cartilage in the medial, lateral, and patellofemoral compartments of the knee and improve the ligamentous stability of the knee. Medial opening wedge high tibial osteotomy (MOW-HTO) and lateral closing wedge high tibial osteotomy (LCW-HTO) are commonly performed osteotomies for correcting varus malalignment, each with distinct indications, surgical techniques, and associated complications. Similarly, distal femoral osteotomy (DFO) plays a critical role in the correction of both varus and valgus malalignment, and may be particularly important in cases where a tibial osteotomy alone would lead to excessive joint line obliquity (JLO). In complex cases where single-level osteotomy does not provide optimal correction, double-level osteotomy may be necessary to achieve appropriate mechanical axis restoration while maintaining joint congruence. Beyond coronal plane corrections, increasing attention has been given to sagittal plane osteotomies for managing ligamentous instability, particularly anterior and posterior cruciate ligament (PCL) deficiencies. Modifying the posterior tibial slope (PTS) through anterior closing wedge or anterior opening wedge high tibial osteotomy can improve knee biomechanics and stability in both anterior cruciate ligament (ACL) and PCL-deficient patients. Additionally, tibial tubercle osteotomies (TTO) have emerged as an important surgical adjunct in the treatment of patellofemoral malalignment and cartilage preservation strategies. The goal of knee osteotomies is to offload the affected compartment, preserve and protect cartilage and menisci, and enhance ligamentous stability, thereby delaying the need for arthroplasty. Therefore, osteotomies represent an intriguing procedure for young and active patients. Recently, with the renewed interest in osteotomy procedures about the knee, studies have demonstrated that osteotomies continue to play a critical role in treatments for limb alignment and cartilage protection.
膝关节周围截骨术是通过矫正整体对线来保留膝关节的有效方法。尽管截骨术在历史上一直用于治疗膝关节病变，但最近作为一种用于对线矫正、韧带稳定性和软骨保留的治疗策略，它再次引起了人们的关注。截骨术是一种在矢状面和冠状面矫正对线的有效方法，以保留和/或保护膝关节内侧、外侧和髌股关节间室的软骨，并改善膝关节的韧带稳定性。内侧开放楔形高位胫骨截骨术（MOW-HTO）和外侧闭合楔形高位胫骨截骨术（LCW-HTO）是常用于矫正内翻畸形的截骨术，每种截骨术都有不同的适应症、手术技术和相关并发症。同样，股骨远端截骨术（DFO）在矫正内翻和外翻畸形中起着关键作用，在仅进行胫骨截骨术会导致过度关节线倾斜（JLO）的情况下可能尤为重要。在单平面截骨术不能提供最佳矫正的复杂病例中，则可能需要进行双平面截骨术，以在保持关节一致性的同时实现适当的机械轴恢复。除了冠状面矫正外，矢状面截骨术在治疗韧带不稳定方面，尤其是前交叉韧带和后交叉韧带（PCL）缺损方面，受到了越来越多的关注。通过前闭合楔形或前开放楔形高位胫骨截骨术改变胫骨后倾（PTS），可以改善前交叉韧带（ACL）和PCL缺损患者的膝关节生物力学和稳定性。此外，胫骨结节截骨术（TTO）已成为治疗髌股关节畸形和软骨保留策略的重要手术辅助手段。膝关节截骨术的目标是减轻受影响的关节间室的负荷，保留和保护软骨及半月板，并增强韧带稳定性，从而推迟关节置换的需求。因此，截骨术对于年轻且活跃的患者来说是一种有趣的手术。最近，随着对膝关节截骨术的重新关注，研究表明截骨术在肢体对线和软骨保护治疗中继续发挥着关键作用。
