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Osteotomies around the Knee—Part I
23 June 2017 (online)
Osteotomies around the knee are versatile surgical procedures aimed to improve the biomechanics of the knee joint. In the decade of 1960s, osteotomies gained more popularity especially for the treatment of unicompartmental knee arthritis. In this regard, it's primary purpose is to shift the mechanical load from a diseased knee compartment to a healthier one. The acceptance of osteotomies varies according to surgeon's training and cultural background. The introduction of arthroplasty has impacted the development of osteotomies negatively. Arthroplasty has been perceived as a more reliable procedure associated with shorter recovery time and earlier total weight-bearing status. At the same time, osteotomies presented mixed outcomes especially due to mechanical failures. In the last two decades, however, critical improvements took place. A better understanding of the biomechanics of the lower limb, advances in the field of image acquisition, and preoperative planning, the introduction of a new generation of stable angle implants, and the development of new surgical techniques have changed the outcomes of osteotomies completely. For young and physically active individuals, with unicompartmental joint pain and arthritis, knee osteotomy is the most recommended surgical procedure. Osteotomies may be used not only for the primary treatment of unicompartmental arthritis but also as a valuable tool in the treatment of knee instabilities. The correction of tibial slope in cases of recurrent anterior cruciate ligament instability, for instance, may represent the turning point between success and a new failure.
The Journal of Knee Surgery, aware about the growing interest in the topic of joint preservation, invited us to edit a supplement dedicated to the current concepts on osteotomies around the knee. Authors with considerable experience in the field prepared an outstanding review of concepts, which will be split into two volumes.
This first one covers the rationale of these surgeries, recent advances in deformity analysis, and preoperative planning, tibial osteotomies for the correction of either varus or valgus deformities, sagittal plane tibial corrections in cases of knee instabilities, and finally the evolution of hardware, which impacted the outcomes of these procedures significantly.
On behalf of the authors of this special focus section, we would like to thank the Journal of Knee Surgery for the opportunity to present to you a very educational material that we hope may be relevant to your current practice.