Inverted V-Shaped High Tibial Osteotomy Decreases the Posterior Tibial Slope More but Shortens the Tibia Less Than Closed-Wedge High Tibial Osteotomy

Editorial Commentary: An Inverted V-Shaped High Tibial Osteotomy Combining a Lateral Closing Wedge and Medial Opening Wedge May Have Advantages

“…Subsequently, Papp et al 7 published the results of a prospective radiologic study of 45 CWHTOs and 46 combined HTOs, which found that a combined HTO resulted in smaller changes in the posterior tibial slope and patellar height. The fact that a combined HTO resulted in less flattening of the posterior tibial slope than a CWHTO contrasts with the findings of Hayashi et al 10 Thus, there is some limited evidence to support the use of an IVHTO. Hayashi et al 10 have argued that an IVHTO may be a better technique than a CWHTO in cases of anterior cruciate ligament deficiency when a decrease in the posterior tibial slope is beneficial, although the findings of Papp et al 7 contradict this view.…”

“…The fact that a combined HTO resulted in less flattening of the posterior tibial slope than a CWHTO contrasts with the findings of Hayashi et al 10 Thus, there is some limited evidence to support the use of an IVHTO. Hayashi et al 10 have argued that an IVHTO may be a better technique than a CWHTO in cases of anterior cruciate ligament deficiency when a decrease in the posterior tibial slope is beneficial, although the findings of Papp et al 7 contradict this view. It also has been suggested that the IVHTO technique may be a good option for larger corrections.…”

“…9 Typically, larger corrections are achieved using either a single osteotomy in the coronal plane, accepting some postoperative joint line obliquity, or a double-level osteotomy, 11,12 which is more complex. The benefits of an IVHTO over these 2 options have yet to be proved, and indeed the results presented by Hayashi et al 10 show that the postoperative medial proximal tibial angle, a measure of joint line obliquity, was similar in their 2 groups: 94.5 AE 2.9 in the IVHTO group and 95.6 AE 2.7 in the CWHTO group.…”