Editorial Commentary: Biplanar Medial Opening-Wedge High Tibial Osteotomy: A Retrotubercular Technique Changes the Patellofemoral Alignment Less Than a Supratubercular Technique but May Increase the Tibial Slope and Complication Rates.

Abstract

An opening-wedge high tibial osteotomy may be performed with a uniplanar cut, usually passing proximal to the tibial tubercle, or a biplanar cut, with the anterior part of the cut passing either proximal to the tibial tubercle (an ascending anterior or supra-tubercular biplanar osteotomy) or distal to the tibial tubercle (a descending anterior or retrotubercular biplanar osteotomy). A retrotubercular osteotomy maintains the patellofemoral alignment, whereas a supratubercular osteotomy can decrease the patellar height and lateralize the tibial tubercle. However, maintaining the patellofemoral alignment may not translate to a clinical benefit, and a retrotubercular technique is technically more difficult, has the potential to increase the posterior tibial slope, and confers an increased risk of complications.