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Revisiting High Tibial Osteotomy: Fifty Years of Experience with the Opening-Wedge Technique
A. Poignard, MD1; C.H. Flouzat Lachaniette, MD1; Julien Amzallag, MD1; P. Hernigou, MD1
1 Chirurgie Orthopedique, Hospital Henri Mondor, University Paris XII, 51 Avenue du Marechal de Lattre de Tassigny, Creteil 94000, France. E-mail address for P. Hernigou: philippe.hernigou@wanadoo.fr
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Dec 01;92(Supplement 2):187-195. doi: 10.2106/JBJS.I.00771
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Since the first description by Debeyre of medial opening-wedge high tibial osteotomy proximal to the tibial tuberosity in 1951 and with the publication of our results in the English-language literature in 19871, our orthopaedic department has performed this osteotomy in 3756 patients over a period of more than fifty years. Although the opening-wedge osteotomy is not new, the advantages of the opening-wedge as compared with a closing-wedge technique have been discussed only recently, particularly in the English-language literature2-9. The aim of the present report is to describe (1) the key steps in the surgical technique, (2) the determination of the size of the wedge, (3) the improvements in the technique during the past twenty years, (4) the specific problem of posterior slope and patella baja, and (5) the technique of concomitant total knee arthroplasty and opening-wedge tibial osteotomy to avoid the need for soft-tissue release in knees with severe varus deformity.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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