A high tibial osteotomy (HTO) is a procedure in which the surgeon changes the alignment of the lower limb inserting a wedge-shaped to the lower leg (tibia). This surgery can be useful when one part of the knee joint has deteriorated due to osteoarthritisor if patients lower limb are severely ‘bow-legged’ or ‘knock-kneed’. Changing the alignment of the leg can unload one part of the knee joint by evenly distributing the stresses across the healthy cartilage; possibly slowing the progression of osteoarthritis and preventing or delaying the need for total knee replacement.

There is a lack of consensus regarding the ideal correction angle to maximize osteotomy survival and knee function. At SORI, we hypothesize that the outcomes from HTO procedures would be improved if the correction angles were determined based on patient’s individual knee function and joint loading.

We are currently in the process of refining a method to determine the optimal cutting angles using these factors.





SORI also recently published an article in the American Journal of Sports Medicine analysing the quality of cartilage in the knees of patients following an HTO surgery. While the HTO might redistribute the loads more evenly across the joint, a cartilage defect still usually remains. One method of treatment is implanting some cartilage in this defect to assist in cartilage regrowth. A group of SORI patients were treated with cartilage implants (MACI) in addition to the standard HTO procedure, and we are comparing these with patients who had HTO only in order to measure the effect of this added procedure on outcomes.