Survival and clinical outcome of isolated high tibial osteotomy and combined biological knee reconstruction

Joshua D. Harris, Ryan McNeilan, Robert A. Siston, David C. Flanigan

Research output: Contribution to journalReview articlepeer-review

113 Scopus citations


Purpose: We sought to determine survival and clinical outcomes of high tibial osteotomy (HTO) with or without articular cartilage surgery and/or meniscal allograft transplantation in patients with medial compartment chondral pathology, varus malalignment, and/or meniscal deficiency, whether there is any difference in survival or clinical outcome between these patient cohorts, and whether there is any difference between opening- (OWHTO) and closing-wedge (CWHTO) techniques. Methods: A systematic review of multiple medical databases was performed using PRISMA guidelines. Study quality was assessed via modified Coleman Methodology Scores (MCMS). Results: Sixty-nine studies were included (4557 subjects). MCMS rating was overall poor. Mean follow-up was 7.1. years. Mean subject age was 53. years. Survival of isolated HTO was 92.4%, 84.5%, 77.3%, and 72.3% at 5, 10, 15, and 20 years of follow-up. At 5. years of follow-up, HTO with articular cartilage surgery had significantly greater survival (97.7%) than either isolated HTO (92.4%) or HTO with MAT (90.9%). Isolated HTO, HTO with articular cartilage surgery, and HTO with MAT all significantly improved subjective and objective clinical outcome scores. At two years of follow-up, survival was significantly greater following OWHTO (98.7%) versus CWHTO (96.7%). However, at all other time points with or without combined articular cartilage surgery and/or MAT, there was no significant survival difference between the techniques. Conclusions: Survival and clinical outcomes of isolated HTO were excellent at short- and mid-term follow-ups, but deteriorated with time. HTO with concomitant procedures also demonstrated excellent early survival and clinical outcomes that deteriorated with time (up to 10. years).

Original languageEnglish (US)
Pages (from-to)154-161
Number of pages8
Issue number3
StatePublished - Jun 2013


  • Articular cartilage surgery
  • High tibial osteotomy
  • Meniscal allograft transplantation
  • Wedge techniques

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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