AANA/ISAKOS Knee and Shoulder Arthroscopy Course-Online Didactics (April 2024)-HTO_DFO’s_ Technique Options and Avoiding Complications

Video Transcription

Video Summary

Dr. Seth Sherman (Stanford) reviews high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) as key alignment procedures for knee joint preservation, emphasizing that alignment underpins outcomes in cartilage, meniscus, and ligament surgery. He summarizes evidence showing good midterm survivorship and >80% return to work/sport, and notes database data suggesting osteotomy combined with cartilage restoration can reduce reoperations without higher costs. Indications include young, active patients with unicompartment arthritis, focal cartilage defects/meniscus deficiency (often correcting >3°), and refractory ligament instability where coronal and sagittal corrections (e.g., tibial slope changes) may help. Contraindications include major ROM loss, complex deformity, inflammatory arthritis, smoking, and BMI >35, plus noncompliance. Key technical themes are precise deformity measurement, avoiding overcorrection, consistent planning, and complication avoidance: protect the hinge (anticipate Takeuchi fractures), safeguard neurovascular structures (including aberrant anterior tibial artery), control tibial slope, and minimize patellofemoral issues (patella baja). He compares opening vs closing wedge options for HTO/DFO, supports biplanar cuts for stability and faster union, and highlights patient-specific 3D guides for accuracy and complex combined reconstructions.

Keywords

high tibial osteotomy (HTO)

distal femoral osteotomy (DFO)

knee alignment correction

cartilage restoration and meniscus deficiency

ligament instability and tibial slope correction

patient-specific 3D cutting guides