AANA25 Knee Access Pass-CONCURRENT SESSION 1D: Knee Osteotomy, Measure Twice, Cut Once

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Video Summary

The session on osteotomy at the Anna conference highlighted its evolving role in knee surgery, emphasizing its resurgence after decline due to the rise of total knee replacements (TKR). Dr. Anil Ranawat discussed osteotomy principles, noting its benefits in preserving ligaments, enabling cartilage procedures, and delaying arthroplasty. He stressed the importance of addressing coronal, sagittal, rotational, and stability aspects, advocating for patient-specific instrumentation (PSI) and emerging technologies like robotics to improve accuracy and reduce complications.<br /><br />Dr. Laith Jaiswari presented outcomes of high tibial (HTO) and distal femoral osteotomies (DFO) in high-level athletes, showing significant improvement in activity and symptoms but a ~50% return to sport rate, with only 40% returning to pre-injury levels among elite athletes. Complication rates were consistent with literature.<br /><br />Stuart Bryant compared biomechanical strength of the Fulkerson and multidirectional tibial tubercle osteotomy (MD3T) techniques. Both had similar ultimate load to failure but distinct failure patterns, suggesting MD3T offers a reproducible alternative.<br /><br />Dean Wang emphasized careful patient selection, avoiding overcorrection in varus knees, and correcting deformities in three planes to maintain joint line obliquity and optimize healing, using protective K-wires, locking plates, and bone grafts.<br /><br />Dr. Rob Ramos reviewed valgus knee osteotomy options, including lateral opening wedge and medial closing wedge distal femoral osteotomy and high tibial osteotomy, noting 80% 10-year survival rates and reasonable return to sport.<br /><br />Andreas Gomoll discussed slope-changing osteotomy for ACL failure cases, highlighting infratubercle techniques to reduce complications and maintain flexibility for concurrent ACL procedures.<br /><br />Joe Robarsky showcased PSI’s advantages in accuracy, safety, and efficiency in complex osteotomies, though randomized studies are pending. The session concluded that osteotomy is a biomechanically sound, versatile procedure whose future is enhanced by digital templating, PSI, and robotics to optimize outcomes and extend joint preservation in knee patients.

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Keywords

osteotomy

knee surgery

total knee replacement

patient-specific instrumentation

robotics

high tibial osteotomy

distal femoral osteotomy

biomechanical strength

valgus knee osteotomy

ACL failure