Locking plate versus non-locking plate in open-wedge high tibial osteotomy: a meta-analysis.

PURPOSE: The purpose of this study was to conduct a meta-analysis to determine whether the locking plate or non-locking plate results in better opening-wedge high tibial osteotomy (OWHTO) outcomes.

METHODS: The MEDLINE, EMBASE, COCHRANE, and KOREAMED register databases were searched for studies. The eligibility criteria for inclusion in the review were studies that compared the locking plate with the non-locking plate for OWHTO, and those that provided clear descriptions of surgical techniques and outcomes. The key outcomes of interest were union rate, correction loss angle, correction loss rate, and full weight-bearing starting point. The statistical software "RevMan" was used in statistical analysis.

RESULTS: Five studies were included in the meta-analysis. Among their reported results, there were no differences in the incidence of union [risk ratio (RR) = 1.01, p = 0.34], non-locking plate was associated with lower incidence of correction maintenance (RR = 1.13, p = 0.0006) and greater angle of correction loss [mean difference (MD) = -2.06, p < 0.00001], and locking plate was associated with a significant improvement in Knee society score and function score (MD = 5.77, p < 0.0001; MD = 7.50, p = 0.0005).

CONCLUSIONS: Locking plate provides better clinical outcomes and reduced correction loss rates and angles as compared to non-locking plate for fixation with OWHTO.

LEVEL OF EVIDENCE: IV.