DEROTATIONAL HIGH TIBIAL OSTEOTOMY IN CASES OF ANTERIOR KNEE PAIN AND/OR PATELLOFEMORAL INSTABILITY: A SYSTEMATIC REVIEW.

IMPORTANCE: Derotational High Tibial Osteotomy (HTO) is a surgical intervention for correcting rotational malalignments in the lower limb, which may contribute to anterior knee pain (AKP) and/or patellofemoral instability (PFI). This surgical technique is not yet widely implemented and requires a systematic evaluation of its outcomes.

AIM: To assess the effectiveness of derotational HTO in correcting rotational malalignments of the lower limb in patients with AKP and/or PFI, through radiological, clinical, and patient-reported outcome measures.

EVIDENCE REVIEW: Searches were conducted in the PubMed, Embase, and Web of Science databases up to March 3, 2023, to identify studies utilizing derotational HTO in patients with AKP and/or PFI. The primary outcome measures of interest were measurements of lower limb angular correction. Other radiological, clinical, and patient-reported outcome measures were also analyzed. Risk of bias was judged with the RoBANS tool.

FINDINGS: A total of 8 studies were included, comprising 215 patients (27.0 ± 3.9 years) and 245 knees. The most reported angle was tibial torsion (k=6 studies, n=173 knees), with a mean difference between post-operative and pre-operative values (post-surgical correction) ranging from -37.8° to -10.8°. Patient reported outcome measures showed significant improvements in post post-operative moment, exceeding the minimal clinically important difference in almost all cases, and with high patient satisfaction (93.6%).

CONCLUSIONS AND RELEVANCE: Derotational HTO allows the correction of rotational malalignments of the lower limb (tibial torsion) and promotes patient satisfaction.

LEVEL OF EVIDENCE: Level IV.