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. The 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 postoperative and preoperative values (postsurgical correction) ranging from -37.8 degrees to -10.8 degrees. Patient-reported outcome measures showed significant improvements in the postoperative 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.