# Return to sport outcomes after inverted V‐shaped (IV) high tibial osteotomy were comparable to those after medial opening‐wedge high tibial osteotomy, even though the IV cohort had more severe preoperative disease

## TL;DR

Inverted V-shaped high tibial osteotomy had similar return to sport and patient outcomes as the traditional method, even with more severe pre-surgery conditions.

## Contribution

IV-HTO showed comparable outcomes to OW-HTO despite more severe preoperative disease, offering a potential alternative for patients with advanced knee osteoarthritis.

## Key findings

- RTS rates were 91% in both IV-HTO and OW-HTO groups.
- Both groups showed significant improvements in Lysholm and KOOS scores.
- IV-HTO did not alter posterior tibial slope or leg length, unlike OW-HTO.

## Abstract

The primary aim was to compare return to sport (RTS) outcomes following inverted V‐shaped high tibial osteotomy (IV‐HTO) versus medial opening‐wedge (OW)‐HTO for medial knee osteoarthritis (OA). The secondary aim was to compare patient‐reported outcomes and radiographic parameters between the procedures.

This retrospective cohort study included patients who underwent HTO for medial knee OA between 2017 and 2022. Inclusion criteria were preoperative sports participation and 2‐year follow‐up. Patients were allocated to IV‐HTO (IV group) or OW‐HTO (OW group) according to indications based on the planned correction angle and patellofemoral OA grade. Outcomes were assessed preoperatively and at 2 years. Between‐group comparisons used appropriate parametric/nonparametric tests, with p < 0.05 considered significant.

A total of 107 patients were analysed (IV group: 54 patients; OW group: 53 patients). Mean age was 58.4 years, body mass index (BMI) 25.6 kg/m2 and follow‐up 29.5 months. Preoperative femorotibial and patellofemoral Kellgren–Lawrence grades and varus deformity (% mechanical axis) were more severe in the IV group (both p < 0.001). RTS rates were 91% (49/54) in the IV group and 91% (48/53) in the OW group (p = 0.975), with mean time to RTS of 8.4 and 8.8 months, respectively (p = 0.523). Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS) improved significantly in both groups (all p < 0.001), with similar minimal clinically important difference (MCID) responder rates. From preoperative to postoperative assessments, OW‐HTO increased posterior tibial slope (9.3 ± 2.3° to 10.2 ± 2.4°, p < 0.001), whole leg length (800 ± 59 to 808 ± 59 mm, p < 0.001) and decreased the Caton–Deschamps ratio (1.03 ± 0.13 to 0.88 ± 0.14, p < 0.001), whereas IV‐HTO showed no significant changes (all p > 0.05).

IV‐HTO achieved RTS and patient‐reported outcomes comparable to OW‐HTO at 2 years in patients with more severe preoperative disease.

Level III, retrospective comparative study.

Inverted V‐shaped high tibial osteotomy (IV‐HTO) achieved return to sport (RTS) and patient‐reported outcomes comparable to opening‐wedge (OW)‐HTO at 2 years in patients with more severe preoperative disease.