Role of osteotomy in cartilage resurfacing procedures

Knee realignment osteotomies have become increasingly important as an adjunct to unload the affected compartment and theoretically protect cartilage repair. Owing to preservation of bone stock, medial opening-wedge high tibial osteotomy has become a popular treatment of varus malalignment, while lateral distal opening-wedge osteotomy is increasingly being used as a surgical treatment for correcting valgus malalignment. This study describes the preoperative assessment, technical description, postoperative rehabilitation, and potential pitfalls of each of these 2 osteotomies. Based on the results from a limited number of studies, expected outcomes following combined realignment osteotomy and cartilage restoration procedures have been reviewed.