Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy

  • Kley Kristian
  • Bin Abd Razak Hamid Rahmatullah
  • Khakha Raghbir S
  • Wilson Adrian J
  • van Heerwaarden Ronald
  • Ollivier Matthieu

  • From London Osteotomy Centre
  • Harley Street Specialist Hospital
  • London
  • United Kingdom KK
  • RSK
  • AJW
  • RvH
  • Orthoprofis
  • Hannover
  • Germany KK
  • SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme
  • Singapore HRBAR
  • Department of Orthopaedic Surgery
  • Sengkang General Hospital


Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. Medial collateral ligament (MCL) release and posterior neurovascular structure protection during OW-HTO are steps that often induce stress and nervousness during surgery, especially for surgeons in the earlier stages of their learning curve. While is it well-known that the MCL should be released during OW-HTO, the standard retraction techniques pose challenges in visualization and instrument placement in the surgical field. We present our technique, which illustrates an alternative method to manage the MCL and safely protect the neurovascular structures using a second and more posterior surgical window during OW-HTO.