The Philosophy of Unloading Cartilage

Unloading an arthritic medial compartment of a varus knee with a high tibial osteotomy has been a common practice for years. Hantes et al. demonstrated the longevity of the medial opening wedge esteotomy with a 95% survival of the native knee joint at an average follow-up of 12.3 years.

Supramalleolar osteotomy (SMO) for ankle arthritis 

Butler et al. reviewed 24 studies with 1,182 ankles to evaluate clinical outcomes with a SMO. The review showed positive results in both clinical and radiological outcomes, with a low failure rate at around 50 months follow-up. The re-operation rate was 28.2% and the failure rate was 6.8%.

But wait … sliding calcaneal osteotomy (SCO) may unload the ankle more efficiently

Using a cadaveric model, Flury et al. compared pressure distribution changes in the ankle with a SMO and with a sliding calcaneal osteomy (SCO). SCO reliably unloaded the medial compartment of the ankle joint for a neutral tibial axis. Changes in the tibial angle by a SMO did not positively affect load distribution. Something to ponder.