Is There a Role for High Tibial Osteotomies in the Athlete?

CONTEXT: The use of high tibial osteotomies (HTOs) in elite and professional athletes has been slow to gain acceptance by both the athlete and the surgeon because it is generally thought that return to competitive sports will be unlikely. Conversely, HTOs have been used extensively and effectively in managing degenerative knee arthrosis in the less active recreational patient with varus deformity who wishes to maintain activity and delay the need for knee arthroplasty. Unfortunately, situations arise where elite athletes develop debilitating pain secondary to malalignment that prevents them from participation, at which time corrective osteotomy may be indicated. Return to sport is not necessarily the goal of osteotomy surgery, but success with correction may allow the athlete to return to high-level activity. Return to elite competition is not the singular goal of HTO in the athlete; however, if the surgery is successful, then consideration can be given to return to play. EVIDENCE ACQUISITION: Despite an extensive literature on return to elite competition after many orthopaedic procedures, there are relatively few data following osteotomies. RESULTS: With expanded indications, osteotomies have become increasingly popular in young patients with malalignment and arthrosis. In addition to addressing malalignment and degenerative processes, HTO can be used in elite athletes in combination with knee reconstructive procedures to address articular defects, meniscal deficiency, and instability, thereby optimizing knee function. CONCLUSION: When performed with the proper indications in competitive athletes, HTO can result in unloading of joint resurfacing procedures, pain reduction, increased functional stability, and restored joint mechanics. Furthermore, as performed in select elite athletes, HTO realignment may not only result in return to play but also improve function and possibly prolong competition at a high level.