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Revista Española de Artroscopia y Cirugía Articular

Asociación Española de Artroscopia (AEA)

Header Vol. 30. Issue. 3. No. 80. December 2023
ISSN online: 2443-9754 (es)
ISSN impreso: 2386-3129 (es)
Vol. 30. Issue 3. No. 80. December 2023
Recibido: 11 January 2024
Aceptado: 13 January 2024

From the start to the top: the history of knee osteotomies

Desde el inicio hasta la cima: la historia de las osteotomías de rodilla

Rev Esp Artrosc Cir Articul En. 2023;30(3):139-40

Dear colleagues,

It is a pleasure for me to address you on occasion of this last issue of the year 2023 and to wish you a prosperous and healthy New Year.

In times of pandemic and geopolitical conflicts everywhere, it is valuable to remember that not only life and politics are subject to cycles, but also our profession. In this case, on examining the orthopedic cycles, we must highlight the moment of splendor being experienced by knee osteotomies, extending beyond the coronal, axial and sagittal planes, and capturing an increasingly significant space at congresses and in journals(1).

In exploring the origins of this technique, we must go back to ancient Egypt, to 1600 years B.C., when a papyrus provided the first notions on the importance of post-fracture bone alignment in order to prevent future deformities(2). Later in time, between the fifth century B.C. and the second century A.D., the Romans and Greeks made use of the hippocratic scamnum as traction device, facilitating alignment and the healing of fractures(3).

And not so long ago, in 1835, John Rhea Barton performed the first knee osteotomy, opening a new chapter in the history of orthopedic surgery(4). Sir William Macewen, in 1880, published the first book fully dedicated to osteotomy, stressing the importance of the specific materials and presenting instruments that persist to this day(5). History reminds us that "specific" osteotomes are not new.

Despite their years of splendor during much of the twentieth century, the 1970s marked the beginning of the "great recession" for osteotomies, due to the variability of indications, disparity of the surgical techniques, and consequently also variability of the results obtained(6). In those years, knee arthroplasties were on the rise, though Coventry pointed out that: “Osteotomy will remain the ideal indication in cases of symptomatic single-compartment osteoarthrosis in young patients”(7).

Names such as Gariepy, Coventry himself, Fujisawa, Miniaci, Hernigou, Paley and Noyes, among others, guided the implementation of surgical planning and the design of specific implants, evolving from the "classical" closing tibial osteotomy to the proximal opening approach. Locally, a notorious group of orthopedic surgeons has kept this technique alive during decades, strengthening the Spanish ties with the history of knee osteotomies(8,9,10).

In recent years we have witnessed renewed interest and advances in the practice of osteotomies. Innovation and good outcomes have gone together. The technique has become more safe, reliable and reproducible(11). The tendency towards individualization of the indication of the technique already causes us to miss the Fujisawa point as the gold standard, and the introduction of "new technologies", more sophisticated planning tools and individualized plates encourages us to explore new limits(12). However, science will continue to serve as our guide in determining the prudent limits.

In consideration of the above, the submission of articles focused on this topic is particularly gratifying for the REACA. We invite potential authors, regardless of their experience, to count on the REACA and its School for Authors for sharing their scientific interests and concerns. We offer them our rigorous and close assistance in this thrilling voyage into the world of research.

I hope you have an excellent experience and enjoy this new issue of our journal!


Juan Ignacio Erquicia
Associate Editor of the REACA
Fundación Universitaria Althaia. Manresa
iMove. Clínica Mi Tres Torres. Barcelona (Spain)


Juan Ignacio Erquicia. Associate Editor of the REACA. Fundación Universitaria Althaia. Manresa. iMove. Clínica Mi Tres Torres. Barcelona (Spain)


Juan Ignacio Erquicia. Associate Editor of the REACA. Fundación Universitaria Althaia. Manresa. iMove. Clínica Mi Tres Torres. Barcelona (Spain)

Cita bibliográfica

Erquicia JIFrom the start to the top: the history of knee osteotomies. Rev Esp Artrosc Cir Articul En. 2023;30(3):139-40. doi: 10.24129/j.reacae.30380.fs2401003

Referencias bibliográficas

  • 1
    Palmer J, Getgood A, Lobenhoffer P, Nakamura R, Monk P. Medial opening wedge high tibial osteotomy for the treatment of medial unicompartmental knee osteoarthritis: a state-of-the-art review. J ISAKOS. 2023 Oct 13:S2059-7754(23)00579-5.
  • 2
    Brorson S. Management of fractures of the humerus in Ancient Egypt Greece, and Rome: an historical review. Clin Orthop Relat Res. 2009 Jul;467(7):1907-14.
  • 3
    Kühn KG (ed.) Claudii Galeni Opera Omnia. Vol 5. Cambridge: Cambridge University Press; 2011. 1.821 p.
  • 4
    Lobenhoffer P. Stellenwert der knienahen Osteotomie bei medialer Gonarthrose. Indikation, Technik und Ergebnisse [Importance of osteotomy around to the knee for medial gonarthritis. Indications, technique and results]. Orthopade. 2014 May;43(5):425-31. German.
  • 5
    Macewen W. Osteotomy, with an inquiry into the aetiology and pathology of knock-knee, bow-leg, and other osseous deformities of the lower limbs. London: J. & A. Churchill; 1880. 64 p.
  • 6
    Harris WR, Kostuik JP. High tibial osteotomy for osteo-arthritis of the knee. J Bone Joint Surg Am. 1970 Mar;52(2):330-6.
  • 7
    Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am. 1973 Jan;55(1):23-48.
  • 8
    Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979 Jul;10(3):585-608.
  • 9
    Nakamura E, Mizuta H, Kudo S, Takagi K, Sakamoto K. Open-wedge osteotomy of the proximal tibia with hemicallotasis. J Bone Joint Surg Br. 2001 Nov;83(8):1111-5.
  • 10
    Paley D, Pfeil J. Prinzipien der kniegelenknahen Deformitätenkorrektur [Principles of deformity correction around the knee]. Orthopade. 2000 Jan;29(1):18-38. German.
  • 11
    Pang R, Jiang Z, Xu C, et al. Is Patient-Specific Instrumentation Accurate and Necessary for Open-Wedge High Tibial Osteotomy? A Meta-Analysis. Orthop Surg. 2023 Feb;15(2):413-22.
  • 12
    Cerciello S, Ollivier M, Corona K, Kaocoglu B, Seil R. CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):555-66.

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