{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:43:58Z","timestamp":1791636238638,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Slope\u2010reducing high tibial osteotomies (SR\u2010HTOs) correct posterior tibial slope (PTS) abnormalities in patients with anterior knee instability, as in cases of anterior cruciate ligament (ACL) deficiency. The SR\u2010HTO techniques, including infra\u2010tubercle and retro\u2010tubercle approaches, provide distinct benefits: retro\u2010tubercle techniques help preserve patellofemoral joint mechanics, while infra\u2010tubercle techniques are effective in mitigating iatrogenic varus. However, there is limited comparative literature available. This study compares the PTS correction precision, frontal plane alignment changes, patellar height (PH) alterations and complications between both SR\u2010HTO techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective matched cohort study including 62 patients who underwent SR\u2010HTO with ACL revision surgery between 2020 and 2023 was conducted. Of the 62 patients included, 40 (64.5%) were male and 22 (35.5%) were female. The mean follow\u2010up period was 23.4\u2009\u00b1\u20097.7 months (range: 12\u201345 months). The cohort was subdivided into infra\u2010tubercle (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929) and retro\u2010tubercle (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200933) groups. Preoperative and post\u2010operative radiographic assessments included hip\u2013knee\u2013ankle angle (HKA), medial proximal tibial angle (MPTA), proximal tibial slope (PTS) and PH indices. Functional outcomes were measured using the simple knee value (SKV) score. Complications such as hinge fractures, ACL re\u2010rupture and hardware removal were recorded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both techniques achieved similar mean slope correction with post\u2010operative PTS in infra\u2010tubercle: 9.2\u2009\u00b1\u20091.1\u00b0 (range: 5\u201313.8\u00b0) versus retro\u2010tubercle: 9.1\u2009\u00b1\u20091.3\u00b0 (range: 5\u201314\u00b0). This has been reduced from a preoperative PTS in the infra\u2010tubercle group of 14.2\u2009\u00b1\u20091.7\u00b0 (range: 11.5\u201317\u00b0) versus retro\u2010tubercle group: 14\u2009\u00b1\u20091.8\u00b0 (range: 11\u201317.5\u00b0). Infra\u2010tubercle osteotomy showed greater precision to pre\u2010operative plans, with a deviation of 1.2\u2009\u00b1\u20091.1\u00b0 (range: 0.0\u20133.6\u00b0) versus 1.8\u2009\u00b1\u20091.3\u00b0 (range: 0.0\u20133.4\u00b0) in the retro\u2010tubercle group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Retro\u2010tubercle SR\u2010HTO induced greater coronal changes compared to infra\u2010tubercle SR\u2010HTO, \u0394HKA: 1.4\u2009\u00b1\u20091.6\u00b0 (range: 0\u20135\u00b0) versus 0.8\u2009\u00b1\u20090.8\u00b0 (range: 0\u20132.8\u00b0) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05); \u0394MPTA: 1.6\u2009\u00b1\u20091.6\u00b0 (range: 0\u20135.7\u00b0) versus 0.9\u2009\u00b1\u20090.7\u00b0 (range: 0\u20132.8\u00b0) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). There was no intergroup difference in PH changes using either Caton\u2013Deschamps or Schroter indices (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.2). SKV improvement was greater in the infra\u2010tubercle group compared to the retro\u2010tubercle group, 28.7\u2009\u00b1\u200910.4 (range: 10.0\u201355.7) versus 20.7\u2009\u00b1\u200912.3 (range: \u22129.2 to 48.4) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). Complications were similar, with no hinge fractures and identical ACL re\u2010rupture rates of 3.4%. Hardware removal was higher in the infra\u2010tubercle group compared to the retro\u2010tubercle group, 24.1% versus 9.1% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.2).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Infra\u2010tubercle SR\u2010HTO demonstrated greater correction accuracy and better preservation of frontal plane alignment and functional outcomes compared to the retro\u2010tubercle technique, although the observed differences were modest. Both techniques maintained PH and exhibited comparable safety profiles. Infra\u2010tubercle SR\u2010HTO may offer a reliable alternative, particularly in ACL\u2010deficient knees where precise slope correction is desired.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70028","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T09:59:55Z","timestamp":1757066395000},"page":"3975-3984","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Higher precision and preservation of frontal plane alignment in slope\u2010reducing infra\u2010tubercle compared to retro\u2010tubercle high tibial osteotomy"],"prefix":"10.1002","volume":"33","author":[{"given":"Romir","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2547-3176","authenticated-orcid":false,"given":"Ahmed","family":"Mabrouk","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"},{"name":"Trauma and Orthopaedics Department Basingstoke and North Hampshire Hospitals Basingstoke UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Kley","sequence":"additional","affiliation":[{"name":"Orthopaedic Care Center Harley Street Specialist Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Jacquet","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Abdelkafi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Th\u00e9o","family":"Plassard","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6910-0873","authenticated-orcid":false,"given":"Matthieu","family":"Ollivier","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520966327"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518820302"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231222643"},{"issue":"5","key":"e_1_2_11_5_1","first-page":"317","article-title":"Patella infera. 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