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This study aims to design a new medial tibial open osteotomy scheme, transtibial tuberosity\u2010high tibial osteotomy (TT\u2010HTO), which can fully protect the patellar tendon insertion. In addition, the area of the osteotomy surface and wedge volume were evaluated in TT\u2010HTO, biplanar distal tibial tuberosity osteotomy (biplanar\u2010DTO), and uniplanar\u2010DTO to evaluate the potential advantages of this technology in bone healing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The tibial tubercle was divided into four equal sections from proximal to distal, which were defined as zones A, B, C, and D. From September to December 2020, the imaging examinations of 200 patients (95 males and 105 females) with a mean age of 40.6\u2009years (range 19\u201360\u2009years) were evaluated to observe the zonation of the tibial tubercle where the insertion of the patellar tendon is located. Then, 59 patients (23 males and 36 females) with a mean age 59.6\u2009years (range 43\u201377\u2009years), for a total of 69 knees (32 right and 37 left), who underwent routine knee surgery were observed and verified. According to the position of the patellar tendon insertion, TT\u2010HTO was designed. Fifteen tibial sawbones were divided equally into three groups: TT\u2010HTO; biplanar\u2010DTO; and uniplanar\u2010DTO. The total area of the osteotomy surface was compared using the graph paper method. The wedge volume at wedge heights of 10\u2009mm was compared among osteotomy types using the plasticine Archimedes principle. One\u2010way repeated\u2010measures analysis of variance was used to compare the total area of the osteotomy surface and the wedge volume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The osteotomy line of TT\u2010HTO passes through the boundary point of zones B and C of the tibial tubercle to fully protect the insertion point of the patellar tendon. The total area of the osteotomy surface in TT\u2010HTO and biplanar\u2010DTO was significantly larger than that in uniplanar\u2010DTO (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). The wedge volume in uniplanar\u2010DTO was significantly smaller than that in TT\u2010HTO and biplanar\u2010DTO (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). No significant differences in the osteotomy surface and the wedge volume were identified between TT\u2010HTO and biplanar\u2010DTO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TT\u2010HTO can protect the patellar tendon insertion and avoid postoperative patella infera. The osteotomy surface is large and located in an area of cancellous bone, which ensures its good healing characteristics.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13562","type":"journal-article","created":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T13:03:42Z","timestamp":1669295022000},"page":"639-647","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Precise Patellar Tendon Insertion Protection and Osteotomy Surface Advantage of Transtibial Tuberosity\u2013High Tibial Osteotomy"],"prefix":"10.1111","volume":"15","author":[{"given":"Zhanyu","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics The Affiliated Hospital of Guizhou Medical University  Guiyang China"},{"name":"Department of Medical\u2010Industrial Integration National\u2010Local Joint Engineering Laboratory of Cell Engineering and Biomedicine  Guiyang 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Biomedicine  Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Affiliated Hospital of Guizhou Medical University  Guiyang China"},{"name":"Department of Medical\u2010Industrial Integration National\u2010Local Joint Engineering Laboratory of Cell Engineering and Biomedicine  Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobin","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Affiliated Hospital of Guizhou Medical University  Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5670-6289","authenticated-orcid":false,"given":"Chuan","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Affiliated Hospital of Guizhou Medical University  Guiyang China"},{"name":"Department of Medical\u2010Industrial Integration National\u2010Local Joint Engineering Laboratory of Cell Engineering and Biomedicine  Guiyang China"},{"name":"China Orthopaedic Regenerative Medicine Group (CORMed)  Hangzhou 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