SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
Consistent indications, targets and techniques for double-level osteotomy of the knee: a systematic review.
Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The efficacy of medial patellofemoral ligament reconstruction combined with distal femoral varus osteotomy in recurrent patellar dislocation and genu valgum.Musculoskeletal surgery · 2025Pooled it
- Modification of the coronal plane alignment of the knee classification considering the joint line convergence angle in high tibial osteotomy: a geometric approach.Journal of orthopaedic surgery and research · 2026Article
- High survival rates and patient satisfaction 12 years after medial open wedge high tibial osteotomy surgery: A prospective cohort study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Mid-term survival and physiological joint angles after double level osteotomy of severe varus osteoarthritis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Article
- Comparing the outcome after double level osteotomies in severe valgus and varus knees.Archives of orthopaedic and trauma surgery · 2025Article
- Double-level knee valgization osteotomy has high survivorship and a low complication rate in a single-center series of 58 cases with a mean clinical follow-up of 10 years.Knee surgery & related research · 2025Article
- Appropriate patient selection based on joint line convergence angle minimizes the difference between the mechanical axis in the standing and supine positions after open-wedge high tibial osteotomy and distal tuberosity osteotomy.Journal of orthopaedic surgery and research · 2025Article
- Double-level osteotomy (DLO) for varus deformity results in over a decade of mean survival without compromising subsequent total knee arthroplasty function at a mean 26-year follow-up.Journal of experimental orthopaedics · 2025Article
- Preoperative Joint Line Convergence Angle as an Indicator of Clinical Outcomes and Accuracy of Alignment Correction After Double-Level Osteotomy.Orthopaedic journal of sports medicine · 2024Article
- Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating.Journal of experimental orthopaedics · 2024Article
- Article
- Surgical Technique and Preliminary Outcomes of Double-Level Osteotomy for Valgus Deformity.Orthopaedic journal of sports medicine · 2024Article
- Morphological analysis of the distal femur as a surgical reference in biplane distal femoral osteotomy.Scientific reports · 2024Article
- Joint line and knee osteotomy.EFORT open reviews · 2024Review
- Osteotomies around the knee are not just space oddities.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Double-level knee osteotomy accurately corrects lower limb deformity and provides satisfactory functional outcomes in bifocal (femur and tibia) valgus malaligned knees.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity.Journal of experimental orthopaedics · 2023Article
- Optimizing indications and technique in osteotomies around the knee.EFORT open reviews · 2022Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo systematically review and critically appraise the literature on double-level osteotomy (DLO) of the knee, and determine the indications, contraindications, targets and outcomes. MATERIALS AND
methodsA systematic literature search was performed on PubMed, Embase®, and Cochrane for studies that reported on DLO by any technique or approach, including indications, contraindications, and targets for DLO, as well as patient-reported outcome measures (pROMS) and radiographic angles.
resultsTwelve eligible studies were found: 9 case series and 3 studies that compared DLO to high-tibial osteotomy (HTO). In all studies, DLO was performed by medial opening-wedge tibial osteotomy and lateral closing-wedge femoral osteotomy. Seven specified that DLO was performed if simple HTO would exceed thresholds of postoperative medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and/or predicted wedge size. The targets were 88°-95° for MPTA, 84°-89° for LDFA, and 0°-4° for hip-knee-ankle (HKA) angle. The 3 comparative studies reported lower MPTA after DLO (89.6°-92.5°) than after HTO (91.5°-98.3°). All 3 reported similar postoperative HKA after DLO (0.2°-4.4°) as HTO (0.4°-4.8°); only 2 compared postoperative LDFA, which was lower after DLO (85.4° and 84.9°) than HTO (88.7° and 88.8°). Two comparative studies reported postoperative overall KOOS which was slightly lower after DLO (351-403) than HTO (368-410); only 1 study reported separate items of the KOOS.
conclusionThere was relative consistency between studies on the indications, targets and techniques for DLO. Furthermore, while the comparative studies reported similar preoperative MPTA, LDFA and HKA, the postoperative MPTA and LDFA were lower after DLO than after HTO, though both treatments achieved equivalent postoperative HKA. LEVEL OF EVIDENCE: IV, systematic review.
Indexed as
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.