Low complication and high bone union rates following acute oblique fibular osteotomy with suture ligation prior to closing wedge high tibial osteotomy: A multicenter study of 231 cases

Abstract Purpose Fibular shortening is required in lateral closing wedge (LCW) high tibial osteotomy (HTO), yet the safety and healing profile of acute fibular oblique osteotomy with suture ligation (AOOL) remain unclear. This study evaluated complications, union rate, and time to union after AOOL, and identified factors associated with delayed union. Methods A retrospective multicenter study was conducted on 240 medial osteoarthritic knees from 227 patients who underwent the AOOL procedure in combination with inverted V‐shaped (hemi‐LCW) HTO. Of the 227 patients, 231 knees from 218 patients were followed up for 2–4 years. Radiographs were taken at 2, 3, 6, 9 and 12 months postoperatively, as well as at the final follow‐up. Bone union was evaluated using a radiographic scoring system. Surgeries were performed by four surgeons. Prior to cohort pooling, it was verified that patient groups across the four surgeons showed no significant differences in patient characteristics, procedures, or outcomes. To present the complication and non‐union rates, two‐sided exact 95% confidence intervals for the proportions were calculated using the Clopper–Pearson method. Logistic regression analyses were performed to identify factors that significantly delay bone healing. Results The complication rate was 1.7% (exact 95% confidence interval, 0.5%–4.4%). The non‐union rate was 1.3% (0.3%–3.7%). Accordingly, the bone union rate was 98.7% (96.3%–99.7%). The time to union was 7.0 months, with the standard deviation of 2.4. Significant factors associated with a longer time to achieve complete bone union at the fibular osteotomy site included male sex, lower bone mineral density, higher Kellgren–Lawrence grade, and a greater initial osteotomy gap. Conclusion Among the 231 fibular osteotomies performed using the AOOL procedure, complications were rare, and the bone union rate was remarkably high. However, the average time to union was 7 months, which was considered relatively prolonged. Level of Evidence Level II, cohort study.