The authors respond to “High tibial osteotomy technique for knee osteoarthritis”
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* Moin Khan
* Anthony Adili
* Mitchell Winemaker

We thank Dr. Preshaw for his comment on our review.1,2 The tibial osteotomy procedure can, in select cases, be an effective treatment option for younger patients with respect to pain relief and improvement in function. The findings of the Cochrane review by Brouwer and colleagues concluded that “valgus high tibial osteotomy reduces pain and improves knee function in patients with medial compartmental osteoarthritis of the knee.”3

To be clear, our comments were comparing high tibial osteotomy to other surgical procedures, not with nonoperative treatment. In fact, none of the studies included in the Cochrane review directly compared osteotomy to conservative treatment. For this reason, the authors of the Cochrane review clarified that “no evidence shows whether an osteotomy is more effective than alternative surgical treatment such as unicompartmental knee replacement or nonoperative treatment,” meaning no study is available in the literature to inform the direct comparison between high tibial osteotomy and conservative treatment. Additionally, it is important to note, as we indicated, that all available comparative studies are of low-quality evidence and that further study is needed to clarify the role of specific techniques and procedures.

## Footnotes

*   **Competing interests:** None declared.

## References

1.  Preshaw RM. High tibial osteotomy technique for knee osteoarthritis. CMAJ 2018;190:E1287.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMjoiMTkwLzQzL0UxMjg3IjtzOjQ6ImF0b20iO3M6MjM6Ii9jbWFqLzE5MC80My9FMTI4OC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Khan M, Adili A, Winemaker M, et al. Management of osteoarthritis of the knee in younger patients. CMAJ 2018;190:E729.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTkwLzIzL0U3MjkiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTkwLzQzL0UxMjg4LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.  Brouwer RW, Huizinga MR, Duivenvoorden T, et al. Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 2014;(12):CD004019.