Return to sport outcomes after inverted V‐shaped (IV) high tibial osteotomy were comparable to those after medial opening‐wedge high tibial osteotomy, even though the IV cohort had more severe preoperative disease.

PURPOSE: The primary aim was to compare return to sport (RTS) outcomes following inverted V‐shaped high tibial osteotomy (IV‐HTO) versus medial opening‐wedge (OW)‐HTO for medial knee osteoarthritis (OA). The secondary aim was to compare patient‐reported outcomes and radiographic parameters between the procedures. METHODS: This retrospective cohort study included patients who underwent HTO for medial knee OA between 2017 and 2022. Inclusion criteria were preoperative sports participation and 2‐year follow‐up. Patients were allocated to IV‐HTO (IV group) or OW‐HTO (OW group) according to indications based on the planned correction angle and patellofemoral OA grade. Outcomes were assessed preoperatively and at 2 years. Between‐group comparisons used appropriate parametric/nonparametric tests, with p < 0.05 considered significant. RESULTS: A total of 107 patients were analysed (IV group: 54 patients; OW group: 53 patients). Mean age was 58.4 years, body mass index (BMI) 25.6 kg/m2 and follow‐up 29.5 months. Preoperative femorotibial and patellofemoral Kellgren–Lawrence grades and varus deformity (% mechanical axis) were more severe in the IV group (both p < 0.001). RTS rates were 91% (49/54) in the IV group and 91% (48/53) in the OW group (p = 0.975), with mean time to RTS of 8.4 and 8.8 months, respectively (p = 0.523). Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS) improved significantly in both groups (all p < 0.001), with similar minimal clinically important difference (MCID) responder rates. From preoperative to postoperative assessments, OW‐HTO increased posterior tibial slope (9.3 ± 2.3° to 10.2 ± 2.4°, p < 0.001), whole leg length (800 ± 59 to 808 ± 59 mm, p < 0.001) and decreased the Caton–Deschamps ratio (1.03 ± 0.13 to 0.88 ± 0.14, p < 0.001), whereas IV‐HTO showed no significant changes (all p > 0.05). CONCLUSIONS: IV‐HTO achieved RTS and patient‐reported outcomes comparable to OW‐HTO at 2 years in patients with more severe preoperative disease. LEVEL OF EVIDENCE: Level III, retrospective comparative study.