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      We read the letter to the editor by Schröter and Ateschrang with great interest and thanks for their thoughtful consideration and questions about our article “Serial assessment of weight-bearing lower extremity alignment radiographs after open-wedge high tibial osteotomy.” They mentioned the TomoFix plate in relation to our figures and methods. First, we are in agreement with them about the TomoFix: 6.5-mm screws cannot be used in holes A through C and holes 3 and 4. Second, the materials for this study were collected retrospectively and from multiple centers from 2007 to 2011. All surgeons performed the osteotomy using a similar technique in relation to the pes anserinus and medial collateral ligament, osteotomy method, and osteotomy level. However, the fixation materials and graft materials were chosen according to the surgeons' preferences. The figures we used in our report were chosen to show and to maximize the phenomenon of weight-bearing line shift after high tibial osteotomy (HTO). In this series, the bony correction loss was minimal and has been reported.
      • Chae D.J.
      • Shetty G.M.
      • Lee D.B.
      • Choi H.W.
      • Han S.B.
      • Nha K.W.
      Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft.
      The only remarkable changes were loss of valgus instability at the last follow-up compared with the instability immediately after surgery. Therefore we thought that the correction loss was not due to bony collapse but to reduced medial instability, which made us disagree with the late progression of valgus alignment after HTO.
      • Sim J.A.
      • Kwak J.H.
      • Yang S.H.
      • Choi E.S.
      • Lee B.K.
      Effect of weight-bearing on the alignment after open wedge high tibial osteotomy.
      Third, we agree with the authors' statement about the nonlocking plates. The results of our study may be derived from the data collected from multiple centers with different plates. Because we are aware of the characteristics of the TomoFix plate, we will keep collecting data to evaluate whether the result differs when only TomoFix with biplanar osteotomy is performed. Fourth, regarding our conclusion, because the results of this study include locking and nonlocking plates from different hospitals, we think the authors' suggestions about the conclusion may not comply with our results. The ongoing studies we are working on may provide evidence for these questions in the future.

      References

        • Chae D.J.
        • Shetty G.M.
        • Lee D.B.
        • Choi H.W.
        • Han S.B.
        • Nha K.W.
        Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft.
        Knee. 2008; 15: 128-133
        • Sim J.A.
        • Kwak J.H.
        • Yang S.H.
        • Choi E.S.
        • Lee B.K.
        Effect of weight-bearing on the alignment after open wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 874-878

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