Knee Osteotomy Plates: Advanced Fixation for Joint Preservation Surgery

After the bone is precisely cut and repositioned during an osteotomy, it must be held in its new alignment with absolute stability while it heals. The fixation device — the plate — acts as an internal scaffold that determines how well and how quickly recovery occurs.

Modern osteotomy plates have transformed this part of the operation. With new materials, engineering precision, and biomechanical understanding, these devices now do far more than simply hold the bone together. They actively contribute to healing and rehabilitation.

Key advantages include:

• Maintaining correction with absolute precision – The plate locks the bone in the exact position established during digital surgical planning, preventing even the smallest loss of alignment.
• Allowing early weight-bearing – Modern locking systems are strong enough to permit early mobilisation and physiotherapy, which reduces stiffness and accelerates recovery.
• Promoting natural bone healing – Stable fixation supports healthy callus formation and maintains blood supply, ensuring solid union at the osteotomy site.

Together, these factors explain why the evolution of plate technology — particularly locking systems such as the Activmotion Type II — has been so pivotal in the global success of osteotomy surgery.

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One of the most important advances in osteotomy surgery has been the introduction of locking plate technology. This innovation has completely changed how the plate and screws interact with bone, making fixation stronger, safer, and more predictable.

Unlike traditional plates, where stability depends on the friction between the plate, screw, and bone, locking plates create a fixed-angle construct — the screws lock directly into the plate. This fixed connection dramatically increases stability, even in softer bone or near the joint surface.

For a comprehensive look at how locking plates function, you can review this overview from the AO Foundation1.

Multiple studies have shown that locking plate fixation significantly reduces loss of correction and improves healing compared with conventional systems — particularly in open-wedge high tibial osteotomy (OWHTO).

This change in fixation philosophy is one of the reasons osteotomy has evolved into a highly reliable, reproducible joint-preserving operation, performed by expert centres worldwide.

The modern era of knee osteotomy began in the mid-1990s, when Professor Giancarlo Puddu introduced his pioneering plate system — a true breakthrough that provided the strength, accuracy, and reproducibility needed to make osteotomy a reliable joint-preserving operation. His work transformed knee realignment surgery and laid the foundation for every major advancement that followed.

The next key development came with the TOMOFIX™ plate, which became the gold standard for more than a decade. Its fixed-angle locking technology brought a new level of biomechanical stability, enabling early mobilisation and establishing high tibial osteotomy (HTO) as a predictable and safe alternative to knee replacement. 

After TOMOFIX™, innovation turned toward metal-free materials, particularly PEEK (polyetheretherketone). Although PEEK implants were radiolucent and biocompatible — allowing clearer imaging and reduced tissue irritation — they lacked the strength and versatility of titanium, limiting their use in complex multi-planar corrections.

The next true leap forward came with the Activmotion Plate Series from Newclip, which marked the beginning of dynamic fixation — fixation that works with bone biology rather than simply holding it rigid.

• The Type I plate introduced controlled dynamisation, a mechanism that allows subtle micromotion to stimulate bone formation through natural loading.
• The Type II, developed by Professor Adrian Wilson and colleagues as part of Newclip’s Scientific Advisory Board, represents the full evolution of this concept: a complete family of anatomically contoured plates designed for osteotomies around the knee, allowing precise realignment in all three planes — coronal, sagittal, and axial. Watch a Newclip Activmotion Plate (Type II) demo by Professor Wilson.