Introduction: The main purpose of HTO is to put off the start of sickness and the requirement for a knee replacement for as long as possible. The opening wedge high tibial osteotomy (OWHTO) and the closing wedge high tibial osteotomy (CWHTO) are the two surgical techniques that are performed the most frequently. Objective: The aim of this meta-analysis of randomized controlled trials (RCTs) is to compare OWHTO with CWHTO with regard to clinical and radiological results as well as adverse events. Materials and methods: PubMed, Embase, Web of Science, and Scopus were searched for RCTs comparing OWHTO and CWHTO for the outcomes of interest. We collected information on the rate of complications, as well as the clinical and radiological results. Results: There were a total of 648 participants across 11 trials that met our inclusion criteria; 324 patients received OWHTO and 326 individuals had CWHTO. Our study showed that OWHTO is linked to a more sloping tibia, a lower patellar height, a longer leg length, and a higher rate of metal removal. Overall effectiveness, degrees of angular rectification, and incidences of complications were comparable between the two methods. Conclusion: Although OWHTO and CWHTO demonstrated different effects on PTS, patellar height, and leg length, no technique was found to be superior in terms of functional outcomes, and postoperative complications. We need more RCTs with similar populations, big sample numbers, and extended follow-up periods.