Osteotomies of the Knee for Valgus Malalignment

» Osteotomy is an effective treatment strategy for young, active patients with symptomatic valgus malalignment of the knee that has been unresponsive to conservative management.» Osteotomies are also indicated to support joint preservation procedures, such as lateral meniscus allograft transplantation and/or cartilage restoration to the lateral compartment, in the valgus malaligned patient, even if the malalignment is subtle.» Techniques to correct valgus include lateral opening wedge distal femoral osteotomy (LOWDFO), medial closing wedge distal femoral osteotomy (MCWDFO), lateral opening wedge high tibial osteotomy (LOWHTO), or medial closing wedge high tibial osteotomy (MCWHTO). The specific technique chosen depends on surgeon preference, concomitant procedures, and deformity location (femoral, tibial, or both).» Each approach comes with its own advantages and disadvantages. LOWDFO offers easier correction for larger deformities but has a higher risk of nonunion, while MCWDFO facilitates faster time to union but is more technically demanding. For those with a tibial-based deformity, LOWHTO carries a higher risk of nonunion, MCWHTO may lead to medial collateral ligament laxity or patella baja, and both may cause alterations of the tibial slope and may be limited as an isolated procedure in severe deformity correction.» Irrespective of the surgical approach, the outcomes of these procedures are generally favorable, improving patient-reported outcomes and potentially delaying the need for total knee arthroplasty. However, it is crucial to carefully select the appropriate procedure based on the patient's anatomy and the specificities of their valgus deformity to ensure the best possible results.