Reverse dome osteotomy for valgus knee from tibial plateau malunion in a young adult: a case report

Malunion of tibial plateau fractures with valgus deformity can cause chronic pain and functional instability, especially in young, active patients. Anatomical correction of the deformity is essential to restore joint function and prevent progression of osteoarthritis. The corrective approach can be intra-articular or extra-articular osteotomy, depending on the type and location of the deformity.

A 32-year-old woman presented with pain and instability of the right knee 2 years after trauma. Radiological examination showed a lateral tibial plateau fracture malunion with valgus deviation and articular surface depression. Arthroscopic examination showed intact anterior and posterior ligament integrity. Reverse dome osteotomy and internal fixation using plate and screw were performed by the trauma team, and lateral meniscus debridement was performed arthroscopically by the sports team.

Alignment correction and plateau elevation were successfully performed without ligament surgery. The patient showed significant improvement in pain, stability, and joint function, with ROM reaching 130° and good clinical function scores at 3-month postoperative evaluation.

Reverse dome osteotomy is an effective technique for the correction of multiplanar deformity in tibial plateau malunion. Arthroscopic evaluation is important to assess joint stability and avoid unnecessary interventions.