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Ankle Alignment Changes After High Tibial Osteotomy due to Valgus-Shaped Distal Tibia
Sem Dorst1, Roel J H Custers1, Nienke van Egmond1
1Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Cartilage
|August 12, 2026
Summary
Medial open-wedge high tibial osteotomy (MOW-HTO) shifts ankle alignment toward valgus, especially with distal tibial valgus and larger corrections. Preoperative assessment of tibial morphology is crucial for anticipating these changes.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Radiology
Background:
- Medial open-wedge high tibial osteotomy (MOW-HTO) effectively corrects varus knee deformity.
- Potential for unintended alterations in adjacent ankle joint alignment exists post-MOW-HTO.
Purpose of the Study:
- To investigate radiographic factors influencing postoperative ankle alignment changes after valgus-producing MOW-HTO.
- To identify predictors of ankle valgus shift following MOW-HTO.
Main Methods:
- Retrospective analysis of 50 knees (49 patients) undergoing MOW-HTO.
- Weight-bearing long-leg radiographs used for pre- and postoperative assessment of tibial and ankle alignment.
- Correlation analyses and group comparisons to evaluate alignment shifts.
Main Results:
- MOW-HTO shifted all alignment parameters towards valgus.
- Distal tibial valgus significantly correlated with talar orientation (ρ = 0.81, p < 0.001).
- Greater distal tibial valgus and valgus-shaped tibias were associated with increased deviation from neutral; larger correction angles correlated with valgus ankle shift (ρ = -0.44, p < 0.001).
Conclusions:
- MOW-HTO induces a valgus shift in talar orientation.
- Preoperative distal tibial valgus, overall valgus tibial shape, and larger correction angles are key factors influencing this shift.
- Comprehensive preoperative tibial morphology assessment is vital for predicting postoperative ankle alignment.
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