Research Papers

Slope-reducing high tibial osteotomy (SR-HTO) is used to decrease excessive posterior tibial slope in patients with anterior knee instability, often in the setting of ACL deficiency or failure. This comparative study examines which technique best preserves frontal-plane alignment when reducing posterior tibial slope — infra-tubercle versus retro-tubercle — a key consideration to avoid unintended varus/valgus […]

This paper reviews the role of proximal tibial osteotomy (PTO) in correcting frontal plane knee deformities — primarily varus or valgus malalignment originating in the upper tibia. The authors outline current best practice for assessment, surgical planning, technique, and aftercare to help surgeons achieve optimal joint-preserving outcomes. When is a Proximal Tibial Osteotomy Indicated? PTO […]

Large tibial varus deformities can be challenging to correct with standard extra-articular high tibial osteotomies (HTO). These conventional approaches may fail to fully restore the joint line or address intra-articular deformity. This technical note presents the Chiba Osteotomy — a tibial condylar valgus osteotomy (TCVO) technique designed to correct significant tibial varus while preserving knee […]

This paper focuses on the operative technique and planning behind externally correcting frontal-plane deformities of the knee using a proximal tibial osteotomy (PTO). The authors highlight that accurate correction in the coronal plane is vital to joint mechanics and long-term knee health when dealing with malalignment. Indications & deformity analysis The authors outline that PTO […]

For younger, active patients with early medial compartment osteoarthritis (OA) and varus alignment, surgeons often face a key decision: High Tibial Osteotomy (HTO) to preserve the native joint, or Unicompartmental Knee Arthroplasty (UKA) for rapid symptom relief and functional gain. This paper provides a structured, evidence-based overview of how to approach this choice to optimise […]

This consensus statement examines the critical role of posterior tibial slope (PTS) as a modifiable anatomical factor in failed anterior cruciate ligament (ACL) reconstructions. It presents expert-based guidelines on when and how to assess and correct increased PTS during revision ACL surgery — helping surgeons improve graft survival and knee stability.  Scope & methodology: international […]

The paper addresses an important evolution in knee osteotomies — specifically the surgical correction of posterior tibial slope (PTS) through infra-tubercle level osteotomies. A steep PTS is increasingly recognised as a modifiable anatomical factor that contributes to graft failures in anterior cruciate ligament (ACL) surgery and knee instability. This editorial argues for the infra-tubercle approach […]

Excessive posterior tibial slope (PTS) is a recognised risk factor for graft failure in anterior cruciate ligament (ACL) reconstruction, and tibial valgum (valgus of the tibial metaphysis) poses additional biomechanical challenges. This paper describes a surgical technique — a triplanar anteromedial closing wedge osteotomy (AMCWO) — designed to correct both PTS and tibial valgum simultaneously, […]

Why the JLCA matters in knee osteoarthritis and deformity planning The joint line convergence angle (JLCA) reflects intra-articular deformity (cartilage loss, meniscal extrusion) and soft tissue laxity in varus/valgus knees. Keywords for SEO: joint line convergence angle, JLCA and osteoarthritis, coronal plane intra-articular deformity, knee alignment planning osteotomy. This study explores how JLCA correlates with […]

In patients with significant tibial-varus deformities (often post-traumatic, developmental or severe metaphyseal conditions), achieving full correction without adversely affecting joint line obliquity (JLO) or patellar height is a key surgical goal. This paper presents outcomes of a specialised approach — a medial tibial condylar valgus osteotomy (TCVO-type) — focusing on correction of large tibial varus […]

In the presence of markedly increased posterior tibial slope (PTS) — recognised as a risk factor for anterior cruciate ligament (ACL) graft failure — conventional anterior closing wedge osteotomies may not achieve the desired correction, especially when the required slope change exceeds ~20° or when patellofemoral mechanics and fixation risks are significant. This paper introduces […]

This editorial reprises the pioneering work of Jan Mikulicz‑Radecki (1850-1905) — a major figure in surgical history — and draws connections to how his principles continue to inform and inspire modern knee orthopaedics. It invites the reader to reflect on surgical legacy, innovation, and the enduring foundations underlying today’s alignment, joint-preservation, and deformity correction strategies.  […]

In varus knees with bifocal or mixed deformities (tibial + femoral), a single-level osteotomy may lead to sub-optimal alignment or excessive joint line obliquity. This study investigates whether using patient-specific cutting guides (PSCGs) in a double-level osteotomy (DLO) improves alignment accuracy compared to conventional techniques — without compromising clinical outcomes. Accuracy of correction is a […]

The Coronal Plane Alignment of the Knee (CPAK) classification system has emerged as a popular tool for phenotyping knee alignment in coronal plane studies — especially in total knee arthroplasty (TKA) planning. However, for surgeons undertaking deformity correction (osteotomies) or assessing extra-articular malalignment, the question arises whether CPAK phenotypes reliably reflect the presence or nature […]

In patients with varus knee alignment and concomitant cartilage lesions, the surgical decision-making becomes complex: should one perform a corrective osteotomy, a cartilage repair procedure, or both in combination? Keywords for SEO include varus knee osteotomy, cartilage repair combined with alignment correction, joint preservation in knee OA, and cartilage regeneration after osteotomy. This narrative review […]

In corrective knee osteotomy planning (for varus/valgus with metaphyseal origin), the widely used heuristic that “1 mm of wedge opening/closing = 1° of angular correction” remains prevalent. This study evaluates that rule’s accuracy against digital planning methods (e.g., the Miniaci method) and finds significant inaccuracy, especially for distal femoral and double-level osteotomies. Keywords: osteotomy planning […]

In the context of medial opening wedge high tibial osteotomy (MOWHTO) for varus knees and early medial compartment OA, this study shifts the focus from global lower-limb alignment correction to the anatomical shape of the proximal tibia itself. Keywords such as “joint line convergence angle (JLCA)”, “medial proximal tibial angle (MPTA)”, “joint line obliquity (JLO)”, […]

Correct planning of a distal femoral osteotomy (DFO) is critical to restoring coronal alignment in knees with femoral-based deformities. This study compares three planning methods— the reversed ­Carlos H. Miniaci method, the Mark J. Dugdale method and the Dror Paley method — examining which technique leads to the most accurate alignment correction. Keywords for SEO: […]