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.
PTO remains a valuable option for younger, active patients with symptomatic unicompartmental knee overload due to malalignment. Ideal candidates typically have early-to-moderate degeneration confined to one compartment, good range of motion, and no significant ligamentous instability. The aim is to realign the limb to redistribute load, relieve pain, and delay or avoid progression to knee arthroplasty.
Accurate deformity analysis is critical. The authors emphasise the need for weight-bearing, full-length radiographs to identify whether the malalignment originates from the tibia, femur, or both. Key parameters include the mechanical medial proximal tibial angle (mMPTA), joint line convergence angle (JLCA), and limb mechanical axis. Correctly identifying the origin of the deformity reduces the risk of incomplete or excessive correction.
Effective pre-operative planning underpins surgical success. Surgeons must determine the required correction angle, hinge position, and whether a medial opening-wedge or lateral closing-wedge osteotomy is most appropriate. The authors highlight the importance of avoiding excessive correction and preserving physiological alignment to prevent joint line obliquity and abnormal cartilage loading.
The paper provides practical technical insights to support reproducible results. Essential considerations include:
Use of navigation or 3D planning tools may enhance precision where available.
The most frequent risks identified include hinge fracture, loss of correction, non-union, unintended slope changes, and patellofemoral issues. The authors stress that meticulous planning and careful execution — particularly hinge management and slope preservation — significantly reduce complication rates. Preventing over-correction is equally crucial, as this can accelerate degeneration elsewhere in the joint.
Post-operative protocols should focus on maintaining correction, supporting bone healing, and progressing functional rehabilitation. Close follow-up helps detect any early loss of correction or complications. When performed well, PTO offers durable symptom improvement and can delay the need for knee replacement surgery.
This paper serves as a clear, practical guide for surgeons performing PTO for frontal plane deformity. The authors reinforce that outcomes depend on:
Done correctly, proximal tibial osteotomy remains an effective, joint-preserving strategy for the management of tibial-based varus and valgus deformities.
Link to full article: Proximal tibial osteotomy for frontal plane deformities correction
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