Available online 15 June 2022, 150930

Lower extremity alignment is a factor paramount in the etiology across various degenerative as well as ligamentous pathologies of the knee and has been shown to be predictive for the postoperative success in a range of reconstructive procedures. Alignment corrective osteotomies have demonstrated to produce favorable outcomes by unloading the affected compartment and optimizing the biomechanical conditions for ligamentous stability, with a consensus on the optimal osteotomy type and configuration as well as targets of correction lacking to date. With valgus correction aiming for a neutral alignment, in varus correction, biomechanical as well as clinical evidence advocates an overcorrection to a valgus of 50-65% on the tibial plateau depending on the underlying pathology. Solid evidence advocates to factor a preoperative intraarticular deformity, patellar height as well as collateral ligamentous laxity into planning and proposes a choice of tibial or/and femoral correction aligned with a slope-neutral preservation of a physiological knee joint line <4°. In the setting of a recurrent anterior cruciate ligament deficiency with a pathological posterior slope >12°, the biomechanical data support a correction via anterior closing wedge osteotomy and propose a simultaneous correction of concomitant varus malalignment depending on the competence of medial and (postero-)lateral structures.

Osteotomy

alignment correction

overcorrection

biomechanics osteotomy

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