• Sueen Sohn, In Jun Koh, Man Soo Kim, and Yong In.
• Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea.
• Arch Orthop Trauma Surg. 2022 Apr 1; 142 (4): 561-569.

PurposeTo investigate risk factors and suggest preventive strategy for excessive coronal inclination of tibial plateau following medial opening-wedge high tibial osteotomy (MOWHTO).MethodsA total of 133 consecutive patients who underwent MOWHTO were retrospectively enrolled. Patients were divided into two groups based on postoperative medial proximal tibial angle (post-MPTA) of 95°: control group (n = 111, 83.5%) with post-MPTA less than 95° and excessive MPTA group (n = 22, 16.5%) with post-MPTA 95° or more. Demographics, radiographic parameters [mechanical lateral distal femoral angle (mLDFA), MPTA, posterior tibial slope, joint line obliquity (JLO), hip-knee-ankle angle, joint line convergence angle (JLCA), weight bearing line ratio, and correction angle], and clinical outcomes of patients were compared. Multiple logistic regression analysis was performed to determine risk factors for post-MPTA 95° or more.ResultsMultiple logistic regression analysis showed that preoperative JLO ≥ 3° [odds ratio (OR) 6.940, 95% confidence interval (CI) 2.373-20.296, p < 0.001] and preoperative JLCA ≥ 5° (OR 5.723, 95% CI 1.833-17.865, p = 0.008) were statistically significant risk factors for post-MPTA ≥ 95°. Incidences of excessive MPTA following MOWHTO in patients with none, one, and two risk factors preoperatively were 3.7%, 26.7%, and 77.8%, respectively.ConclusionPreoperative JLO ≥ 3° and JLCA ≥ 5° were two significant risk factors for excessive MPTA following MOWHTO. Thus, surgeon should consider other types of osteotomy if these two risk factors are present together preoperatively in MOWHTO candidates.Level Of EvidenceLevel III.© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.

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