{
  "abstract": "Background: Most failed high tibial osteotomy (HTO) ultimately proceed to conversion to total knee arthroplasty; therefore, revision HTO is rarely performed, and revision lateral open-wedge HTO (LOWHTO) is even rarer. We report a rare and technically demanding case of revision LOWHTO for a complex multiplanar deformity following failed HTO for cosmesis, achieving planned coronal varization and posterior tibial slope reduction with CT-documented decrease in excessive tibial external rotation. This case also describes posterolateral menisco-tibial subsidence (PLMTS) as a hypothesis-generating arthroscopic observation.\n\nCase presentation: A 40-year-old woman presented with worsening right knee pain and an externally rotated gait with subtle foot drag during the terminal stance phase, 20 years after undergoing lateral closed-wedge HTO for cosmesis. Preoperative evaluation revealed excessive valgus deformity (8.2° valgus and MPTA 95.0°), increased PTS (19.6°), excessive tibial external rotation (35.8°), reduced tibiofibular height difference and proximal tibiofibular synostosis. MRI showed intact articular cartilage and meniscus in the knee joint. Diagnostic arthroscopy revealed a qualitatively widened posterolateral compartment gap, which we interpreted as a PLMTS-like finding.\n\nRevision LOWHTO was performed with planned coronal varization, posterior tibial slope reduction, and intended axial-plane adjustment. Postoperative arthroscopy demonstrated marked restoration of the previously abnormally widened posterolateral gap. Postoperative assessment showed improvement in MPTA from 95.0° to 87.7°, PTS from 19.6° to 12.0°, and tibial external rotation from 35.8° to 26.1°. At the 1-year follow-up, the patient demonstrated marked clinical improvement with a notable reduction in pain and gait abnormalities.\n\nConclusions: This case suggests that salvage LOWHTO may be a feasible joint-preserving option for complex multiplanar deformities after failed HTO. When multiple technical maneuvers are appropriately integrated, revision LOWHTO may allow planned coronal and sagittal correction with intended axial-plane adjustment, even in challenging scenarios. Furthermore, this case describes PLMTS as a hypothesis-generating arthroscopic observation associated with unipolar correction of the proximal tibia relative to the fibula, providing additional insight into the biomechanical sequelae of failed lateral closed-wedge HTO.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241 Republic of Korea",
    "College of Medicine, Pusan National University, Yangsan, 50612 Republic of Korea"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Kyoung Won Park"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Seok Jin Jung"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Seung Joon Rhee"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c50g9p2dq4zyw.bib",
  "cited_by": 0,
  "doi": "10.1186/s12891-026-10294-1",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13711956/",
  "id": "c50g9p2dq4zyw",
  "issns": [
    "1471-2474"
  ],
  "landing_url": "https://doi.org/10.1186/s12891-026-10294-1",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2746|Knee injuries and reconstruction techniques"
    ]
  ],
  "openalex": "W7171770866",
  "pdf_url": null,
  "pmcid": "PMC13711956",
  "pmid": "42934599",
  "published": "2026-07-30",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/c50g9p2dq4zyw.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:22:38Z",
      "native_id": "PMC13711956",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12891-026-10294-1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Knee injuries and reconstruction techniques",
      "subfield": "surgery"
    }
  ],
  "title": "Salvage lateral open-wedge high tibial osteotomy for multiplanar deformity after failed cosmetic lateral closed-wedge high tibial osteotomy: a case report",
  "title_text": "Salvage lateral open-wedge high tibial osteotomy for multiplanar deformity after failed cosmetic lateral closed-wedge high tibial osteotomy: a case report",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:38Z",
  "url": "https://research.draconitic.com/paper/c50g9p2dq4zyw",
  "venue": "BMC Musculoskeletal Disorders",
  "versions": []
}