Salvage lateral open-wedge high tibial osteotomy for multiplanar deformity after failed cosmetic lateral closed-wedge high tibial osteotomy: a case report
- 1Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, 49241 Republic of Korea
- 2College of Medicine, Pusan National University, Yangsan, 50612 Republic of Korea
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.
Case 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.
Revision 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.
Conclusions: 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.
Related
- Comparative Study between Evans Calcaneal Osteotomy and Medial Sliding Osteotomy in Adolescents with Symptomatic Flexible Flatfoot Deformity
- Digital three-dimensional planning combined with 3D-printed patient-specific guide-assisted step-cut osteotomy for correction of old cubitus varus deformity: a case report.
- Effects of vertebral shortening during corrective osteotomy for spinal deformity on spinal cord biomechanics and cerebrospinal fluid-anterior spinal artery fluid-structure interaction
- A comparative study of distal chevron osteotomy and minimally invasive surgery for surgical correction of hallux valgus deformity.
- SCOPE (Scapular Corrections for Posterior Escape) for posterior glenohumeral instability: technique of posterior acromial corrective osteotomy with optional glenoid corrective osteotomy
BibTeX
@article{park2026salvage,
title = {{Salvage lateral open-wedge high tibial osteotomy for multiplanar deformity after failed cosmetic lateral closed-wedge high tibial osteotomy: a case report}},
author = {Kyoung Won Park and Seok Jin Jung and Seung Joon Rhee},
journal = {BMC Musculoskeletal Disorders},
year = {2026},
month = jul,
doi = {10.1186/s12891-026-10294-1},
url = {https://doi.org/10.1186/s12891-026-10294-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Salvage lateral open-wedge high tibial osteotomy for multiplanar deformity after failed cosmetic lateral closed-wedge high tibial osteotomy: a case report
AU - Kyoung Won Park
AU - Seok Jin Jung
AU - Seung Joon Rhee
PY - 2026
DA - 2026/07/30
JO - BMC Musculoskeletal Disorders
DO - 10.1186/s12891-026-10294-1
UR - https://doi.org/10.1186/s12891-026-10294-1
AB - 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. Case 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. Revision 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. Conclusions: 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.
SN - 1471-2474
ER -