Biplanar Osteotomies for Knee Malalignment

After a diagnostic arthroscopy procedure, biplanar supracondylar lcwDFO^{34 (link)} or mowHTO^{14 (link)} was performed as previously described. For the biplanar mowHTO, first a bicortical frontal osteotomy was performed with an ascending or a descending osteotomy orientation, depending on the patellofemoral cartilage status.^{14 (link)} Next, 2 axial K-wires were positioned in an oblique direction toward the fibular head. For lcwDFO, the biplanar osteotomy planes were marked and an ascending bicortical frontal osteotomy was performed. Next, 4 axial K-wires marking the osteotomy wedge to be excised proximally and distally were placed for an axial osteotomy. Next, respective osteotomies preserving the contralateral cortex were performed with the hinge located at a 0.5- to 1-cm distance from the medial cortex. The osteotomy gap was carefully closed (lcwDFO) or opened (mowHTO), applying valgus stress and axial compression. To control for adequate mechanical correction, the osteotomy was fixed temporarily, and alignment was assessed via intraoperative hip-knee-ankle alignment fluoroscopy with an alignment rod^{8 (link)} and adjusted as needed. Consecutively, the osteotomy was secured with a locking compression plate, using either a Polyetheretherketone-Power plate (Arthrex) or a Tomo-Fix plate (DePuy Synthes).