Tibial condylar valgus osteotomy – indications and technique

PURPOSE: To describe the indications for, and surgical technique of, tibial condylar valgus osteotomy (TCVO). INDICATIONS: TCVO is commonly performed in patients with middle-to-end-stage medial unicompartmental osteoarthritis. Among the most important TCVO indication criteria are the types of tibial plateau shape. The convex-type (also called “pagoda-type”), with over a 5° joint line convergence angle on the standing X-ray, meets the indication criteria for TCVO. SURGICAL TECHNIQUE: An L-shaped osteotomy is performed from the medial side of the proximal tibia to the lateral beak of the intercondylar eminence. The apex of the L-shaped osteotomy line is on the medial border of the patellar tendon insertion. Surgeons should note the direction of the chisel (during the osteotomy) to the intercondylar eminence following fluoroscopic guidance. The posterior cortical bone is cut under a lateral view observation, and the crossed-leg position is adopted to prevent injury to the popliteal blood vessels. The spreader should be positioned at the posterior cortical bone to avoid increasing the tibial slope. The locking plate reliably stabilizes the osteotomy and helps shorten the period of postoperative rehabilitation. CONCLUSIONS: TCVO adjusts varus deformity alongside joint congruity. Accurate identification of indications and a detailed surgical plan would ensure effective correction and proper alignment. Additional osteotomies are recommended in case of under-correction of the varus limb deformity. TCVO is an effective intervention in patients with advanced knee osteoarthritis and lateral joint laxity with the pagoda-type tibial plateau shape.