Surgical techniques

An identical operative approach was applied in all patients. The arthroscopic evaluation and treatment of additional intraarticular lesions were performed after the application of a tourniquet. An approximately 8-cm-long skin incision was made along the anteromedial portion of the proximal tibia, and the medial collateral ligament was elevated from the subperiosteal bone. Then, two K-wires were threaded to the medial tibial diaphysis toward the fibular head under fluoroscopic guidance. The proximal tibia was cut on the medial, anterior, and posterior cortices under the guide wire, leaving the lateral cortex intact with the use of an oscillating saw. The mechanical axis was then adjusted according to the preoperative plan, and the correction was retained with a bone spreader. Then, the HTO plate was inserted into a subcutaneous tunnel and centered on the anteromedial plane of the tibia. Patients were allowed weight bearing as tolerated after the drain was removed. Patients were able to advance their weight bearing as pain and strength allowed with two crutches for 6 weeks, and full weight-bearing was permitted 6 weeks after surgery.