Osteotomy at the distal third of tibial tuberosity with LCP L-buttress plate for correction of tibia vara

BACKGROUND Many osteotomy methods and fixation types have been used to correct the misalignment observed in tibia vara and to achieve a more uniform distribution of weight across the knee joint. PURPOSE The aim of this study is to test the efficacy and safety of a modified closing wedge high tibial osteotomy (CWHTO) procedure for tibia vara. METHODS In this prospective study, young adults with tibia vara and mild medial arthritic changes were included. A CWHTO was performed at the distal third of the tibial tuberosity, instead of the conventional proximal site. An L-shaped locking compression plate was used for internal fixation. Before/after evaluation of femoro-tibial angle (FTA), pain relief, patellar height, and posterior tibial slope were evaluated. Adverse events were monitored. RESULTS Seventy-five knees from 46 patients aged 27.2 ± 5.8 years (range, 14-43 years) underwent the modified CWHTO procedure. After a follow-up of 26.3 ± 7.4 months (range, 15-46 months), FTA correction was 12.4° ± 4.7° (range, 7°-31°), and pain was relieved. Reduction in the posterior tibial slope was 3.0° ± 2.3° (p<0.001), while there was no significant change in patella height. Bone union was observed in all patients. There were a delayed union in four knees, a peroneal nerve lesion in five knees causing partial paralysis and/or sensory loss, and infections in two knees. Three patients underwent a second surgery. All adverse events were successfully treated except for a case of extensor hallucis longus muscle paralysis. CONCLUSIONS The modified CWHTO procedure is efficient and safe for the correction of tibia vara in young patients.