Editorial Commentary: Alignment for Open-Wedge High Tibial Osteotomy Can Be Planned Using the Hip-Knee-Ankle Angle and the Weightbearing Line

Abstract

Correct alignment of the limb mechanical axis is a principal goal of open-wedge high tibial osteotomy and determines successful postoperative outcomes. Excessive postoperative joint line obliquity must be avoided. A mechanical medial proximal tibial angle (mMPTA) less than 95° results in poor outcomes. Preoperative planning is commonly performed using a picture archiving and communication system; however, this is time-consuming and sometimes inaccurate because many landmarks and parameters need to be confirmed manually. Hip-knee-ankle (HKA) angle and weightbearing line (WBL) percentage are perfectly correlated to the Miniaci angle when planning open-wedge high tibial osteotomy, and ΔmMPTA and ΔWBL percentage are nearly perfectly correlated with the ΔHKA angle. Surgeons can easily measure the Miniaci angle according to the preoperative HKA and preoperative WBL percentage without digital software, and mMPTA greater than 95° can be avoided. Finally, bony and soft tissue components must be considered during preoperative planning. Medial soft tissue laxity must be specifically avoided.