Fig 4 - uploaded by Pedro Díaz Allende
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Severe genu varum and double-level osteotomy. (A) This case is the same presented in ►Figure 3. Note that the Mikulicz line (red) does not contact the knee, which is a significant indication of a double-level procedure. In addition, the pathological joint line obliquity (JLO) of 7° (yellow) is critical for the indication. (B) Resolution with a double-level osteotomy with a 10° lateral closing wedge distal femoral osteotomy and a 10° medial open wedge high tibial osteotomy. The following are fundamental concepts for an optimal functional outcome: preoperative planning, simulation of the final JLO, locking plates, and biplanar osteotomy at both levels. Axis correction is proper, with a Mikulicz line crossing the joint surface in 60% (green line) and a physiological JLO of 1°.
Source publication
With single-level osteotomy, correction of the limb axis in patients with combined femoral and tibial deformities can be achieved. This correction, however, will generate a pathological alteration in the joint line oblicuity, leading to ligament elongation, instability, joint degeneration and, ultimately, it will compromise the longevity and functi...
