Open-wedge high tibial osteotomy (OWHTO) is an established treatment for osteoarthritis (OA) with varus knee patients are allowed early full weight-bearing using a locking plate, and several studies have reported desirable clinical outcomes after OWHTO. TCVO is an effective intervention in patients with advanced knee osteoarthritis and lateral joint laxity with the pagoda-type tibial plateau shape. Additional osteotomies are recommended in case of under-correction of the varus limb deformity. Accurate identification of indications and a detailed surgical plan would ensure effective correction and proper alignment. TCVO adjusts varus deformity alongside joint congruity. The locking plate reliably stabilizes the osteotomy and helps shorten the period of postoperative rehabilitation. The spreader should be positioned at the posterior cortical bone to avoid increasing the tibial slope. 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. Surgeons should note the direction of the chisel (during the osteotomy) to the intercondylar eminence following fluoroscopic guidance. ![]() The apex of the L-shaped osteotomy line is on the medial border of the patellar tendon insertion. Surgical techniqueĪn L-shaped osteotomy is performed from the medial side of the proximal tibia to the lateral beak of the intercondylar eminence. ![]() ![]() 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. Among the most important TCVO indication criteria are the types of tibial plateau shape. TCVO is commonly performed in patients with middle-to-end-stage medial unicompartmental osteoarthritis. To describe the indications for, and surgical technique of, tibial condylar valgus osteotomy (TCVO).
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