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Introduction <p>In medial opening wedge high tibial osteotomy (MOWHTO), the goal extends beyond lateralizing the mechanical axis; restoring a horizontal joint line is crucial for optimal biomechanics. The Coronal Plane Alignment of the Knee (CPAK) classification, which incorporates mechanical axis deviation and joint line obliquity (JLO), offers a phenotype-based framework, though its application in MOWHTO remains underexplored.</p> Materials and methods <p>A retrospective review included 147 knees from 123 patients undergoing MOWHTO with at least 24 months of follow-up. Radiographic parameters assessed were mFTA, MPTA, mLDFA, JLCA, aHKA, and JLO. Knees were categorized based on postoperative weight-bearing line (WBL) positions, and CPAK phenotypes were recorded pre- and postoperatively. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee score.</p> Results <p>Preoperatively, CPAK type I (varus, apex distal JLO) predominated (82.3%). Postoperatively, many transitioned to Types V (neutral, apex neutral JLO, 24.5%) and VI (valgus, apex neutral JLO, 17.7%), both yielding significantly higher HSS scores (<i>p</i> &lt; 0.001). Optimal outcomes were observed with a WBL between 50% and 60%. The mean aHKA improved from − 7.35° to + 1.59°, while JLO corrected from 172.4° to 180.8°.</p> Conclusion <p>This study demonstrates that transitions to CPAK Types V–VI, with 50–60% WBL and horizontal joint line restoration, are linked to improved HSS scores, highlighting the CPAK classification’s potential for guiding individualized correction strategies in MOWHTO.</p> Level of evidence <p>Level III (retrospective comparative study).</p>

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Impact of mechanical axis position and coronal plane alignment phenotypes on clinical outcomes in medial opening wedge high tibial osteotomy

  • 期刊论文

  • 发表日期：

    2025年9月23日

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  • Ahmetcan Erdem,
  • Vahdet Uçan,
  • Gökhan Lebe,
  • Muhammet Ali Geçkalan,
  • Cemil Burak Demirkıran,
  • Ali Toprak,
  • Nurzat Elmalı

摘要

Introduction

In medial opening wedge high tibial osteotomy (MOWHTO), the goal extends beyond lateralizing the mechanical axis; restoring a horizontal joint line is crucial for optimal biomechanics. The Coronal Plane Alignment of the Knee (CPAK) classification, which incorporates mechanical axis deviation and joint line obliquity (JLO), offers a phenotype-based framework, though its application in MOWHTO remains underexplored.

Materials and methods

A retrospective review included 147 knees from 123 patients undergoing MOWHTO with at least 24 months of follow-up. Radiographic parameters assessed were mFTA, MPTA, mLDFA, JLCA, aHKA, and JLO. Knees were categorized based on postoperative weight-bearing line (WBL) positions, and CPAK phenotypes were recorded pre- and postoperatively. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee score.

Results

Preoperatively, CPAK type I (varus, apex distal JLO) predominated (82.3%). Postoperatively, many transitioned to Types V (neutral, apex neutral JLO, 24.5%) and VI (valgus, apex neutral JLO, 17.7%), both yielding significantly higher HSS scores (p < 0.001). Optimal outcomes were observed with a WBL between 50% and 60%. The mean aHKA improved from − 7.35° to + 1.59°, while JLO corrected from 172.4° to 180.8°.

Conclusion

This study demonstrates that transitions to CPAK Types V–VI, with 50–60% WBL and horizontal joint line restoration, are linked to improved HSS scores, highlighting the CPAK classification’s potential for guiding individualized correction strategies in MOWHTO.

Level of evidence

Level III (retrospective comparative study).