# Sagittal biplanar ‘L’-shaped tibial osteotomy associated with osteochondral allograft for symptomatic varus knee and low patella

## TL;DR

A new surgical technique combines an L-shaped tibial osteotomy with allograft to correct knee deformities while preserving patellar height and avoiding common complications.

## Contribution

Introduces a novel single-stage surgical approach combining sagittal L-shaped osteotomy and osteochondral allograft for varus knee correction.

## Key findings

- The technique preserved patellar height and posterior tibial slope during correction.
- Early bone healing and functional recovery were achieved at 12 months.
- Avoided complications of standard medial opening wedge osteotomies.

## Abstract

The “L”-shaped tibial osteotomy is a relatively recent surgical technique aimed at correcting the mechanical axis without altering patellar height or posterior tibial slope (common complications associated with conventional medial opening wedge osteotomies).

We report the case of a young patient with symptomatic genu varum, osteochondral lesion in the medial femoral condyle, and low patellar height. A sagittal biplanar “L”-shaped proximal tibial osteotomy was performed, fixed with a Puddu plate and two anteroposterior screws. The osteotomy gap was filled with non-irradiated morselized bone allograft to promote consolidation. Additionally, a fresh osteochondral allograft transplant was carried out in the same surgical procedure.

This technique allows for multiplanar correction while avoiding the increase in posterior tibial slope or reduction in patellar height, commonly seen with standard approaches. In our experience, combining dual anteroposterior screw fixation, morselized allograft, and osteochondral transplantation in a single stage resulted in improved mechanical stability, early bone integration, and satisfactory functional recovery.

The biplanar “L”-shaped tibial osteotomy offers a theoretical biomechanical advantage by enabling coronal correction without altering the posterior tibial slope or patellar height in the sagittal plane. In this case, it allowed simultaneous management of the deformity and the osteochondral lesion in a single-stage procedure. However, as this is a single case, the results should be interpreted with caution and require confirmation through larger series with long-term follow-up.

•Novel use of sagittal L-shaped tibial osteotomy with fresh allograft•Preserves patellar height and posterior tibial slope in varus knee correction•Combined in one-stage with osteochondral allograft for focal cartilage lesion•Early bone healing and functional recovery achieved at 12-month follow-up•New Technique avoids common complications of standard medial opening HTO.

Novel use of sagittal L-shaped tibial osteotomy with fresh allograft

Preserves patellar height and posterior tibial slope in varus knee correction

Combined in one-stage with osteochondral allograft for focal cartilage lesion

Early bone healing and functional recovery achieved at 12-month follow-up

New Technique avoids common complications of standard medial opening HTO.