Table 2.

Pearls and Pitfalls

Pearls

•Elevate upper border of pes tendons to improve posterior access •The lateral point of the osteotomy should be at the proximal tibiofibular joint to avoid impingement by the fibula when closing the osteotomy •Ensure at least 5 mm of a “lateral hinge” to avoid iatrogenic fracture •Use the arthroscope and fluoroscopy to visualize within the osteotomy and remove any remaining bone from deep within the osteotomy with pituitary •Plan for under-resection when making bone cuts—can always resect additional bone if needed

Pitfalls

•Keep the incision small to avoid compromise of future arthroplasty incision •Position the lateral thigh post high enough to allow figure-4 position to access the posteromedial tibia and ensure fluoroscopic views at hip, knee, and ankle before draping •When elevating posteromedial soft tissues from the proximal tibia, beware of medial inferior genicular artery along the posteromedial border of the tibia •Close osteotomy slowly with passive force to avoid iatrogenic fracture of lateral hinge

•Assess alignment intraoperatively with fluoroscopy to confirm correction •Assess tibial slope pre- and intraoperatively to avoid excessive increase or decrease