Table 3.

Surgical Procedure

1. Approach

•Where necessary, perform partial or total meniscectomy/meniscal repair for a torn lateral meniscus.

•Medial parapatellar straight incision.

•Subvastus approach.

•Coagulate or ligate the muscular branches from the descending genicular artery in elevating the vastus medialis muscle.

•Full-extension position and mid-flexion position are recommended for the anterior and posterior exposure, respectively.

•Pulsation of the popliteal artery can be easily confirmed if a tourniquet is not applied.

2. Osteotomy

•At the midpoint of the femoral width, insert the first K-wire from the starting level of the oblique osteotomy toward just below the hinge point.

•Insert the second K-wire proximally at the planned distance from the starting point, aiming at a point just above the hinge point.

•Draw the osteotomy lines described in Table 2 with an electrosurgical knife.

•Cut the ascending osteotomy line, leaving the lateral cortex intact in full knee extension.

•Perform the distal and proximal oblique osteotomy between the 2 K-wires and remove the wedge.

•Finish the osteotomy by inserting a chisel and/or a reciprocating saw into the hinge point between the wires.

3. Fixation

•After the gradual closure of the osteotomized site, fix the plate temporarily with K-wires, and check the lateral view.

•Insert and lock the 2 distal screws and remove the distal K-wire.

•Mount the compression hook on a hole with the bumper perpendicular to the oblique osteotomy line.

•Tighten the hook with a dedicated screwdriver after removing the proximal K-wire sleeve.

•Replace the proximal K-wire with a bi-cortical locking screw and add an additional proximal locking screw.

•Take the hook away and insert locking screws into the remaining holes.