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Changes in coronal alignment of the ankle joint after high tibial osteotomy

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The purpose of this study was to investigate changes in coronal alignment of the ankle joint after HTO. Our hypothesis was that ankle joint orientation may become more parallel or less parallel to the ground after HTO, and this change may affect ankle symptoms.


Eighty-six knees were retrospectively analysed after HTO for varus osteoarthritis. Preoperative and follow-up whole-leg radiographs were taken. The hip–knee–ankle (HKA) angle and medial proximal tibial angle (MPTA) were measured to evaluate coronal alignment of the knee. Tibial plafond inclination (TPI), talar inclination (TI), talar tilt (TT), and lateral distal tibial angle (LDTA) were measured to evaluate coronal alignment of the ankle. Patients were divided into two groups: those who exhibited a decrease in the absolute value of TPI and TI after HTO (group A) and those who exhibited an increase in the absolute value of TPI or TI after HTO (group B). Clinical outcomes of the knee and ankle were evaluated pre- and postoperatively.


Mean TPI and TI changed from 6.9° ± 3.6° and 8.0° ± 3.8° to 2.8° ± 3.1° and 3.9° ± 3.0° in group A (P < 0.001 for both) and from −1.3° ± 3.7° and 0.6° ± 4.5° to −6.0° ± 4.2° and −4.6° ± 5.9° in group B (P = 0.018 for both). VAS for ankle pain did not change significantly after HTO (n.s.) in group A, whereas those of group B increased significantly after HTO (P = 0.014).


Ankle joint orientation becomes more parallel or less parallel to the ground after HTO. Smaller preoperative HKA and LDTA result in a more valgus ankle joint orientation after HTO. Ankle symptoms were affected by coronal alignment changes of the ankle after HTO.

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Correspondence to Jung Ro Yoon.

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Choi, G.W., Yang, J.H., Park, J.H. et al. Changes in coronal alignment of the ankle joint after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25, 838–845 (2017).

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  • High tibial osteotomy
  • Alignment
  • Knee
  • Ankle