Challenge of the Week / Knee / 01.24.20

A 48-year-old female patient with lateral left knee pain and valgus malalignment has standing hip-knee-ankle radiographs that reveal an anatomic tibiofemoral angle of 9° of valgus. The deformity is correctable, and the patient has not undergone any prior surgical procedures. This patient may benefit from which of the following interventions?
  • Opening proximal medial tibial osteotomy
  • Performing a medial opening osteotomy in the proximal aspect of the tibia will push the joint into further valgus, causing increasing load in the lateral compartment.

  • Medial unicompartmental knee arthroplasty
  • A medial unicompartmental replacement would not address this patient’s issue. She has overall valgus alignment; therefore, the advanced wear in the joint would be to the lateral compartment. The patient is young and has not failed nonoperative measures; therefore, an operation would not be the first option.

  • Lateral femoral condyle osteochondral autograft transfer
  • The question does not describe an articular cartilage defect in the lateral compartment and, therefore, an osteochondral transfer is not appropriate.

  • Medial wedge insole
  • The medial heel wedge would unload the lateral compartment and would be a reasonable initial nonoperative intervention in this case.

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