JAAOS - 2026-05-15 - Journal Article
Results of Dome-shaped Proximal Tibial Osteotomy in Varus and Axial Malalignment of Tibia.
Yazdi H, Bahrami Zanjanbar D, Solooki M
Topics
Key Takeaway
Dome-shaped proximal tibial osteotomy above the tibial tubercle achieved significant WOMAC and pain score improvement (P<0.001) with high patient satisfaction in 28 knees with combined varus deformity >5° and external tibial torsion >30°.
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Summary
This study evaluated dome-shaped proximal tibial osteotomy for combined varus deformity (>5°) and excessive external tibial torsion (>30°) in 21 patients (28 knees) with anterior knee pain and acceptable hip anteversion. The procedure incorporated internal tibial rotation, medial translation, valgus correction, and medial locking plate fixation. WOMAC and pain scores improved significantly (P<0.001), Q-angle and thigh-foot angles normalized, and complications were limited to two transient peroneal nerve pareses and one conservatively managed peroneal arterial aneurysm, with no nonunion, infection, or compartment syndrome.
Key Limitation
Follow-up duration is not reported, making it impossible to assess osteotomy durability, maintenance of correction, or progression of patellofemoral arthritis.
Original Abstract
BACKGROUND
Anterior knee pain, with varus deformity and excessive external tibial torsion, can markedly impair function and quality of life. Although various surgical techniques address these deformities, dome-shaped osteotomy offers a promising approach for correcting malalignment while preserving joint integrity. This study evaluated clinical and radiological outcomes of dome-shaped osteotomy in patients with these combined deformities.
METHODS
Twenty-eight knees from 21 patients with anterior knee pain, varus deformity (more than 5°), and excessive external tibial torsion (more than 30°) but acceptable hip anteversion (anteversion 30°) underwent dome-shaped tibial osteotomy proximal to the tibial tubercle. The group comprised nine male (32.1%) and 19 female patients (67.9%) with an average age of 28.5 years (17 to 45 years) and a mean body mass index of 19.9 kg/m 2 . Sixteen surgeries were done on right knees and the rest on left knees. Five female and two male patients were operated on bilaterally. Surgical steps included internal tibial rotation to correct axial deformity, medial translation as needed, valgus correction for optimal coronal alignment, and stabilization with a medial locking plate. Postoperative protocols included early mobilization with range-of-motion exercises. Outcomes were assessed using Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC scores) and The Knee injury and Osteoarthritis Outcome Score and radiographic evaluations of varus correction and patellar position.
RESULTS
Postoperative Q-angle and thigh-foot angles normalized. WOMAC and pain scores markedly improved, with most patients reporting complete or high satisfaction ( P value <0.001). Complications were minimal, including transient peroneal nerve paresis in two knees and a small peroneal arterial aneurysm in one knee, which was managed conservatively. No infections, compartment syndrome, patella baja, or delayed/nonunion were observed.
CONCLUSION
Dome-shaped osteotomy above the tibial tubercle is an effective surgical option for improving pain, function, and satisfaction in patients with anterior knee pain, varus deformity, and excessive external tibial torsion.
LEVEL OF EVIDENCE
Level IV.