Osteotomy: Coronal and Axial Plane Deformity

Lower extremity alignment has a direct impact on the biomechanics of the knee. Malalignment can predispose the knee to various issues and exacerbate intra-articular pathology, such as lesions of the cartilage or meniscus. Limb malalignment can be addressed by corrective procedures. Varus deformity of the lower extremity results in medial compartment overload, which is typically corrected with medial opening wedge or lateral closing wedge osteotomies of the proximal tibia. Valgus deformity results in lateral compartment overload and can often be corrected with medial closing wedge or lateral opening wedge osteotomies of the distal femur. Abnormalities in femoral rotation, often manifesting as patellofemoral instability, can be addressed with femoral or tibial derotational osteotomies to correct femoral anteversion and external tibial torsion. This chapter reviews lower extremity alignment in the normal, varus, and valgus states, and describes the indications and techniques to perform surgical intervention aimed to correct lower extremity malalignment.