case_images: PMC11723749_01
case_images: (a) Pre-operative axis deviation; (B) correction calculation with Miniaci method. Blue arrow indicated Fujisawa point, red arrow indicates hinge point while white indicates angle of correction (C) angle and thickness of opening wedge; (D) post-operative correction of axis; (E) 14-year follow-up showing varus progression but a neutral axis.
case_images: JOCR-15-202-g001.jpg
case_images: PMC11723749_01_JOCR-15-202-g001.jpg
case_images: F1
case_images: A 56-year-old female was diagnosed with medial compartment osteoarthritis (Kellgren-Lawrence grade 3) with varus malalignment (Fig. 1a) and medial meniscus posterior root tear. The planned correction angle was 8.5  with opening wedge thickness of 9 mm (Fig. 1c). Once sure, osteotomy was done was oscillating saw and opened using "3 chisel technique." The correction was planned using Miniaci technique at Fujisawa point, i.e., 62% of tibial plateau as measured from medial side (Fig. 1b). Long leg X-ray showed some loss of correction with axis passing through 50% point (Fig. 1e), but the patient had no arthritis-related complaints.
case_images: Radiolucent Hohmann placement to protect neurovascular structures.
case_images: JOCR-15-202-g002.jpg
case_images: PMC11723749_01_JOCR-15-202-g002.jpg
case_images: F2
case_images: The Hohmann was placed obliquely all the way along the osteotomy line which was directing toward the tip of fibula under fluoroscopy guidance (Fig. 2).
case_images: Nerve conduction study (A) 3-week post-surgery (B) At 14-year follow-up.
case_images: JOCR-15-202-g003.jpg
case_images: PMC11723749_01_JOCR-15-202-g003.jpg
case_images: F3
case_images: Nerve conduction velocity (NCV) test was done at 3 weeks which showed right tibial nerve injury pattern around knee level with moderate axonotmesis (Fig. 3a). The NCV at this stage was suggestive of chronic tibial nerve injury (Fig. 3b).
case_images: Follow-up X-rays showing progressive union (A) 4 months (B) 1 year [C] 14 years.
case_images: JOCR-15-202-g004.jpg
case_images: PMC11723749_01_JOCR-15-202-g004.jpg
case_images: F4
case_images: The X-rays showed good progressive union (Fig. 4).