{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:23:41Z","timestamp":1789586621060,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate whether a high lateral distal femoral angle (LDFA) contributes to undercorrection of lower\u2010limb alignment following medial open wedge high tibial osteotomy (MOWHTO), and to determine the LDFA threshold above which tibial correction alone may be insufficient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analysed 68 patients who underwent MOWHTO at our hospital between 2020 and 2022. Based on their postoperative mechanical axis (MA), patients were categorised into two groups: the acceptable correction group (A\u2010group; MA 57%\u201367%) and the undercorrection group (U\u2010group; MA\u2009\u2264\u200956%). Radiographic parameters before and after surgery were compared between the two groups. Simple and multiple regression analyses were used to identify factors affecting postoperative MA. A receiver operating characteristic (ROC) curve was utilised to identify the LDFA cut\u2010off value associated with undercorrection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 54 patients met the inclusion criteria (A\u2010group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935; U\u2010group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200919). The U\u2010group demonstrated a significantly higher preoperative mechanical LDFA (89.5\u00b0 vs. 87.6\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and a lower medial proximal tibial angle (mMPTA) (84\u00b0 vs. 86\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014) than that in the A\u2010group. Both mLDFA (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) and mMPTA (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010) were independent predictors of postoperative MA in multiple regression analysis. The ROC analysis identified an LDFA cut\u2010off of 89.2\u00b0 for predicting undercorrection (area under the curve\u2009=\u20090.78; sensitivity, 36.8%; specificity, 88.6%). Patients with an LDFA\u2009\u2265\u200989.2\u00b0 had significantly higher body mass index, joint line convergence angle, varus stress angle, percentage condylar tibial translation and preoperative knee joint line obliquity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A high LDFA (\u226589.2\u00b0) is associated with an increased risk of undercorrection after MOWHTO, despite accurate tibial correction. These findings suggest that in cases with significant distal femoral varus, isolated tibial osteotomy may be insufficient. Double\u2010level osteotomy, including femoral correction, should be considered in such cases to achieve optimal alignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level \u2163, retrospective comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70621","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T10:29:56Z","timestamp":1768300196000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Distal femoral varus deformity becomes a cause of undercorrection in open wedge high tibial osteotomy"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3142-7889","authenticated-orcid":false,"given":"Akira","family":"Maeyama","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty 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