{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:38:38Z","timestamp":1788896318097,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the distribution of coronal plane alignment of the knee (CPAK) phenotypes before and after medial closing\u2010wedge distal femoral osteotomy (MCW\u2010DFO) and assess their correlation with long\u2010term clinical outcomes in valgus knee deformity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective analysis included patients who underwent MCW\u2010DFO for valgus knee correction between 2007 and 2022. Preoperative and post\u2010operative knee alignment was assessed using standard long leg weight\u2010bearing radiographs, and clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner and visual analogue scale (VAS). Patients were stratified based on preoperative and post\u2010operative CPAK classification phenotypes. Outcomes were compared between the most common preoperative and post\u2010operative CPAK phenotypes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010one patients (54 knees) were included in the study, with a mean age of 48.7\u2009\u00b1\u200913.2. The overall mean follow\u2010up was 97\u2009\u00b1\u200957 months. Statistically significant improvements were observed in all clinical scores, and a statistically significant radiological correction of valgus was achieved following MCW\u2010DFO. According to preoperative CPAK phenotype, the most prevalent groups, CPAK 6 and 3, showed no significant differences in clinical outcomes (final IKDC CPAK 3: 60.7\u2009\u00b1\u200912.2, CPAK 6: 62.9\u2009\u00b1\u200917 [<jats:italic>p<\/jats:italic>\u2009=\u20090.67]; final KOOS CPAK 3: 76.8\u2009\u00b1\u20096.9, CPAK 6: 77.3\u2009\u00b1\u200914.9 [<jats:italic>p<\/jats:italic>\u2009=\u20090.37]). Similarly, stratification by post\u2010operative CPAK showed no significant differences between CPAK 5 and 8 (final IKDC CPAK 5: 63.3\u2009\u00b1\u200915.7, CPAK 8: 71.1\u2009\u00b1\u200910.2 [<jats:italic>p<\/jats:italic>\u2009=\u20090.12]; final KOOS CPAK 5: 79.8\u2009\u00b1\u20097.9, CPAK 8: 82.3\u2009\u00b1\u20099.3 [<jats:italic>p<\/jats:italic>\u2009=\u20090.53]). During the study period, one patient (1.8%) sustained a peri\u2010implant fracture, one patient (1.8%) underwent re\u2010intervention due to pseudoarthrosis and three patients (5.5%) underwent total knee arthroplasty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MCW\u2010DFO is a safe, effective treatment for symptomatic valgus knee deformity. Surgical correction achieved a neutral mechanical axis (CPAK 5 and 8), with no clinical differences for different JLO values.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level III, case\u2013control study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12795","type":"journal-article","created":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T12:05:29Z","timestamp":1752408329000},"page":"3686-3696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Preoperative CPAK phenotype does not affect clinical and radiological outcomes after medial closing\u2010wedge distal femoral osteotomy in valgus knees at 8\u2010year follow\u2010up"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4464-2254","authenticated-orcid":false,"given":"Alessio","family":"Maione","sequence":"first","affiliation":[{"name":"ASST Gaetano Pini U.O.C. 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