{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T08:35:42Z","timestamp":1793262942491,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Double\u2010level knee osteotomy (DLO) is a challenging procedure that requires precision in preoperative planning and intraoperative execution to achieve the desired correction. It is indicated in cases of severe varus or valgus deformities where a single\u2010level osteotomy would yield significantly tilted joint line obliquity (JLO). This study aimed to evaluate the effectiveness of DLO in achieving accurate correction without compromising JLO, using patient\u2010specific cutting guides (PSCGs), in cases of bifocal valgus maligned knees.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single\u2010centre, retrospective analysis of prospectively collected data for a total of 26 patients, who underwent DLO by PSCGs for valgus malaligned knees, between 2015 and 2020. Post\u2010operative alignment was evaluated and the delta for different lower limb0.05, not statistically significant (ns)). All KOOS subs alignment parameters was calculated; the hip\u2010knee\u2010ankle angle (\u0394HKA), medial proximal tibial angle (\u0394MPTA), and lateral distal femoral angle (\u0394LDFA). At the two\u2010year follow\u2010up, changes in the KOOS sub\u2010scores, UCLA scores, lower limb discrepancy (LLD), and mean time to return to work and sport were recorded. All intraoperative and postoperative complications were recorded. The Mann\u2013Whitney <jats:italic>U<\/jats:italic> test with a 95% confidence interval (95% CI) was used to evaluate the differences between two variables; one\u2010way ANOVA between more than two variables and the paired Student's <jats:italic>t<\/jats:italic>\u2010test was used to estimate the evolution of functional outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The postoperative mean \u0394HKA was 0.9\u2009\u00b1\u20090.9\u00b0, the mean \u0394MPTA was 0.7\u2009\u00b1\u20090.7\u00b0, and the mean \u0394LDFA was 0.7\u2009\u00b1\u20090.8\u00b0 (all values with <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05, not statistically significant (ns)). All KOOS subscore's mean values were improved to an extent two\u2010fold superior to the reported minimal clinically important difference (MCID) (all with <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). There was a significant increase in the UCLA score at the final follow\u2010up (5.4\u2009\u00b1\u20091.5 preoperatively <jats:italic>versus<\/jats:italic> 7.7\u2009\u00b1\u20091.4, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). The mean time to return to sport and work was 4.7\u2009\u00b1\u20091.1 and 4.3\u2009\u00b1\u20092.1\u00a0months, respectively. There was an improvement in Lower\u2010limb discrepancy preoperative (LLD\u2009=\u20091.3\u2009\u00b1\u20092\u00a0cm) to postoperative measures (LLD\u2009=\u20090.3\u2009\u00b1\u20090.4\u00a0cm), ns. Complications were 2 femoral hinge fractures, 2 deep vein thromboses, 1 delayed tibial healing, and 1 hardware removal for hamstring irritation syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>DLO is effective and safe in achieving accurate correction in bifocal valgus malaligned knees with maintained lower limb length and low complication rate with no compromise of JLO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07325-y","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T02:03:37Z","timestamp":1674785017000},"page":"3007-3014","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Double\u2010level knee osteotomy accurately corrects lower limb deformity and provides satisfactory functional outcomes in bifocal (femur and tibia) valgus malaligned knees"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1180-4955","authenticated-orcid":false,"given":"Charles","family":"Pioger","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Ambroise Par\u00e9 Hospital, Paris Saclay University 9, Avenue Charles de Gaulle 92100 Boulogne\u2010Billancourt France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Mabrouk","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Sainte\u2010Marguerite Hospital, Institut du Mouvement de L\u2019Appareil Locomoteur (IML) 19, Avenue Viton 13009 Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Siboni","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Orthopaedic Surgery Reims Teaching Hospital, H\u00f4pital Maison Blanche 45 Rue Cognacq\u2010Jay 51092 Reims France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Jacquet","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Sainte\u2010Marguerite Hospital, Institut du Mouvement de L\u2019Appareil Locomoteur (IML) 19, Avenue Viton 13009 Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Seil","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Orthopaedic Surgery Centre Hospitalier Luxembourg\u2013Clinique d\u2019Eich Luxembourg Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Ollivier","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Sainte\u2010Marguerite Hospital, Institut du Mouvement de L\u2019Appareil Locomoteur (IML) 19, Avenue Viton 13009 Marseille 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December 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 January 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Institutional review board approval (CIL-APHM-2019\u2013127) was granted for the study and all patients provided informed consent to participate.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}