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We hypothesized that joint line obliquity with mLDFA &gt; 90\u00b0 after distal femur osteotomy (DFO) is associated with inferior clinical outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a retrospective study, a total of 52 patients with isolated femoral valgus deformities were included in the study. The mean postoperative follow\u2010up was 70.5 (SD 33.3) months (standard deviation SD\u00b133.3). In all patients, a distal femur osteotomy was performed. A clinical examination and survey of questionnaires was conducted with the HSS (Hospital for Special Surgery), LG (Lysholm\u2010Gilquist), and KOOS (Knee Injury and Osteoarthritis Outcome Score) scores. Several radiological parameters were assessed on long\u2010standing x\u2010rays: mechanical tibio\u2010femoral angle (mTFA), mLDFA, mechanical medial proximal tibia angle (mMPTA), joint\u2010line convergence angle (JLCA). The <jats:italic>t<\/jats:italic> test was used for normally distributed data. The Mann\u2010Whitney <jats:italic>U<\/jats:italic> test was performed in non\u2010normally distributed data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mLDFA was 84.9\u00b0 (SD\u00b12.3) preop and changed to 91.9\u00b0 (SD\u00b13, 22.9) postop. The mTFA (mechanical tibio\u2010femoral angle) was 5.2\u00b0 (SD\u00b12.9\u00b0) preop and \u2212 1.8\u00b0 (SD\u00b12.9) postop demonstrating a difference of 6.7\u00b0. For analysis, the data was divided into two groups based on postop mLDFA. Group 1: mLDFA \u2264 90\u00b0; Group 2: &gt; 90\u00b0. Postoperatively, a mean mLDFA of 88.6\u00b0 (SD\u00b11.4\u00b0) was measured in group 1 and 93.9\u00b0 (SD\u00b12.1) in group 2. The change in mLDFA was 4.7\u00b0 (SD\u00b11.6) in group 1 and 8.4\u00b0 (SD\u00b12.8) in group 2. Preoperatively, the mTFA was 4.8\u00b0 (SD\u00b11.9) in group 1 and 5.5\u00b0 (SD\u00b13.3) in group 2. Postoperatively, the mTFA decreased in group 1 by 4.8\u00b0 (SD\u00b12.3) to \u2212 0.1\u00b0 (SD\u00b12.1). In group 2, the mTFA decreased by 8.2\u00b0 (SD\u00b13.8) to \u2212 2.8\u00b0 (SD\u00b12.9). Regarding the HSS, group 1 showed a 10.4 points better score than group 2 (<jats:italic>p<\/jats:italic>&lt;0.01). Also, regarding the Lysholm, a significant difference of 16.9 points was found (<jats:italic>p<\/jats:italic>&lt;0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Correction of valgus knees using closed wedge DFO leads to good clinical results. A postoperative mLDFA of 85\u201390\u00b0 results in superior clinical outcome compared to mLDFA &gt; 90\u00b0. Joint\u2010line obliquity should be avoided using double level osteotomy, if needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07449-1","type":"journal-article","created":{"date-parts":[[2023,5,7]],"date-time":"2023-05-07T01:01:12Z","timestamp":1683421272000},"page":"3992-3999","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8669-2217","authenticated-orcid":false,"given":"Steffen","family":"Schr\u00f6ter","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics and Traumatology Diakonie Klinikum GmbH Jung\u2010Stilling Siegen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Konrads","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedics and Traumatology Helios Hanseatic Hospital Stralsund Stralsund Germany"},{"name":"<!--<label>3<\/label>--> Medical Faculty University of T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Maiotti","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Shoulder Unit Villa Stuart Clinic (Rome) Orthopedics Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Mederake","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Department of Trauma and Reconstructive Surgery, BG Klinik University of T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Fischer","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Department of Trauma and Reconstructive Surgery, BG Klinik University of T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ahrend","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Department of Trauma and Reconstructive Surgery, BG Klinik University of T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Sch\u00fcll","sequence":"additional","affiliation":[{"name":"<!--<label>6<\/label>--> Department of Orthopaedic Surgery University of T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,7]]},"reference":[{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010021\u201006589\u20106"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010021\u201004163\u2010w"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010200208000\u201000014"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00132\u2010014\u20103036\u20101"},{"key":"e_1_2_11_6_2","first-page":"114","article-title":"Prognostic factors in the outcome of supracondylar femoral osteotomy for lateral compartment osteoarthritis of the knee. 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