{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:32:06Z","timestamp":1788258726374,"version":"build-2803163510"},"reference-count":57,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Data are limited regarding the surgical technique or outcomes of double-level osteotomy (DLO) combining medial closing-wedge distal femoral osteotomy and medial closing-wedge high tibial osteotomy in patients with moderate-to-severe valgus deformity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Hypothesis:<\/jats:title>\n                    <jats:p>To describe the surgical technique and assess the short-term outcomes and surgical accuracy of DLO in patients with a moderate or severe valgus deformity. It was hypothesized that this technique would result in good clinical outcomes with precise deformity correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Case series; Level of evidence, 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Eight patients (mean age, 44.2 \u00b1 10.9 years) with a moderate or severe valgus knee treated with DLO (9 knees; mechanical tibiofemoral angle [mTFA], 10.3\u00b0\u00b1 3.5\u00b0) were included. The mean follow-up was 25.1 \u00b1 11.1 months. Preoperative to postoperative changes in radiographic parameters (mTFA, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, joint line convergence angle) and clinical scores (Hospital for Special Surgery score, Oxford Knee Score, Lysholm score) were assessed. Surgical accuracy was calculated by subtracting the achieved postoperative correction from the preoperatively planned targeted correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The mTFA changed significantly from 10.3\u00b0\u00b1 3.5\u00b0 preoperatively to \u20131.8\u00b0\u00b1 3.4\u00b0 postoperatively ( P &lt; .001); the mechanical lateral distal femoral angle and mechanical medial proximal tibial angle changed significantly by 5.1\u00b0\u00b1 2.7\u00b0 and 5.9\u00b0\u00b1 2.2\u00b0, respectively ( P &lt; .001 for both); and the posterior distal femoral angle decreased significantly from 85.9\u00b0\u00b1 3.1\u00b0 to 84.2\u00b0\u00b1 2.4\u00b0 ( P &lt; .01). There was no significant difference between pre- and postoperative joint line convergence angles (3.3\u00b0\u00b1 2.3\u00b0 to 2.6\u00b0\u00b1 2.1\u00b0). The accuracy of the correction was high: the mTFA achieved postoperatively differed from the mTFA planned preoperatively by a mean of 2.7\u00b0\u00b1 1.9\u00b0 (range, 0.6\u00b0-6.6\u00b0). Significant pre- to postoperative improvement was seen for all outcome scores (Hospital for Special Surgery, from 67 \u00b1 11 to 93 \u00b1 4; Oxford Knee Score, from 29 \u00b1 7 to 43 \u00b1 3; Lysholm, from 41 \u00b1 24 to 89 \u00b1 8; P &lt; .001 for all).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>High surgical accuracy was achieved, and patients who underwent varus DLO for valgus knees showed improved knee function at short-term follow-up. Varus DLO can be a surgical option to restore the optimal alignment and joint line obliquity in patients with moderate or severe valgus malalignment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671241252167","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T12:00:53Z","timestamp":1717416053000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Surgical Technique and Preliminary Outcomes of Double-Level Osteotomy for Valgus Deformity"],"prefix":"10.1177","volume":"12","author":[{"given":"Umito","family":"Kuwashima","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuntaro","family":"Nejima","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yokohama City University School of 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