{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:26:21Z","timestamp":1792697181695,"version":"4.5.0"},"reference-count":19,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"5","license":[{"start":{"date-parts":[[2016,5,1]],"date-time":"2016-05-01T00:00:00Z","timestamp":1462060800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>In patients undergoing medial opening wedge high tibial osteotomy (MOWHTO), soft tissue opening on the medial side of the knee is difficult to predict. When the load bearing axis is corrected beyond a certain point, the knee joint tilts open on the medial side. We therefore hypothesised that there is a tipping point and defined this as the coronal hypomochlion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>In this prospective study of 150 navigated MOWHTOs (144 consecutive patients), data were collected before surgery and at three months post-operatively. In order to calculate the hypomochlion, we compared the respective changes to the joint line convergence angle (JLCA) with the post-operative axis of the leg. The change to the medial proximal tibial angle accounts for only about 80% of the change to the femorotibial angle; 20% of the correction can therefore be attributed to non-osseous, soft-tissue changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We were able to demonstrate a linear change of JLCA in a range of 0\u00b0 to 5\u00b0 of valgus which started when the post-operative long-leg axis was corrected beyond 2\u00b0 of valgus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found that the coronal hypomochlion occurs at 2\u00b0 of valgus. Take home message: It is recommended to plan realignment for medial open wedge high tibial osteotomy at a maximum of 2\u00b0 valgus. Cite this article: Bone Joint J 2016;98-B:628\u201333.<\/jats:p><\/jats:sec>","DOI":"10.1302\/0301-620x.98b5.33394","type":"journal-article","created":{"date-parts":[[2016,5,3]],"date-time":"2016-05-03T10:07:42Z","timestamp":1462270062000},"page":"628-633","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":31,"title":["The coronal hypomochlion"],"prefix":"10.1302","volume":"98-B","author":[{"given":"E.","family":"Heijens","sequence":"first","affiliation":[{"name":"Gelenkzentrum Rhein-Main, Wilhelmstr.30, 65193 Wiesbaden, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Kornherr","sequence":"additional","affiliation":[{"name":"Dr. Horst Schmidt Kliniken, Ludwig-Erhardt Str. 100, 65199 Wiesbaden, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Meister","sequence":"additional","affiliation":[{"name":"Gelenkzentrum Rhein-Main, Wilhelmstr.30, 65193 Wiesbaden, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.90B12.21198"},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2175-3"},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2016-4"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1007\/s00132-009-1458-y"},{"key":"r5","unstructured":"Lobenhoffer P, Agneskirchner J, Galla M.Kniegelenknahe osteotomien: indication planung, operations technik mit platten fixateuren. 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Detailed planning algorithm for high-tibial osteotomy. In: Lobenhoffer P, van Heerwaarden RJ, Staubli AE, Jakob RP, eds. Osteotomies around the Knee. AO Publishing, 2008:40\u201341."}],"container-title":["The Bone &amp; Joint Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.98B5.33394","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/full-xml\/10.1302\/0301-620X.98B5.33394","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.98B5.33394","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,19]],"date-time":"2022-06-19T17:27:28Z","timestamp":1655659648000},"score":1,"resource":{"primary":{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/10.1302\/0301-620X.98B5.33394"}},"subtitle":["a tipping point of clinical relevance when planning valgus producing high tibial osteotomies"],"short-title":[],"issued":{"date-parts":[[2016,5]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2016,5]]}},"alternative-id":["10.1302\/0301-620X.98B5.33394"],"URL":"https:\/\/doi.org\/10.1302\/0301-620x.98b5.33394","relation":{},"ISSN":["2049-4394","2049-4408"],"issn-type":[{"value":"2049-4394","type":"print"},{"value":"2049-4408","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5]]},"assertion":[{"value":"2014-01-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-01-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-05-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}