{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:43:36Z","timestamp":1787755416937,"version":"build-2784847793"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>We report a patient who was diagnosed with idiopathic genu valgum at the age of 11 years and underwent bilateral distal femur osteotomies. At age 30 years, she presented with pain around her right knee with a varus deformity. Although the corrective osteotomy was at the distal femur, she was noticed to have a bifocal deformity in both femur and tibia. She was managed with single-stage osteotomies at the distal femur and proximal tibia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case report highlights the importance of preoperative analysis to identify the site of deformity. In bifocal pathology, a 2-level osteotomy is required to prevent an oblique joint line.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.21.00771","type":"journal-article","created":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T14:08:35Z","timestamp":1648044515000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Double Level Osteotomy in an Overcorrected Distal Femoral Varisation Osteotomy"],"prefix":"10.2106","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0930-6183","authenticated-orcid":false,"given":"Nizaj","family":"N","sequence":"first","affiliation":[{"name":"VPS Lakeshore Hospital, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3282-1148","authenticated-orcid":false,"given":"Sukesh A.","family":"N","sequence":"additional","affiliation":[{"name":"VPS Lakeshore Hospital, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8027-0283","authenticated-orcid":false,"given":"Bobby","family":"Jacob","sequence":"additional","affiliation":[{"name":"Lisie Hospital, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9410-0568","authenticated-orcid":false,"given":"Bibu","family":"George","sequence":"additional","affiliation":[{"name":"Lisie Hospital, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4326-376X","authenticated-orcid":false,"given":"Julio C.","family":"Kandathil","sequence":"additional","affiliation":[{"name":"VPS Lakeshore Hospital, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8956-1618","authenticated-orcid":false,"given":"Bipin","family":"Theruvil","sequence":"additional","affiliation":[{"name":"VPS Lakeshore Hospital, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1]]},"reference":[{"issue":"5","key":"bib1-20240805","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1111\/os.13021","article-title":"Osteotomy around the knee: the surgical treatment of osteoarthritis","volume":"13","author":"Peng","year":"2021","journal-title":"Orthop Surg."},{"issue":"1","key":"bib2-20240805","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s12891-020-03232-2","article-title":"Tibial and femoral osteotomies in varus deformities\u2013radiological and clinical outcome","volume":"21","author":"F\u00fcrmetz","year":"2020","journal-title":"BMC Musculoskelet Disord."},{"issue":"10","key":"bib3-20240805","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1007\/s00113-002-0522-4","article-title":"Analysis and correction of leg deformities. 2. Correction [in German]","volume":"105","author":"Strecker","year":"2002","journal-title":"Correction Der Unfallchirurg."},{"issue":"8","key":"bib4-20240805","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.2106\/00004623-200208000-00014","article-title":"Double level osteotomy of the knee: a method to retain joint-line obliquity. Clinical results","volume":"84","author":"Babis","year":"2002","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib5-20240805","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1302\/0301-620X.84B2.0840223","article-title":"Varus inclination of the distal femur and high tibial osteotomy","volume":"84","author":"Terauchi","year":"2002","journal-title":"J Bone Joint Surg Br."},{"issue":"1","key":"bib7-20240805","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s40634-020-00283-1","article-title":"Managing intra-articular deformity in high Tibial osteotomy: a narrative review","volume":"7","author":"Micicoi","year":"2020","journal-title":"J Exp Orthop."},{"issue":"3","key":"bib8-20240805","doi-asserted-by":"crossref","first-page":"237","DOI":"10.4103\/0971-3026.137028","article-title":"Imaging of articular cartilage","volume":"24","author":"Paunipagar","year":"2014","journal-title":"Indian J Radiol Imaging."},{"issue":"1","key":"bib9-20240805","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.knee.2019.10.018","article-title":"What is the relationship between the \u201fFujisawa point\u201d and postoperative knee valgus angle? A theoretical, computer-based study","volume":"27","author":"Yin","year":"2020","journal-title":"Knee."},{"issue":"6","key":"bib10-20240805","first-page":"1873","article-title":"Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surgery, Sports Traumatology","volume":"26","author":"Nakayama","year":"2018","journal-title":"Arthroscopy."},{"issue":"2","key":"bib11-20240805","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s00264-009-0902-2","article-title":"Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material","volume":"34","author":"Staubli","year":"2010","journal-title":"Int Orthop."},{"issue":"5","key":"bib12-20240805","doi-asserted-by":"crossref","first-page":"23259671211002289","DOI":"10.1177\/23259671211002289","article-title":"Association of gap healing with angle of correction after opening-wedge high tibial osteotomy without bone grafting","volume":"9","author":"Park","year":"2021","journal-title":"Orthop J Sports Med."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.21.00771","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:42:45Z","timestamp":1787751765000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.21.00771"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.21.00771","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]}}}