{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:53:00Z","timestamp":1792461180355,"version":"4.5.0"},"reference-count":22,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Medial compartment knee osteoarthritis (OA) is characterized by varus deformity. A medial open-wedge high tibial osteotomy (MOWHTO), frequently invoked in the treatment of this deformity, affects the knee as well as the ankle joints. This study aims to evaluate the radiological and clinical effects of a MOWHTO on the ankle joint. Materials and Methods: A retrospective analysis was conducted with data from 110 patients (mean age: 52 years; 74.5% female) who underwent a MOWHTO between 2020 and 2023. Radiographic assessments were conducted both preoperatively and one year after surgery using full-length weight-bearing radiographs. The measurements included several alignment parameters such as the hip\u2013knee\u2013ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral distal tibial angle (LDTA), and talar tilt. Clinical outcomes were assessed using the Lysholm knee score and the American Orthopedic Foot and Ankle Society (AOFAS) ankle score. Results: While changes in the LDTA demonstrated a small effect size (d = 0.225), moderate-to-large effect sizes were observed in key alignment parameters (MPTA (d = 0.838), the JLCA (d = 0.798), and talar tilt (d = 0.752)), all of which showed statistically significant differences indicative of a correction in the joint alignment of potential clinical significance. Median Lysholm and AOFAS scores at one year were 90 and 100, respectively, indicating favorable clinical outcomes. No significant difference in outcomes was observed based on the amount of correction. Conclusions: An MOWHTO not only restores knee alignment but also significantly improves ankle alignment in the coronal plane. These findings suggest that an MOWHTO is associated with the restoration of knee alignment and with improvements in ankle alignment in the coronal plane.<\/jats:p>","DOI":"10.3390\/jcm15010315","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T11:11:46Z","timestamp":1767352306000},"page":"315","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["High Tibial Osteotomy Is Associated with Improvements in Both Knee and Ankle Alignment in Medial Compartment Osteoarthritis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8436-8934","authenticated-orcid":false,"given":"Umut","family":"Oktem","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ankara City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3103-4578","authenticated-orcid":false,"given":"Muhammed Cihan","family":"Dastan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ankara City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1405-9754","authenticated-orcid":false,"given":"Hanife","family":"Avci","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Medicine, Hacettepe University, 06100 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6375-8247","authenticated-orcid":false,"given":"Mustafa","family":"Bulut","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Aksaray University Training and Research Hospital, 50300 Aksaray, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1591-4844","authenticated-orcid":false,"given":"Gulfem Ezgi","family":"Ozaltin","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Inonu University, 44280 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3610-0938","authenticated-orcid":false,"given":"Durmus Ali","family":"Ocguder","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, 06010 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8181-1128","authenticated-orcid":false,"given":"Osman","family":"Tecimel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Memorial Health Group Ankara Hospital, 06520 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0097-3905","authenticated-orcid":false,"given":"Izzet","family":"Bingol","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, 06010 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1530\/EOR-23-0104","article-title":"Osteotomies around the knee alter alignment of the ankle and hindfoot: A systematic review of biomechanical and clinical studies","volume":"8","author":"Burssens","year":"2023","journal-title":"EFORT Open Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.arthro.2007.05.018","article-title":"The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: A biomechanical study","volume":"23","author":"Agneskirchner","year":"2007","journal-title":"Arthroscopy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/s13018-022-02976-y","article-title":"Knee-ankle joint line angle: A significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy","volume":"17","author":"Tseng","year":"2022","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e70252","DOI":"10.1002\/jeo2.70252","article-title":"Knee osteotomies significantly influence coronal ankle alignment: A radiographic analysis","volume":"12","author":"Maione","year":"2025","journal-title":"J. Exp. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3230","DOI":"10.1007\/s00167-018-4840-7","article-title":"Following the correction of varus deformity of the knee through total knee arthroplasty, significant compensatory changes occur not only at the ankle and subtalar joint, but also at the foot","volume":"26","author":"Jeong","year":"2018","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2442","DOI":"10.1007\/s00167-015-3916-x","article-title":"Hindfoot alignment at one year after total knee arthroplasty","volume":"24","author":"Takenaka","year":"2016","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.knee.2016.09.023","article-title":"Radiographic assessment of knee-ankle alignment after total knee arthroplasty for varus and valgus knee osteoarthritis","volume":"24","author":"Gao","year":"2017","journal-title":"Knee"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s43019-024-00212-x","article-title":"Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: A prospective observation","volume":"36","author":"Choudhury","year":"2024","journal-title":"Knee Surg. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e04140","DOI":"10.1002\/ccr3.4140","article-title":"Open-wedge high tibial osteotomy for the treatment of osteoarthritis of both knee and ankle in the same leg: A report of two cases","volume":"9","author":"Baek","year":"2021","journal-title":"Clin. Case Rep."},{"key":"ref_10","first-page":"166","article-title":"High Tibial Osteotomy Effects on Subtalar Joint in Patients with Genu Varum","volume":"10","author":"Kazemi","year":"2022","journal-title":"Arch. Bone Jt. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40634-021-00440-0","article-title":"The novel epiligament theory: Differences in healing failure between the medial collateral and anterior cruciate ligaments","volume":"9","author":"Georgiev","year":"2022","journal-title":"J. Exp. Orthop."},{"key":"ref_12","first-page":"9","article-title":"Evaluation of postoperative orientation of the knee and ankle joint after open wedge high tibial osteotomy","volume":"29","author":"Kawashima","year":"2022","journal-title":"Asia Pac. J. Sports Med. Arthrosc. Rehabil. Technol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1007\/s00167-015-3890-3","article-title":"Changes in coronal alignment of the ankle joint after high tibial osteotomy","volume":"25","author":"Choi","year":"2017","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e245842","DOI":"10.1590\/1413-785220223001e245842","article-title":"Comparison of changes in the ankle after unicondylar knee arthroplasty and high tibial osteotomy","volume":"30","author":"Sari","year":"2022","journal-title":"Acta Ortop. Bras."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1111\/2041-210X.13384","article-title":"Metan: An R package for multi-environment trial analysis","volume":"11","author":"Olivoto","year":"2020","journal-title":"Methods Ecol. Evol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bouchard, M.D., M\u2019BArki, H., Haque, O., Vincent, A., Abouali, J., Belzile, E.L., and Matache, B.A. (2025). High Tibial Osteotomy Improves Function and Alignment in Patients Above and Below 50 Years: A Systematic Review. J. Orthop. Rep., 100789.","DOI":"10.1016\/j.jorep.2025.100789"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1002\/jor.22793","article-title":"Effect of medial opening wedge high tibial osteotomy on intraarticular knee and ankle contact pressures","volume":"33","author":"Suero","year":"2015","journal-title":"J. Orthop. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1002\/jor.24834","article-title":"Change in intersegmental foot and ankle motion after a high tibial osteotomy in genu varum patients","volume":"39","author":"Kyung","year":"2021","journal-title":"J. Orthop. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1055\/s-0038-1641143","article-title":"Ankle and Hindfoot Symptoms after Medial Open Wedge High Tibial Osteotomy","volume":"32","author":"Shah","year":"2019","journal-title":"J. Knee Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1051\/sicotj\/2025051","article-title":"Ankle pain and orientation after high tibial osteotomy as a treatment of medial compartment knee osteoarthritis","volume":"11","author":"Elsayed","year":"2025","journal-title":"SICOT J"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1177\/1071100714531230","article-title":"Ankle Deformity After High Tibial Osteotomy for Correction of Varus Knee: A Case Report","volume":"35","author":"Jeong","year":"2014","journal-title":"Foot Ankle Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"10225536241273889","DOI":"10.1177\/10225536241273889","article-title":"Effects of high tibial osteotomy on the coronal, sagittal, and axial alignments of the ankle joint","volume":"32","author":"Oh","year":"2024","journal-title":"J. Orthop. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/315\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T11:30:20Z","timestamp":1767353420000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/315"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010315"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010315","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,1]]}}}