Preoperative soft tissue laxity around knee was associated with less accurate alignment correction after hybrid closed-wedge high tibial osteotomy



This study aimed to assess the effect of soft tissue correction due to knee joint laxity, which induces alignment error after hybrid closed-wedge high tibial osteotomy (CWHTO). In addition, to verify whether postoperative soft tissue correction can be predicted from preoperative radiographic parameters.


A retrospective evaluation of data from patients treated by CWHTO in 2016–2019 was performed. Standing full-length anteroposterior radiograph measurement was performed pre- and post-surgery, and short anteroposterior radiographs of the knee under maximal manual varus and valgus stress were taken preoperatively. The weight-bearing line, hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured, in addition to JLCA under varus or valgus conditions. Soft tissue correction was defined as ΔHKA minus ΔMPTA. Multiple regression analysis was performed to evaluate preoperative factors that could influence soft tissue correction.


Data from 49 knees were included in the analysis. The mean soft tissue correction was 3.2°, which indicates an over-correction. Multiple regression analysis revealed that JLCA (β = 0.642; p < 0.001) and valgus JLCA (β = − 0.422; p = 0.001) were significantly associated with postoperative soft tissue correction. The final model of the regression formula was described by the following equation: postoperative soft tissue correction = 0.691 × JLCA − 0.411 × valgus JLCA − 0.399.


Preoperative values for JLCA and JLCA under valgus stress are associated with soft tissue correction. Surgeons should, therefore, consider these measurements to achieve postoperative limb alignment.

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The authors thank Yohei Sasaki for their advice and expert technical assistance with the surgical procedures.


This study did not receive any funding.

Author information




Designed the study: ST, NK, and YI. Analysed the data: ST and MT. Wrote the manuscript: ST and NK. Supervised the study: YY and TO. All the authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Naomi Kobayashi.

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All the procedures involving human participants were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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For this retrospective study, formal consent was not required.

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Takagawa, S., Kobayashi, N., Yukizawa, Y. et al. Preoperative soft tissue laxity around knee was associated with less accurate alignment correction after hybrid closed-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28, 3022–3030 (2020).

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  • Closed-wedge high tibial osteotomy
  • Osteoarthritis
  • Joint laxity
  • Joint line convergence angle