Outcomes of Surgery for Coronal Instability

Patients presenting with coronal plane instability in association with varus or valgus deformity are a challenging population to treat. In most cases, isolated ligament repair or reconstruction is insufficient as soft tissues stretch with time. Therefore, osteotomy is typically required. There are data to support both a staged approach consisting of osteotomy followed by delayed ligamentous reconstruction as well as single-stage procedure. If a staged approach is chosen, subsequent ligament reconstruction may or may not be necessary depending on the patient’s symptoms following osteotomy. Patients with higher-energy injuries and those with multiple ligament injuries are more likely to require ligament reconstruction. Medial opening-wedge HTO is recommended for larger (>8 mm) corrections and corrections associated with posterior or posterolateral laxity and varus thrust.