A Unique Case of Negative Weight-bearing Line Ratio in a Young Male Adult: Insights and Implications

Opening-wedge high tibial osteotomy (OWHTO) is a well-documented surgical intervention for medial compartment osteoarthritis with knee varus deformity. The optimal alignment, specifically targeting the Fujisawa point and managing a negative weight-bearing line ratio (WBLR), remains a challenge, especially with severe varus deformities. We detail the case of a 46-year-old Asian male medical staff member with a negative WBLR and severe varus deformity due to a combination of traumatic events and underlying osteoarthritis. Despite the existing debate around alignment targets, our patient underwent OWHTO alongside a segmental meniscus transplant using autologous tendon graft. One-year postoperative assessments showed improved alignment, a negative McMurray test result, and enhanced patient-reported outcomes. This case underscores the potential of integrating OWHTO and medial meniscus autograft transplantation in patients with challenging presentations, such as a negative WBLR. Large corrections in such patients’ risk enhancing the medial proximal tibial angle leading to altered knee dynamics. Our approach demonstrates the viability of a concurrent meniscus transplant with a focus on neutral alignment, aiming to mitigate risks associated with overcorrection. Combining OWHTO with meniscus autograft transplantation can be a feasible solution for complex cases presenting with negative WBLR, offering improved patient outcomes and function at 6-month follow-up. Further research is needed to validate these findings in larger patient cohorts.