Oblique Vertical Component and Dual Anteroposterior Fixation in Sagittal “L”-Shaped High Tibial Osteotomy: Technical Considerations and Biomechanical Reasoning

AIM: To describe an oblique vertical modification of the sagittal “L”-shaped high tibial osteotomy combined with dual anteroposterior fixation and to present the biomechanical reasoning supporting its potential application.METHODS: A technical note was developed based on the previously described sagittal “L”-shaped high tibial osteotomy (HTO). The proposed modification consists of introducing a slight obliquity (10°–20°) in the vertical osteotomy component posterior to the tibial tubercle while maintaining supplementary parallel anteroposterior fixation. The surgical technique, preoperative planning, indications, and biomechanical reasoning were reviewed and described.RESULTS: The proposed modification was designed to increase the available metaphyseal cancellous contact area without substantially altering the original osteotomy geometry. Based on geometric principles and previously published biomechanical studies evaluating osteotomy configurations, the oblique orientation may theoretically improve contact surface characteristics and facilitate load transfer across the osteotomy interface. Dual anteroposterior fixation is maintained as an adjunct stabilization strategy previously described for this osteotomy configuration.CONCLUSIONS: The oblique vertical modification represents a technical refinement of the sagittal “L”-shaped high tibial osteotomy. Although its proposed biomechanical advantages remain theoretical and require experimental and clinical validation, the modification may provide a useful geometric framework for increasing metaphyseal contact area while preserving the established principles of sagittal alignment control, posterior tibial slope preservation, and maintenance of patellar height.