Sagittal biplanar 'L'-shaped tibial osteotomy associated with osteochondral allograft for symptomatic varus knee and low patella.

Introduction: The "L"-shaped tibial osteotomy is a relatively recent surgical technique aimed at correcting the mechanical axis without altering patellar height or posterior tibial slope (common complications associated with conventional medial opening wedge osteotomies). Case presentation: We report the case of a young patient with symptomatic genu varum, osteochondral lesion in the medial femoral condyle, and low patellar height. A sagittal biplanar "L"-shaped proximal tibial osteotomy was performed, fixed with a Puddu plate and two anteroposterior screws. The osteotomy gap was filled with non-irradiated morselized bone allograft to promote consolidation. Additionally, a fresh osteochondral allograft transplant was carried out in the same surgical procedure. Clinical discussion: This technique allows for multiplanar correction while avoiding the increase in posterior tibial slope or reduction in patellar height, commonly seen with standard approaches. In our experience, combining dual anteroposterior screw fixation, morselized allograft, and osteochondral transplantation in a single stage resulted in improved mechanical stability, early bone integration, and satisfactory functional recovery. Conclusion: The biplanar "L"-shaped tibial osteotomy offers a theoretical biomechanical advantage by enabling coronal correction without altering the posterior tibial slope or patellar height in the sagittal plane. In this case, it allowed simultaneous management of the deformity and the osteochondral lesion in a single-stage procedure. However, as this is a single case, the results should be interpreted with caution and require confirmation through larger series with long-term follow-up.