Fig. 5

Biplanar distal tibial osteotomy and osteochondral autograft transplantation. a The distal tibia was exposed, medial malleolar osteotomy was performed about 5 cm above the tip of medial malleolus. b The distal fragment was flipped downward for direct visualization. The wall and base of the lesion were abraded and curetted down to viable subchondral bone. c Cylindrical autografts taken from the ipsilateral knee joint was inserted into the defect to resurface the articular cartilage. d The fragment was stabilized with two cannulated screws parallel to distal tibial plafond. e The distal tibial osteotomy was performed about 5 cm above the medial malleolar tip, which was almost at the same level of medial malleolar osteotomy. f The osteotomy was stabilized with plates and screws