The surgical treatment of typical pathological conditions of the knee combined with deflections along the sagittal axis is complex, especially when the angles of such deflections are considerable in size.

Prior to treatment, the first problem concerns detecting the origin of the deflection, whether it is osseous, ligamentous or mixed, especially in cases of knee recurvation. The possibility of finding patients with what is known as “prophylactic” correction of the deflection is very rare.

Orthopaedic surgeons may encounter some cases in which deformation along the sagittal axis represents the primum movens of the pathology and others in which this deflection represents a further problem in curing the condition. The different situations may require the following different treatments: (a) Correction of the deflection; (b) correction of the deflection and the pathological condition; and (c) correction of the pathological condition and not the deflection.

We believe that, in the most serious cases, the deflection must be corrected and then meticulous pre-operative preparation is required. However, in order to select the most appropriate treatment, it is essential, in our opinion, to determine the cause of the deflection along the sagittal axis.

In our experience, the treatment of pathological conditions of the knee such as ligamentous reconstruction, knee arthroplasty and corrective osteotomies combined with deflection along the sagittal axis increase the difficulties of surgery, especially in cases of relevant knee recurvation, both osseous and ligamentous.