Osteoarthritis of the knee is a frequent condition [
1], with a higher occurrence in subjects affected by axis deviation of the lower limbs. In patients affected by osteoarthritis, valgus deformity occurs less frequently than varus deformity, affecting only 10–15% of their knees [
2]. Unfortunately, there are multiple factors that could lead to a valgus deformity of the lower limb, and no specific recurrent cause has been identified. The most common theory is that the valgus deformity originates from the bone and might be localized mostly in the femur [
3]; this hypothesis is supported by some comparative studies in which better results were obtained through femoral rather than tibial osteotomy to correct valgus knee. Recent studies only partly support this theory; as a matter of fact, this deformity was found to originate from hypoplasia of the lateral femoral condyle in most cases, although a tibial component was associated [
4] in approximately half of the cases. Correct patient selection for
distal femoral osteotomy (DFO), as well as high tibial osteotomy, is mandatory for achieving good outcomes. First of all, medical comorbidities should be addressed, as well as the patients’ functional expectations. Obesity, evaluated as 1.32 times the normal weight or a BMI greater than 30 kg/m
2, has been associated with poorer outcomes [
5]. The presence of inflammatory disorders should be addressed as well; in this population, valgus deformity is common but osteotomies are normally contraindicated [
6]. Patients considered for a DFO should be less than 65 years old, active, and affected only by lateral arthritis; however, not only the patient’s age but also their activity level, lifestyle, and general health must be taken into consideration [
7]. DFO should be considered in the presence of isolated lateral compartment arthritis, but the tibial axis should always be evaluated. A bifocal osteotomy should be considered in order to exert a combined action on both femur and tibia, especially for wide ranges of deviations [
4]. Once it has been established that a distal femoral osteotomy is indicated, the most appropriate surgical technique should be selected. However, there is no general agreement regarding the best technique; each surgeon evaluates the advantages and disadvantages of each method. DFO options include
medial closing-wedge distal femoral osteotomy (MCW-DFO) and
lateral opening-wedge distal femoral osteotomy (LOW-DFO). MCW-DFO has some advantages: (i) a single osteotomy cut is required; (ii) it ensures a more precise measurement of the wedge thickness, especially for wedges with considerable dimensions [
8,
9]; (iii) this technique might be more familiar to the surgeon, who may use the surgical access to carry out associated procedures as well. The closing-wedge procedure can also overcome some of the disadvantages of LOW-DFO; for instance, the opening procedure requires bone grafting to fill and stabilize the osteotomy site in order to prevent excessive diastasis of bone fragments, with a delay in consolidation as a consequence. Fracture healing usually takes more time in LOW-DFO than in MCW-DFO, and LOW-DFO does not allow partial weight bearing immediately after surgery [
10]. However, the X-ray-monitored angular correction and functional results are equivalent for the two techniques in the medium to long term [
11], as is the conversion rate to knee prosthesis [
12]. For these reasons, neither technique can be considered better than the other, but a thorough assessment of patient characteristics needs to be done. Therefore, in subjects who might be affected by bone healing defects, such as smokers or individuals with low bone quality, MCW-DFO should be preferred [
13]. On the other hand, in patients who previously underwent lateral meniscectomy, the LOW-DFO technique should be preferred for its ability to compensate for subsequent substance loss. The MCW-DFO technique was chosen by the surgeon for the cohort of patients considered in the present work, as it was considered more appropriate to correct the actual site of deformity in these patients, meaning that an etiological treatment was needed instead of just a compensatory treatment. The aim of the present study was to retrospectively evaluate subjective radiological and clinical outcomes of medial closure supracondylar femoral osteotomies for arthritic valgus knee treatment at long-term follow-up.