 Open wedge high tibial osteotomy is a form of surgery designed for certain patients with osteoarthritis, namely those with bowed knees. The goal of open wedge HTO is to realign the lower limb so that the inner joint takes on less force and symptoms of arthritis can be relieved. But things don't always go according to plan. Surgeons often miss their mark during the procedure leading to under or over corrected alignment. How does this offset affect patient outcomes after surgery? To find out, researchers examined the knees of 72 patients who underwent open wedge HTO between 2013 and 2018. The alignment of each knee was classified based on two measures captured three months after surgery, the weight bearing line of the full leg and a special location known as the Fuji Sawa point. The weight bearing line is an imaginary axis that runs from the head of the femur to the ankle. The Fuji Sawa point is a reference point indicating ideal alignment and lies 62.5% along the width of the tibial plateau. Knees with weight bearing lines lying within 5% of the Fuji Sawa point were considered appropriately corrected. Knees with weight bearing lines outside of that zone were classified as either under corrected or over corrected. Results showed that over corrected knees were strongly associated with poor outcomes following surgery. Patients with over corrected knees reported lower scores on the International Knee Documentation Committee questionnaire, Kujala questionnaire, and knee injury and osteoarthritis outcome questionnaire. Patients with under corrected knees, on the other hand, reported scores similar to those of patients with appropriately corrected knees. It should be noted that the follow up period of three months after surgery is relatively short. Beyond this point, it's possible that misalignment could reappear or that osteoarthritis could progress. A longer term study examining a larger pool of patients could provide a clearer picture of how overcorrection affects patient outcomes. For now, the findings suggest that given the differences observed in clinical outcomes, overcorrected alignment should be avoided among patients undergoing open wedge high tibial osteotomy.