Review Question - QID 211612

Figure A is the AP radiograph of a 42-year-old male construction worker presenting with medial-sided knee pain. He reports a history of subtotal medial meniscectomy 12 years ago. He has failed conservative management including physical therapy and injections. He had initial success with the use of a medial unloader brace, however it no longer provides relief. The patient has a BMI of 24. On examination, he has knee range of motion from 8°-130° of flexion, negative Lachman, and has a varus-thrust during ambulation. Which of the following is a contraindication to a valgus-producing high tibial osteotomy in this patient?