Review Question - QID 215513

A 38-year-old non-obese female presents to your clinic with a primary complaint of medial knee pain. Past medical history is significant for psoriatic arthritis. On standing examination, you note varus malalignment compared to the contralateral side. There is no limp or gait abnormality. She extends the knee 10 degrees short of full extension and flexes to 130 degrees. Full length lower extremity radiographs demonstrate 10 degrees of varus malalignment. MRI demonstrates a 1.5 x 1.5cm chondral defect on the medial femoral condyle. You consider recommending a high-tibial osteotomy (HTO) to correct her alignment. Which of the following is a contraindication to HTO in this patient?