Background Puddu had presented a special osteotomy plate in early 1990s, which had a spacer for internal support of the medial opening wedge osteotomy of variable heights (from 5mm to 17.5mm). In the current study, we present our results of opening wedge HTO using Puddu plate. Patients and methods Between June 2012 and august 2015, 30 knees (in 29 patients) were prospectively enrolled in current study. Twenty patients were male and 9 were females. The average age of the patients were 21.5 years (range, 15-30). Two adolescent patients had open proximal tibial growth plate. The average follow up period was 30 m0nth (range, 24 to40). All patients had opening wedge high tibial osteotomy using Puddu plate. Results Union was achieved in all patients with no need for bone grafts except in only one patient. The average time to union was 16 weeks (range, 12 to 24). The mean pre-operative mechanical tibiofemoral (MTF) angle was11.27 degrees varus (range, 5 to 16), while the mean post-operative MTF angle was 4.53 degrees’ valgus (range, 2 to 7). Overcorrection (MTF angle >6) occurred in 4 cases, while no under correction (MTF angle