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Purpose Methods Results Conclusion Level of Evidence To evaluate the relationship between pre‐ and postoperative joint line convergence angle (JLCA) changes and patient‐reported outcome measures related to medial open‐wedge high tibial osteotomy (MOWHTO).Sixty‐one patients (71 knees) who underwent MOWHTO were examined. Preoperative and 2‐year postoperative radiographic parameters (hip–knee–ankle angle, weight‐bearing line ratio, medial proximal tibial angle and JLCA) were measured, and knee injury and osteoarthritis outcome scores (KOOS) were assessed. Patients were divided into two groups: group D (decreased JLCA compared with preoperative status) included 44 knees with a ΔJLCA < 0° and group I (increased JLCA and no‐change JLCA compared with preoperative status) included 27 knees with a ΔJLCA ≥ 0°. KOOS sub‐scores and the proportion of patients whose improvement exceeded the minimum clinically important difference (MCID) were compared between both groups using Student's t tests, Mann–Whitney U tests and chi‐square tests. Multiple regression analysis was performed to determine the factor that had an influential effect on the postoperative KOOS total.Significant differences in 2‐year postoperative KOOS were observed between the two groups, including total, symptom, pain and activities of daily living scores. Group D had significantly more patients who achieved MCID for both KOOS symptoms and pain scores than group I did. Multivariate analysis indicated that JLCA change and body mass index were significantly associated with the postoperative KOOS total.Patients with decreased JLCA had better 2‐year post‐MOWHTO KOOS and better symptom and pain improvements. Therefore, strategies that reduce JLCA are crucial to improving clinical outcomes, and efforts should be made to improve JLCA in surgical techniques.Level Ⅳ, Case series. [ABSTRACT FROM AUTHOR]