Slope Correcting Anterior Closing Wedge Tibial Osteotomy Using Patient-Specific Instrumentation in Setting of Multiple Previous Revision ACL Reconstructions

Background

Graft failure after anterior cruciate ligament (ACL) reconstruction (ACLR) is a rare but devastating complication that is often multifactorial. Increased posterior tibial slope (PTS) is a known risk factor for graft failure after ACLR. Anterior closing wedge high tibial osteotomy (ACW-HTO) has been shown to reliably correct PTS and improve knee stability. Indications: In patients with failed ACLR and PTS ≥12°, ACW-HTO for posterior slope correction may be indicated. Technique Description: The presented technique demonstrates an ACW-HTO in a female Division I athlete with 2 previous ACLRs and recurrent graft failure. Patient-specific instrumentation (PSI) planning software is used to develop a 3-dimensional-printed cutting guide for HTO and a proximal tibia plate guide to aid in precise slope correction. An ACW-HTO is performed from the anteromedial aspect of the proximal tibia utilizing the premade cutting guide and a posterior hinge pin. A 6-hole patient-specific proximal tibia plate is then applied, taking care to avoid potential future ACLR tibial tunnel trajectory.