Anterior Closing‐Wedge High Tibial Osteotomy Using Patient‐Specific Cutting Guide in Chronic Anterior Cruciate Ligament–Deficient Knees

An increased posterior tibial slope has been identified as an independent risk factor for anterior cruciate ligament (ACL) graft rupture, with a critical threshold of 12°. Surgical slope correction by anterior closing wedge (ACW)-high tibial osteotomy (HTO) can reduce ACL force and anterior tibial translation with good clinical outcomes when combined with revision ACL reconstruction. Performing ACW-HTO preserving the tibial tubercule can be challenging for inexperienced surgeons. Patient-specific cutting guides have been shown to be effective in facilitating the surgeon's learning curve in medial opening wedge-HTO by reducing operative time and the use of fluoroscopy as well as decreasing anxiety. The present technique describes a retro-tibial tubercule ACW-HTO using a patient-specific cutting guide.