Tibial Tuberosity-Sparing Anterior Opening-Wedge High Tibial Osteotomy for Posttraumatic Symptomatic Genu Recurvatum

Background: Reverse posterior tibial slope is a clinically significant cause of symptomatic genu recurvatum and posterior knee instability that alters tibiofemoral biomechanics and increases posterior tibial translation. Anterior opening-wedge high tibial osteotomy (AOW-HTO) is an effective joint-preserving technique that restores physiologic sagittal alignment and improves functional stability in this setting. Indications: This technique is indicated in patients with symptomatic osseous genu recurvatum who have failed conservative management. Technique Description: Under fluoroscopic imaging, 2 guide pins were placed aimed from above the tibial tubercle to the posterior cruciate ligament facet. Osteotomes and an oscillating saw completed the osteotomy in line with the guide pins, with the posterior cortex remaining intact. The osteotomy site was slowly opened with calibrated tines to 12 mm until the recurvatum and heel-height differences were comparable to those of the contralateral extremity. An intact posterior cortical hinge was confirmed under fluoroscopy. A contoured plate with locking screws was placed medially and a large Richards staple laterally to fix the osteotomy in place, while allograft tricortical wedges filled the osteotomy defect. Results: AOW-HTO is a reliable treatment for symptomatic osseous genu recurvatum. The tuberosity-sparing technique produced no significant change in coronal alignment or patellar height. Reported complications include neurovascular injury, posterior cortical hinge fracture, delayed union, hardware irritation, and loss of correction. Discussion/Conclusion: AOW-HTO, using a tuberosity-sparing approach, is a reliable and joint-preserving procedure for correcting posttraumatic reverse tibial slope and symptomatic genu recurvatum secondary to proximal tibial malunion. Strict patient selection, careful osteotomy planning, structural allograft support, and a phased rehabilitation protocol are critical to achieving durable outcomes. Patient Consent Disclosure Statement: The author(s) attest that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) have included a statement of release or other written form of approval from the patient(s) with this submission for publication.