Triplanar Anteromedial Closing Wedge Tibial Osteotomy in Excessive Slope and Tibial Valgum Patients

Excessive posterior tibial slope (PTS) is a known risk factor for anterior cruciate ligament (ACL) injury and subsequent failure of ACL reconstruction. While anterior closing wedge osteotomy effectively reduces PTS, it offers limited correction for coronal plane deformities such as tibial valgum. Tibial valgum can occur as a growth abnormality, particularly in skeletally immature patients, even after ACL reconstruction. Addressing both excessive PTS and tibial valgum simultaneously poses a significant challenge due to the lack of an established correction procedure. The triplanar anteromedial closing wedge osteotomy is a demanding surgical technique that addresses this challenge by correcting both sagittal and coronal plane deformities in patients with excessive PTS and tibial valgum. By utilizing patient-specific instrumentation, this complex osteotomy is made simpler and more accurate, allowing for optimal deformity correction. This article describes an open surgical technique for performing anteromedial closing wedge osteotomy using patient-specific instrumentation to reduce recurrent ACL injury risk while maintaining physiologic joint alignment.