Anterior Closing Wedge Osteotomies for Anterior Cruciate Ligament Deficiency: Indications, Technique, and Outcomes

Anterior cruciate ligament (ACL) deficiency leads to knee instability and increased joint degeneration. While ACL reconstruction (ACLR) is common, a steep posterior tibial slope (PTS) raises the risk of graft failure. Anterior closing wedge osteotomy (ACWO), or tibial deflexion osteotomy, is an effective surgical option for high PTS, especially in revision cases. ACWO alters tibial slope, reducing strain on ACL grafts and improving stability. With excellent long-term outcomes, including low rerupture rates and good return-to-sport results, ACWO is effective in cases with increased tibial slope and static anterior tibial translation, though its role in primary ACLR is still debated.