Varus collapse following anterior closing wedge proximal tibial osteotomy for ACL revision reconstruction: a case series

A slope-correcting anterior closing wedge proximal tibial osteotomy is a powerful tool for correcting increased posterior tibial slope in the setting of a failed anterior cruciate ligament reconstruction. This case series documents three cases in which patients collapsed into varus following an anterior closing wedge proximal tibia osteotomy. Two patients had osteotomies fixated with a “suture-staple” construct, and all had medical comorbidities or reported noncompliance post-operatively. Therefore, meticulous care during the planning, execution, and rehabilitation phases is critical as multiple factors throughout the arc of care may contribute towards anterior closing wedge proximal tibial osteotomy varus collapse. Careful optimization of medical comorbidities and rigid fixation with either a plate and screws or compression staples should be used rather than a “suture-staple” to mitigate this risk. Level of evidence: IV.