High tibial osteotomy with ACL reconstruction

Knee malalignment in coronal and sagittal can alter knee biomechanics especially in anterior cruciate ligament (ACL) deficient knee that easily underdiagnosed and can endangered the reconstructed ACL to failure. Varus deformity is one of the coronal knee malalignment that shown increased tension on ACL and contribute to medial compartment degeneration. Sagittal malalignment also shown related effects on native ACL and reconstructed one. Increased posterior tibial slope will increase anterior tibia translation in weight-bearing and increase stress received by the reconstructed ACL. Eventually will leads to failure of the reconstructed ACL. High tibial osteotomy (HTO) can be utilized for deformity correction to create more biomechanically stable knee. ACL reconstruction can be performed simultaneously with HTO to achieve better outcomes and reduce re-tear rate of the reconstructed ACL.