Proximal Tibial Opening Wedge Osteotomy for the Treatment of Posterior Knee Instability and Genu Recurvatum Secondary to Increased Anterior Tibial Slope

Decreased posterior tibial slope has been associated with increased risk of graft failure and knee instability after posterior cruciate ligament (PCL) reconstruction. Premature physeal arrest at the tibial tubercle is a common cause of osseous genu recurvatum. Surgical management is recommended to correct the tibial slope and prolong the integrity of the PCL graft. This article discusses our preferred treatment using a proximal tibial opening wedge osteotomy for surgical management of posterior knee instability and genu recurvatum secondary to significant anterior tibial slope.
Technique Video Video 1 The patient is examined under anesthesia and is found to have a right heel height of 15 cm and a positive right posterior drawer test. An incision is made from the midportion of the patella down distally to the tibial tubercle, raising full-thickness subcutaneous flaps. A proximal tibial opening wedge osteotomy is performed with 2 guide pins, a small saw blade, and osteotomes. The osteotomy is then widened using a spreader device until the desired tibial slope is achieved. Measurements are taken intraoperatively, confirming preoperative planning for appropriate size of the posteriorly sloped Puddu plate. The osteotomy is completed by placing the plate just medial to the patellar tendon anteriorly. A large Richards staple is placed on the anterolateral aspect of the osteotomy, and the incision is then closed.