Excessive posterior tibial slope (PTS) is a recognised risk factor for graft failure in anterior cruciate ligament (ACL) reconstruction, and tibial valgum (valgus of the tibial metaphysis) poses additional biomechanical challenges. This paper describes a surgical technique — a triplanar anteromedial closing wedge osteotomy (AMCWO) — designed to correct both PTS and tibial valgum simultaneously, thereby addressing two major deformity planes in one procedure.
Study design & technique overview
Published in Arthroscopy Techniques, this article is a technical surgical technique paper. The authors (Ollivier et al.) present the operative steps of the triplanar AMCWO: creating a wedge that reduces slope (sagittal plane) and closes medially (coronal plane) with patient-specific instrumentation for accurate alignment. The procedure is aimed at patients with combined deformities of slope and tibial valgum, often in the context of ACL revisions or complex knee deformity cases.
Key technical considerations
- Pre-operative planning with long-leg standing and lateral tibial imaging to quantify PTS and valgus deformity.
- Use of patient-specific cutting guides to execute accurate wedge removal in the triplanar geometry.
- Aimed correction example: reducing PTS from ~20° pre-operatively to ~8° post-operatively, while bringing tibial coronal alignment toward neutral.
- Stabilisation with locking plates; care to avoid compromise of tunnel zones when combined with ACL revision.
Clinical implication & take-home messages
- For patients with both excessive PTS and tibial valgum, a combined osteotomy addressing both planes may be more effective than separate procedures.
- The use of patient-specific guides enhances precision in these complex deformity corrections.
- Surgeons dealing with revisions of ACL in the context of abnormal tibial geometry should consider this combined triplanar technique to optimise alignment and reduce graft failure risk.
- As the article is a technique description rather than an outcomes cohort, further clinical-follow-up data is needed to evaluate durability and functional results.
