# Triplanar Anteromedial Closing Wedge Tibial Osteotomy in Excessive Slope and Tibial Valgum Patients

## TL;DR

A new surgical technique is described to correct both excessive tibial slope and tibial valgum, reducing the risk of ACL injury.

## Contribution

The triplanar anteromedial closing wedge osteotomy is introduced as a novel method to address combined tibial deformities.

## Key findings

- The triplanar osteotomy corrects both sagittal and coronal deformities effectively.
- Patient-specific instrumentation enhances the accuracy and simplicity of the procedure.
- This technique helps maintain physiologic joint alignment while reducing ACL injury risk.

## Abstract

Excessive posterior tibial slope (PTS) is a known risk factor for anterior cruciate ligament (ACL) injury and subsequent failure of ACL reconstruction. While anterior closing wedge osteotomy effectively reduces PTS, it offers limited correction for coronal plane deformities such as tibial valgum. Tibial valgum can occur as a growth abnormality, particularly in skeletally immature patients, even after ACL reconstruction. Addressing both excessive PTS and tibial valgum simultaneously poses a significant challenge due to the lack of an established correction procedure. The triplanar anteromedial closing wedge osteotomy is a demanding surgical technique that addresses this challenge by correcting both sagittal and coronal plane deformities in patients with excessive PTS and tibial valgum. By utilizing patient-specific instrumentation, this complex osteotomy is made simpler and more accurate, allowing for optimal deformity correction. This article describes an open surgical technique for performing anteromedial closing wedge osteotomy using patient-specific instrumentation to reduce recurrent ACL injury risk while maintaining physiologic joint alignment.