Concomitant Opening-Wedge Distal Femoral Osteotomy and Anterior Closing-Wedge Proximal Tibial Osteotomy With Tunnel Bone Grafting for the First Stage of a Revision Anterior Cruciate Ligament Reconstruction

Multiple risk factors for anterior cruciate ligament (ACL) reconstruction graft failure have been reported, including improper tunnel placement, unrepaired meniscus or ligamentous injuries, and coronal/sagittal malalignment. Various biomechanical studies have reported on the increased forces experienced by the ACL graft when there is valgus malalignment or increased posterior tibial slope. This technique describes an opening-wedge distal femoral osteotomy to correct valgus alignment and a closing-wedge proximal tibial osteotomy to correct increased posterior tibial slope in the setting of an ACL reconstruction graft failure. This technique is the first stage of a 2-stage surgery in which the second stage is the revision ACL reconstruction. By performing both osteotomies first, the patient can begin weight bearing earlier after the revision ACL reconstruction.