The Role of High Tibial Osteotomy in ACL Reconstruction in Knees with Coronal and Sagittal Plane Deformity

Purpose of Review: Coronal and sagittal malalignment in the setting of anterior cruciate ligament (ACL) deficiency alters knee biomechanics and is shown to increase stress and strain on the native ACL and on the ACL graft during reconstruction. The purpose of this review was to determine the role and indications of high tibial osteotomy to correct coronal and/or sagittal plane malalignment with ACL reconstruction. Recent Findings: Recent literature illustrates that an increase in varus malalignment and increased posterior tibial slope increases the biomechanical stress that is seen in a native or reconstructed ACL graft. It has been proposed to correct the sagittal and coronal malalignment by employing a high tibial osteotomy either prior to or at the time of ACL reconstruction to correct these deformities and to decrease the stress placed on the reconstructed ACL graft. Summary: The use of high tibial osteotomy for deformity correction creates a more stable knee for ACL reconstruction and has been shown to have good outcomes with regard to post-operative pain, stability, satisfaction scores, and function.