Opening Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction or Revision

High tibial osteotomy (HTO) is a valid treatment option for young active patients with medial tibiofemoral osteoarthrosis (OA) and varus deformity. Sometimes medial OA is combined with symptomatic anterior cruciate ligament (ACL) deficiency. Although isolated HTO (with possible delayed ACL reconstruction) might be indicated in the older population, young active patients may require combined HTO and ACL reconstruction. In addition, an abnormally increased tibial slope may predispose to ACL reconstruction failure and should be addressed for a successful ACL revision. The combination of HTO and ACL reconstruction produces good results, with resumption of normal daily activities, as well as recreational sports, and does not seem to increase the risk of complications compared with isolated HTO. The purpose of this Technical Note is to describe our indications, planning, and technique for opening wedge HTO fixed with a spacer plate and anatomic soft-tissue (autograft or allograft) ACL reconstruction, with proximal extracortical suspension and distal interference screw fixation.