High Tibial Osteotomy with ACL Reconstruction

High tibial osteotomy (HTO) can be performed in conjunction with ACLR when there is mechnical axis varus and medial compartment degeneration in addition to the ACL rupture. HTO can be done with or without additional cartilage restoration procedures. HTO either be performed simultaneously or sequentially to the ACL reconstruction.

Dr Prodromos does HTOs using an Orthofix external fixation opening wedge osteotomy below the tubercle. There are 4 advantages of this system.

  1. There are no adverse effects on possible subsequent TKA.
  2. No adverse effect on the patello-femoral joint since the osteotomy is below the tubercle and does not shorten the extensor mechanism.
  3. There is no residual hardware.
  4. The alignment is corrected as an outpatient with mechanical axis measurement. This prevents excessive valgus or residual varus results. Alignment measurements in the OR are not as accurate.

The video below details the surgical technique involved in performing this type of HTO.

The running time of this video is 4 minutes 30 seconds. Because of its long length, it may take awhile to download. If you are having problems viewing this video, please contact us at the email or phone numbers listed below and we can send you a DVD of the video.

For full copies of Dr. Prodromos' articles or DVDs, please contact us at 847-699-6810 x207 or