Check out Dr. Garcia’s technique for high tibial osteotomy in a young active patient wanting to return to high impact activities.

This video, titled "Check out Dr. Garcia’s technique for high tibial osteotomy in a young active patient," demonstrates an opening-wedge high tibial osteotomy (HTO). The procedure is performed on a young, active patient with isolated medial compartment wear caused by a bow-legged alignment (roughly 10 degrees of varus).

The goal of the surgery is to cut the upper shinbone (tibia) and open a small gap to shift the patient's weight-bearing line away from the damaged inner knee toward the healthy outer knee.

The procedural steps shown in the video include:

• Surgical Access and Alignment: The surgeon begins with an inverted L-shaped dissection on the inner upper shinbone. Under real-time X-ray (fluoroscopic) guidance, a guide pin is advanced toward the tip of the fibular head on the opposite side of the leg. A parallel guide pin is added next to it to establish a precise cutting track.
• Performing the Bone Cut: A radiolucent retractor is positioned behind the bone to safely guard the critical neurovascular bundle (blood vessels and nerves). The surgeon uses a specialized saw to begin the cut, followed by surgical chisels (osteotomes) to carefully break the front and back bone cortex. A one-centimeter bridge of bone is left completely intact on the outer side to serve as a stable hinge.
• Gradual Correction: The cut bone is slowly expanded, starting at 2 to 3 millimeters. Once the gap reaches the pre-planned correction size, a long metal alignment rod is placed from the hip down to the ankle. The surgeon checks the X-ray to confirm that the weight-bearing line has shifted exactly to the lateral tibial spine.
• Fixation and Stability: A low-profile HTO wedge plate—featuring a built-in metal block that sits inside the bone gap to prevent it from collapsing—is held against the bone. The surgeon secures the top portion of the plate into the tibia using 6.5mm cancellous screws and the lower section using 4.5mm cortical screws. A side-view X-ray is reviewed to verify that the natural front-to-back slope of the joint surface was not accidentally changed.
• Bone Grafting and Closure: Pre-measured blocks of freeze-dried iliac crest bone graft are packed firmly into the open front and back sections of the bone gap to stimulate fast fusion. The knee is put through a physical range of motion to confirm perfect joint stability. Finally, a tissue sleeve is repaired over the top of the surgical site to fully cover and cushion the hardware.