Dr. Garcia demonstrates his anterior tibial osteotomy technique

This video demonstrates Dr. Garcia’s technique for an anterior tibial osteotomy (closing wedge). The procedure is performed on a patient with multiple failed ACL reconstructions and an excessively high tibial slope of over 13 degrees.

Here is a summary of the surgical steps:

• Initial Setup and Cuts: The surgeon places four guide pins under continuous fluoroscopic (X-ray) guidance to determine the trajectory. A specialized TPS saw and a larger saw blade are utilized to make precise cuts above and below the tibial tubercle, ensuring the cut is low enough to later accommodate a fixation plate.
• Bone Removal and Closure: Sequential osteotomes and a spreader are used to loosen and remove the target wedge of bone. A trochleoplasty guide is used to carefully clear out the posterior cancellous bone without penetrating the back wall. The surgeon pre-measured for a 9 mm closure to reduce the tibial slope by approximately 8 degrees. The knee is placed into full extension to carefully compress the gap and close the wedge without fracturing the bone.
• Plate Fixation: A locking plate is positioned on the upper portion of the bone. The surgeon inserts polyaxial and locking screws under X-ray guidance, ensuring they achieve secure purchase without penetrating the back of the bone or entering the joint space. A K-wire temporarily holds the osteotomy closed while a bicortical compression screw is inserted to firmly secure the closing wedge.
• Supplemental Fixation and Testing: To provide extra robust backup fixation on the lateral side, two compression staples (18 mm and 20 mm) are placed and compressed down. The surgeon tests the knee through a range of motion from 0 to 90 degrees to confirm that there is absolutely no gapping.

This robust fixation method allows the patient to begin range-of-motion exercises in about a week, with the plan to undergo a final revision ACL surgery in roughly 6 months once healed.