Book An Appointment
Dr. Garcia demonstrates his technique for a closing wedge high tibial osteotomy
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
This video features Dr. Garcia demonstrating his technique for a medial closing wedge high tibial osteotomy (HTO). This corrective procedure is performed on a patient presenting with a valgus deformity (knock-kneed alignment) originating from the tibia.
The surgical procedure involves the following steps:
- Initial Markings and Plan: Based on pre-measured data from a CT scan and X-rays, the surgeon marks the target correction area just below the tibial tubercle insertion. Two parallel guide pins are placed to serve as the trajectory for the initial bone cut.
- The First Biplanar Cut: Using a TPS saw blade, and with retraction protective handles placed posteriorly, the surgeon initiates a biplanar cut approximately 1 cm below the tubercle. A crucial trick shown here is making the anterior portion of the cut slightly larger—removing a small bit of the anterior tibial plateau—to prevent mechanical impingement when the bone is later collapsed.
- Wedge Isolation and Bone Removal: An osteotome is advanced deep into the bone, stopping within 5 mm to 1 cm of the far cortex. Once mobility is confirmed, a small wedge is inserted to facilitate an angled guide system for the second cut. A larger saw blade is utilized to isolate a predictable wafer of bone. The trickiest part is freeing up the posterolateral hinge area, which the surgeon manages with a laminar spreader and a synovial rongeur.
- Deep Access and Clearing: To safely reach deep into the wedge area without breaching the far side, a thin trochleoplasty tool is used to clear remaining bone tissue. The surgeon manipulates the biplanar cut at the front to ensure it will close smoothly without catching.
- Fixation and Alignment Check: A specialized locking plate is introduced. The surgeon temporarily compresses the bone gap shut and holds it tightly in place using two pinning wires. With the bone compressed, a physical alignment rod is laid down to check the weight-bearing line, confirming it has successfully shifted to the medial tibial spine.
- Final Screws and Evaluation: The surgeon places three screws into the upper portion of the plate, inserts a dedicated cortical compression screw across the osteotomy line to promote rapid bone healing, and populates the remaining holes with locking screws. The knee is moved through a manual range of motion to confirm perfect joint stability and structural closure with zero remaining gaps.
