Slope-Increasing Anterior Opening Wedge-Proximal Tibial Osteotomy for Posterior Knee Instability Due to Symptomatic Flat Posterior Tibial Slope.

A flat posterior tibial slope increases posterior tibial translation and places additional stress on the posterior cruciate ligament. In cases where posterior cruciate ligament insufficiency is exacerbated by altered posterior tibial slope, such as following the malunion of a lateral tibial plateau fracture or anterior physeal arrest, a slope-increasing tibial osteotomy can be a valuable strategy to reduce posterior tibial translation and restore sagittal alignment. This Technical Note outlines the surgical approach for an anterior slope-increasing tibial osteotomy in the setting of chronic posterior knee instability associated with a flat posterior tibial slope following a malunion of a tibial plateau fracture.