Fig 7.

Left knee anterior approach for anterior closing-wedge proximal tibial osteotomy with the patient in the supine position. The medial periosteum is elevated up first (black arrow) at the desired position of the tibial osteotomy with a 1-cm tissue flap from distal to proximal. For this patient, the tibial screw was in this area and was removed. Next, a similar 1-cm flap is elevated up laterally above the anterior compartment musculature and back to the fibular head. Then, the patellar tendon (white arrow) is elevated up to visualize the proximal tibial cortex underneath.