Table 1.

Contraindications, Pearls, Advantages, Disadvantages, and Potential Risks

Contraindications

Severe misalignment of the limb (i.e., >10° varus valgus)

Hyperextension of the knee (>10°)

Grade IV osteoarthritis according to Kellgren and Lawrence classification

Pearls

Medial and lateral dissection allows good soft-tissue closure around osteotomy site.

Vertical cut on TT oriented distally along the tibia leaves a cortical distal hinge.

Marking the osteotomy length on the osteotome and verifying it with fluoroscopy helps to preserve a posterior bony hinge.

Complete the bone resection before attempting to reduce the osteotomy.

Close the osteotomy by gentle knee extension to avoid fracturing the posterior cortex.

Advantages

Safe and reproducible method for tibial slope correction

Vertical cut in the TT preserves the extensor mechanism without distal detachment and allows accurate positioning of the osteotomy at the appropriate level.

Osteotomy is located in the epiphysis with a low angle for better healing and lower risk of non-union.

Using staples keeps the central tibial epiphysis free of hardware, allowing for standard tibial tunnel placement during ACL reconstruction.

Potential risks and disadvantages

Damage to the popliteal vessels and nerves

Modification of patellar height

Non-union

TT fracture

Does not allow varus or valgus correction

Potential for overcorrection or undercorrection

ACL, anterior cruciate ligament; TT, tibial tubercle.