Table 2.

Advantages and Disadvantages of ACWO Techniques

Technique	Advantages	Disadvantages
Supratuberosity	No TTO required Better healing in pure cancellous bone Can allow usage of a BPTB graft for simultaneous revision ACL reconstruction	Only a short oblique ACL tibial tunnel is possible Potential to cause patella alta Potential to cause injury to the patella tendon Small proximal segment can compromise ACWO fixation
Transtuberosity	TTO provides safe exposure When reinserting the tibial tuberosity at its original proximal position, preoperative patella height will be preserved The tibial tuberosity can be used as a biological plate fixation46	Usually requires a TTO Postoperative mobilization is slower if a TTO is conducted to protect TTO bone healing
Infratuberosity	No TTO required Allows plenty of space for ACL tibial drilling Does not compromise patellofemoral mechanics	Metadiaphyseal bone has lesser healing potential than epimetaphyseal bone

ACL = anterior cruciate ligament, ACWO = anterior closing wedge osteotomy, BPTB = bone–patella tendon–bone, TTO = tibial tubercle osteotomy