Abstract
Sagittal and coronal knee alignment impacts the biomechanics of the surrounding ligamentous structures, including the anterior cruciate ligament (ACL). Biomechanical studies have shown that increased degrees of varus alignment (>3°-5°) and increased amount of posterior tibial slope (>12°) significantly increase the force on the native ACL. Malalignment in the coronal and sagittal planes have been implicated as primary contributing factors in graft failure following ACL reconstruction. Clinical series have demonstrated encouraging results following either valgus-producing or slope-reducing proximal tibial osteotomy, although largely in the setting of revision ACL reconstruction, with lower rates of graft failure and improved patient-reported outcomes. However, few studies have reported on the success of osteotomy in the setting of a primary ACL rupture.
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