Anterior schließende subtuberositäre Osteotomie

Increased posterior tibial slope is a risk factor for the development of recurrent instability after reconstruction of the anterior cruciate ligament (ACL). Therefore, increased posterior tibial slope of more than 12° in combination with recurrent instability after reconstruction of the ACL is seen as an indication for corrective osteotomy. After exposing the tibial tuberosity via anterior skin incision of approximately 8–10 cm, two converging guide wires are inserted directly below the patellar tendon, ascending obliquely to the area of the posterior cruciate ligament (PCL) insertion. After checking the wire position with the image intensifier, the osteotomy is performed with an oscillating saw and the wedge is removed. Then, the osteotomy is carefully closed and stabilized with an interfragmentary screw and an anteromedial angle-stable plate. The rehabilitation protocol involves partial weight bearing with 10–20 kg for 2 weeks with free range of motion, followed by a stepwise increase of weight bearing.