Anterior Opening-Wedge Tibial Osteotomy for Correction of Posterior Tibial Slope in Posterior Cruciate Ligament Instability: A Case Report
L.C. Fonseca, A.R. Neto, J.S.N. Ferreira, D.D.S. Lobo, V.B. Melo, S.S. BlunckIntroduction:
Posterior cruciate ligament (PCL) insufficiency is an uncommon but functionally disabling condition that may progress to chronic posterior knee instability when associated biomechanical factors are not adequately addressed. Alterations in posterior tibial slope (PTS), particularly a pathologically reduced slope, are increasingly recognized as key contributors to posterior tibial sag, recurvatum, and failure of isolated ligament reconstruction. In such cases, correction of sagittal plane deformity may be necessary to restore knee stability.
Methods:
We report the case of a young adult male with chronic posterior knee instability following a high-energy motorcycle accident during adolescence. The injury resulted in PCL rupture and anterior tibial plateau collapse, leading to a markedly reduced posterior tibial slope. Despite subsequent PCL reconstruction, the patient remained symptomatic. Preoperative imaging confirmed significant sagittal deformity with preserved coronal alignment. An anterior opening-wedge proximal tibial osteotomy was performed to increase the posterior tibial slope using tricortical iliac crest bone grafting and plate fixation under fluoroscopic guidance.
Results:
Postoperative radiographs demonstrated restoration of a physiological posterior tibial slope and stable fixation of the osteotomy. Clinically, the patient showed marked improvement in posterior knee stability and correction of recurvatum, without intraoperative or early postoperative complications.
Conclusion:
Abnormal posterior tibial slope is an important biomechanical factor in refractory PCL instability. Anterior opening-wedge tibial osteotomy effectively addresses sagittal plane deformity and should be considered in selected patients with persistent posterior instability following isolated ligament reconstruction. This approach emphasizes comprehensive biomechanical assessment and individualized surgical planning in complex posterior cruciate ligament cases management strategies.