Anterior Opening Wedge Osteotomy of the Tibia for the Treatment of Genu Recurvatum

Pathologic genu recurvatum is defined by knee hyperextension in excess of 15 degrees and is usually asymmetric. This is a rare disease that can be related to bony, soft tissue or a combination of both. Patients with genu recurvatum commonly present with anterior knee pain, knee instability, ambulation difficulty on uneven ground, and patellofemoral instability. Anterior opening wedge osteotomy of the tibia is indicated when deformity in the sagittal plane emanates from the tibia (reversed posterior tibial slope) or a combination of tibia and soft tissue. The aim of this study is to present a surgical technique for anterior high tibial osteotomy, with indications, limitations, and review of the literature. We explain the different steps of the surgery with radiologic preoperative planning, skin incision and approach, osteotomy and fluoroscopic control, fixation, and bone grafting. Although this surgery is uncommon and difficult, the overall results in the literature are very positive and lead to increased patient satisfaction and function.