Medial opening wedge high tibial osteotomy (HTO) can provide symptom relief, improved ligamentous stability, and lower failure rates in patients with symptomatic medial knee osteoarthritis, ligament instability, and varus alignment after ligament reconstruction. It has been reported that correcting coronal plane abnormalities with a medial opening wedge HTO has resulted in altered posterior tibial slope angle (PTSA). We describe a 38-year-old woman with a history of severe polytrauma who presented with an anterior cruciate ligament tear in the setting of increased PTSA and a posterolateral corner injury with varus deformity of the knee. A medial biplanar HTO was performed using plate position to correct varus malalignment and decrease PTSA simultaneously. This case describes a method for simultaneously correcting varus malalignment while deliberately changing PTSA.

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