Technical Tips and Tricks for Complex Biplanar High Tibial Osteotomy

Although conventional high tibial osteotomy (HTO) primarily addresses coronal plane malalignment, the importance of sagittal plane alignment—particularly the posterior tibial slope (PTS)—cannot be overlooked in the setting of cruciate ligament insufficiency. Combined coronal and sagittal plane deformities are relatively uncommon and present unique surgical challenges. This narrative review summarizes the relevant literature and introduces technical strategies for managing complex biplanar deformities through case-based discussions of various techniques.