Radiographs of 110 patients who had undergone 120 high tibial osteotomies (60 closed-wedge, 60 open-wedge) were assessed for posterior tibial slope before and after operation, and before removal of the hardware. In the closed-wedge group the mean slope was 5.7 degrees (SD 3.8) before and 2.4 degrees (SD 3.9) immediately after operation, and 2.4 degrees (SD 3.4) before removal of the hardware. In the open-wedge group, these values were 5.0 degrees (SD 3.7), 7.7 degrees (SD 4.3) and 8.1 degrees (SD 3.9) respectively, when stabilised with a non-locking plate, and 7.7 degrees (SD 3.5), 9.4 degrees (SD 4.1) and 9.1 degrees (SD 3.8), when stabilised with a locking plate. The reduction in slope (-2.7 degrees (SD 4.1)) in the closed-wedge group and the increase (+2.5 degrees (SD 3.4), in the open-wedge group was significantly different before and after operation (p = 0.002, p = 0.003). In no group were the changes in slope directly after operation and before removal of the hardware significant (p > 0.05). There was no correlation between the amount of correction in the frontal plane and the post-operative change in slope. Posterior tibial slope decreases after closed-wedge high tibial osteotomy and increases after an open-wedge procedure because of the geometry of the proximal tibia. The changes in the slope are stable over time, emphasising the influence of the operative procedure rather than of the implant.

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Gradual fibular transfer by Ilizarov external fixator is a reliable technique in management of post-traumatic and post-infection large tibial bone defects with good clinical outcome, and with few complications.

The anterior cruciate ligament suture augmentation technique is a method to augment anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendons using a braided ultrahigh–molecular weight polyester or polyethylene suture or suture tape and fixed on both the femoral and tibial sides independent of the graft to act as a backup or secondary stabilizer until complete integration and ligamentization of the graft take place. The technique is proposed to allow early rehabilitation and return to sports after ACLR and may be advantageous in patients with a high body mass index and in cases with small grafts (7 or 7.5 mm in diameter). In such situations the technique is supposed to decrease the risk of reinjury, as well as the degree of postoperative lengthening or stretching of the graft, in the early postoperative avascular phase. We describe graft preparation with the internal suture augmentation technique in arthroscopic ACLR using a cortical button system on the femoral side and a Bio-Interference Screw (Arthrex, Naples, FL) on the tibial side.

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