The Outrigger Technique for Medial Opening Wedge High Tibial Osteotomy Using a Hintermann Distractor to Control the Osteotomy Gap Opening and the Posterior Tibial Slope

Abstract Medial opening wedge high tibial osteotomy is a successful procedure for correction of varus malalignment in isolation or in combination with other knee ligamentous and cartilage procedures. This article describes a technique for medial opening wedge high tibial osteotomy using a Hintermann distractor, which allows better control of the osteotomy gap opening and the posterior tibial slope. Preoperative digital planning is undertaken. A small longitudinal incision and a minimally invasive approach are performed to expose the proximal tibia. The Hintermann distractor is applied over 2 guide wires inserted divergently proximal and distal to the transverse osteotomy. The Hintermann distractor is used to open the osteotomy gap and maintain or change the posterior tibial slope according to the preoperative plan. Unimpeded access is provided, with no instrumentation in the gap, and this allows precise positioning of an allograft bone wedge, which is followed by fixation with an angular stable locking plate. In this technique, the Hintermann distractor serves as an outrigger that provides support to the osteotomy and offers rotational control to change the posterior tibial slope if desired.