Intraoperative Laximetry-Based Selective Transtibial Anterior Cruciate Ligament Reconstruction Concomitant With Medial Open Wedge High Tibial Osteotomy for Treating Varus Knee Osteoarthritis With Anterior Cruciate Ligament Deficiency.

High tibial osteotomy (HTO) is used in the treatment of varus knee osteoarthritis (KOA) in young and active patients. At times, a concomitant anterior cruciate ligament (ACL) deficiency is found, and there is no conclusive evidence comparing the osteotomy options for an ACL-deficient knee despite the popularity of medial opening-wedge (MOW) HTO in varus KOA with ACL deficiency. To minimize the incidence of an unnecessary ACL reconstruction with MOW-HTO, we developed an intraoperative laximetry-based selective technique for transtibial ACL reconstruction concomitant with MOW-HTO using a sterilizable metal laximeter. To successfully use the device required for this procedure, surgeons must understand the proper techniques. Hence, this Technical Note aims to give a comprehensive description of the technique.