Failure after anterior cruciate ligament reconstruction develops due to multifactorial causes. Accurate analysis of these factors is critical for treatment success. Untreated coronal and sagittal alignment abnormalities of the lower extremity play a significant role in failure. In patients with varus or valgus malalignment, performing revision ligament surgery alone may lead to repetitive abnormal loading on the graft, resulting in graft laxity, residual instability, meniscal damage, and early osteoarthritis. Therefore, in patients scheduled for revision anterior cruciate ligament (ACL) surgery, it is essential to perform a detailed evaluation of the mechanical axis and the origin of the deformity using weight-bearing long-leg radiographs. By combining revision ACL surgery with high tibial osteotomy or distal femoral osteotomy, the goals are to correct coronal plane varus or valgus deformity, reduce related compartment loading, decrease stress on the graft, and improve knee stability by reducing the tendency for anterior tibial translation. This review comprehensively summarizes the indications for osteotomy in revision ACL surgery, principles of preoperative planning, surgical techniques, and current clinical outcomes.