Slope-Reducing High Tibial Osteotomy and Over-The-Top Anterior Cruciate Ligament Reconstruction With Achilles Tendon Allograft in Multiple Failed Anterior Cruciate Ligament Reconstruction

Bálint Zsidai; Emre Anil Özbek; Ian D Engler; Janina Kaarre; Ehab M Nazzal; Andrew J Curley; Volker Musahl

doi:10.1016/j.eats.2022.07.019

Slope-Reducing High Tibial Osteotomy and Over-The-Top Anterior Cruciate Ligament Reconstruction With Achilles Tendon Allograft in Multiple Failed Anterior Cruciate Ligament Reconstruction

Arthrosc Tech. 2022 Oct 20;11(11):e2021-e2028. doi: 10.1016/j.eats.2022.07.019. eCollection 2022 Nov.

Authors

Bálint Zsidai^{1

2}, Emre Anil Özbek^{1

3}, Ian D Engler¹, Janina Kaarre^{1

2}, Ehab M Nazzal¹, Andrew J Curley¹, Volker Musahl^{1

2}

Affiliations

¹ Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA.
² Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Orthopedics and Traumatology, İbn'i Sina Training and Research Hospital, Ankara University, Ankara, Turkey.

Abstract

Graft failure is a challenging complication following anterior cruciate ligament reconstruction (ACL-R). Among the multiple anatomic and nonanatomic risk factors contributing to ACL-R failure, there is accumulating evidence that a posterior tibial slope of 12° or greater may predispose patients to graft failure of primary and revision ACL-R. In addition, previously malpositioned or widened tunnels, as well as limited autograft options, pose challenges in the setting of revision ACL-R. This Technical Note describes a technique to correct an increased posterior tibial slope using slope-reducing high tibial osteotomy, and single stage revision ACL-R with Achilles tendon allograft using the over-the-top route, in a single-stage procedure. The surgical technique involves an anterior approach to the proximal tibia, followed by tibial tubercle osteotomy and anterior closing-wedge osteotomy. The posterior cortical osteotomy hinge is left intact below the insertion of the posterior cruciate ligament. Over-the-top revision ACL-R is then performed using an Achilles tendon allograft passed around the posterior aspect of the lateral femoral condyle and fixed onto the lateral femur.