Closing-Wedge Posterior Tibial Slope-Reducing Osteotomy in Complex Revision ACL Reconstruction

Thiago Vivacqua; Stephan Thomassen; Philipp W Winkler; Gian A Lucidi; Alexis Rousseau-Saine; Andrew D Firth; Mark Heard; Volker Musahl; Alan M J Getgood

doi:10.1177/23259671221144786

Closing-Wedge Posterior Tibial Slope-Reducing Osteotomy in Complex Revision ACL Reconstruction

Orthop J Sports Med. 2023 Jan 11;11(1):23259671221144786. doi: 10.1177/23259671221144786. eCollection 2023 Jan.

Authors

Affiliations

¹ Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
² Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Linz, Austria.
³ Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany.
⁴ Department of Orthopedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁵ Banff Sport Medicine, University of Calgary, Calgary, Alberta, Canada.

Abstract

Background: A posterior tibial slope (PTS) >12° has been shown to correlate with failure of anterior cruciate ligament (ACL) reconstruction (ACLR). PTS-reducing osteotomy has been described to correct the PTS in patients with a deficient ACL, mostly after failure of primary ACLR.

Purpose: To report radiologic indices, clinical outcomes, and postoperative complications after PTS-reducing osteotomy performed concurrently with revision ACLR (R-ACLR).

Study design: Case series; Level of evidence, 4.

Methods: A review of medical records at 3 institutions was performed of patients who had undergone PTS-reducing osteotomy concurrently with R-ACLR between August 2010 and October 2020. Radiologic parameters recorded included the PTS, patellar height according to the Caton-Deschamps Index (CDI), and anterior tibial translation (ATT). Patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]), reoperations, and complications were evaluated.

Results: Included were 23 patients with a mean follow-up of 26.7 months (range, 6-84 months; median, 22.5 months). Statistically significant differences from preoperative to postoperative values were found in PTS (median [range], 14.0° [12°-18°] vs 4.0° [0°-15°], respectively; P < .001), CDI (median, 1.00 vs 1.10, respectively; P = .04) and ATT (median, 8.5 vs 3.6 mm, respectively; P = .001). At the final follow-up, the IKDC score was 52.4 ± 19.2 and the KOOS subscale scores were 81.5 ± 9.5 (Pain), 74 ± 21.6 (Symptoms), 88.5 ± 8 (Activities of Daily Living); 52.5 ± 21.6 (Sport and Recreation), and 48.8 ± 15.8 (Quality of Life). A traumatic ACL graft failure occurred in 2 patients (8.7%). Reoperations were necessary for 6 patients (26.1%) because of symptomatic hardware, and atraumatic recurrent knee instability was diagnosed in 1 patient (4.3%).

Conclusion: Tibial slope-reducing osteotomy resulted in a significant decrease of ATT and can be considered in patients with a preoperative PTS ≥12° and ≥1 ACLR failure. In highly complex patients with multiple prior surgeries, the authors found a reasonably low graft failure rate (8.7%) when utilizing PTS-reducing osteotomy. Surgeons must be aware of potential complications in patients with multiple previous failed ACLRs.

Keywords: knee; posterior tibial slope; revision anterior cruciate ligament reconstruction; slope-reducing osteotomy.