Trapezoidal Wedge Osteotomy with Ligament Reconstruction for Chronic Instability following Failed ACLR

We describe a case of a failed anterior cruciate ligament (ACL) reconstruction that underwent revision surgery. Lachman, anterior drawer and valgus stress tests were all grade 3, indicating ACL and medial collateral ligament (MCL) insufficiency. Posterior tibial slope (PTS) was 18° and coronal alignment was 5° valgus. The PTS and valgus alignment were possible contributing factors to the failure of the ACL reconstruction (ACLR). A novel approach was taken wherein an anterior closing wedge osteotomy (ACWO) and varising osteotomy were done after performing a tibial tuberosity (TT) osteotomy followed by revision ACLR and MCL reconstruction (MCLR). At 2-year follow-up, the coronal alignment changed to 1° varus and the tibial slope to 5°. The Knee Society Score improved from 34 pre-operatively to 90, with the patient returning to weightlifting and pre-injury activity levels.