Posterior Slope Reducing Osteotomy With Concomitant Anterior Cruciate Ligament Reconstruction

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanics

Background:

• Despite advancements in anterior cruciate ligament (ACL) reconstruction, graft rerupture rates remain significant, affecting 10-18% of patients.
• An increased posterior tibial slope (greater than 12°) is a key risk factor for ACL graft failure, increasing failure risk by 5-fold due to enhanced anterior tibial translation.

Purpose of the Study:

• To describe a technique for concurrent revision ACL reconstruction and tibial slope correction.
• To highlight the benefits of a single-stage procedure for patients with failed ACL reconstructions and elevated posterior tibial slope.

Main Methods:

• The study details a preferred technique involving a slope-reducing anterior closing wedge proximal tibial osteotomy performed concurrently with revision ACL reconstruction.
• This approach is contrasted with traditional staged procedures.

Main Results:

• Concurrent osteotomy and ACL reconstruction corrects tibial slope and restores knee stability in one surgical setting.
• This single-stage approach offers decreased recovery time, reduced costs, and minimized patient risks by avoiding a second surgical intervention.

Conclusions:

• Elevated posterior tibial slope is a critical factor in ACL reconstruction failures, especially in revision cases.
• A concurrent anterior closing wedge osteotomy and revision ACL reconstruction is an effective treatment for patients with a posterior tibial slope exceeding 12°, offering substantial advantages over staged procedures.