Slope-reducing Tibial Osteotomy With Repeat Revision ACL Recon — Goals and Realities

"Happiness is the management of expectations"

What’s the Claim?

An unusually well-performed and well-reported case series on patients who’d torn two or more ACL grafts (that is, patients on their second revision ACL or more) and who had posterior tibial slope of >12° were treated with closing-wedge, slope-reducing high tibial osteotomy along with re-revision ACL reconstruction. The knees were corrected to a mean posterior tibial slope of about 4°. At follow-up of ≥2 years:

  • About two-thirds returned to impact sports (UCLA score of ≥8) and nearly half returned to high-impact sports (UCLA score of 9 to 10)
  • Outcomes scores improved, though patients retained some real limitations; for example, the average Lysholm score was only “fair” (74 of 100), and the average IKDC Score likewise was 69 of 100 at latest follow-up
  • Objective laxity on arthrometer testing improved by about 4 mm
  • About one-third of the patients had “asymptomatic” recurvatum and 5% re-ruptured the graft

How’s It Stack Up?