Anterior Closing Wedge Proximal Tibial Osteotomy for Slope Correction in Failed ACL Reconstructions

Abstract

Increased sagittal plane posterior tibial slope has been identified as a risk factor for primary anterior cruciate ligament reconstruction (ACLR) failure. Although ACLR failure is multifactorial, correction of sagittal plane posterior tibial slope should be evaluated in patients with an ACLR graft rupture. There are limited technical descriptions of proposed decreasing tibial slope osteotomy procedures; therefore, the purpose of this Technical Note is to describe the current senior author's technique of performing an anterior closing wedge proximal tibial osteotomy to decrease sagittal plane tibial slope in patients requiring a revision ACLR.

An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries

“…Many studies have shown the association between steep posterior tibial plateau slope and risk of ACL graft failure. [5][6][7]10 The one-stage arthroscopic approach described here combines (1) ACL reconstruction or (2) reduction and fixation of tibial spine avulsion, with a concomitant arthroscopy-assisted reduction of a PLTP fracture that restores the anatomic slope of the tibial plateau. Performing this one-stage procedure may help avoid the need for a subsequent slope-correcting osteotomy, and can help reduce postoperative morbidity and the overall rehabilitation period.…”

“…A growing body of literature has demonstrated the association between steep posterior tibial plateau slope with an increased risk of ACL rupture, [2][3][4] as well as a significantly increased risk of graft failure of the reconstructed ACL. [3][4][5] In fact, a recent study by Grassi et al 4 has shown that the most accurate predictor of ACL graft failure was a steep PLTP slope measuring greater than 7.4 . Therefore, in cases of PLTP fracture occurring in the context of a "high-energy ACL" injury, initial recognition and surgical restoration of the anatomic PLTP slope represents a crucial opportunity to prevent failure of the reconstructed ACL.…”

“…Therefore, in cases of PLTP fracture occurring in the context of a "high-energy ACL" injury, initial recognition and surgical restoration of the anatomic PLTP slope represents a crucial opportunity to prevent failure of the reconstructed ACL. [4][5][6][7][8][9][10] Presently, there is no consensus on the optimal timing or a gold-standard surgical procedure for this type of tibial plateau fractures associated with "high-energy ACL" injuries. 1,11 This necessitates surgical innovation and development of a procedure that maximizes postoperative functional outcome while minimizing the duration of discomfort and morbidity associated with operative management.…”

“…A growing body of literature has demonstrated the association between steep posterior tibial plateau slope with an increased risk of ACL rupture, 2 , 3 , 4 as well as a significantly increased risk of graft failure of the reconstructed ACL. 3 , 4 , 5 In fact, a recent study by Grassi et al. 4 has shown that the most accurate predictor of ACL graft failure was a steep PLTP slope measuring greater than 7.4°.…”

“…Therefore, in cases of PLTP fracture occurring in the context of a “high-energy ACL” injury, initial recognition and surgical restoration of the anatomic PLTP slope represents a crucial opportunity to prevent failure of the reconstructed ACL. 4 , 5 , 6 , 7 , 8 , 9 , 10 …”