Slope-Reducing High Tibial Osteotomy and Over-The-Top Anterior Cruciate Ligament Reconstruction With Achilles Tendon Allograft in Multiple Failed Anterior Cruciate Ligament Reconstruction

Zsidai, Bálint; Özbek, Emre Anıl; Engler, Ian D.; Kaarre, Janina; Nazzal, Ehab M.; Curley, Andrew J.; Musahl, Volker

doi:10.1016/j.eats.2022.07.019

Cited by 3 publications

(1 citation statement)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, a slope-reducing osteotomy, which is indicated for cases of revision ACL reconstructions with an increased posterior slope, may lead to iatrogenic increase in knee recurvatum 14 and can potentially benefit from the addition of our proposed POL advancement technique as a means to prevent this unwanted effect.…”

Section: Video Transcriptmentioning

confidence: 99%

A Soft Tissue Technique for Treating Knee Hyperextension or Recurvatum: Posterior Oblique Ligament Advancement

Franciozi,

Mameri,

Schumacher

et al. 2023

Video Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Genu recurvatum is a challenging disorder and can negatively affect knee biomechanics, as reflected in its role as a risk factor for knee ligament injury and poor outcomes following ligament reconstruction or arthroplasty. Indication: Pathological recurvatum should be addressed in the presence of a causative correctible structural abnormality, whether due to decreased posterior tibial slope or due to multiligament injury. We described a posterior oblique ligament (POL) advancement technique for the treatment of knee recurvatum. Technique Description: After completion of all concomitant procedures such as ligament reconstructions, the procedure is initiated with a medial approach. The POL is isolated with an inverted L-shaped dissection and mobilized. Mattress sutures are passed through the resulting POL flap, and are re-tensioned and fixed anteriorly and distally, with the knee close to extension, in order for the imbrication to restrain hyperextension. Results: Anecdotal evidence points to satisfactory control of knee recurvatum postoperatively, which can potentially avoid its deleterious effects in surgical outcomes. Discussion/Conclusion: We present a promising option in the treatment of pathological recurvatum, with favorable cost-efficacy, low morbidity relative to slope-altering osteotomy or posterolateral soft tissue procedures, and focused on the biomechanically demonstrated main restrictors to knee hyperextension. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

show abstract

Section: Video Transcriptmentioning

confidence: 99%

A Soft Tissue Technique for Treating Knee Hyperextension or Recurvatum: Posterior Oblique Ligament Advancement

Franciozi,

Mameri,

Schumacher

et al. 2023

Video Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

The Role of Osteotomy in Anterior Cruciate Ligament Reconstruction

Herman,

Keeling,

Fox

et al. 2024

Clinics in Sports Medicine

View full text Add to dashboard Cite

Slope Osteotomies in the Setting of Anterior Cruciate Ligament Deficiency

Kayaalp,

Winkler,

Zsidai

et al. 2024

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

➤ Posterior tibial slope (PTS) of ≥12° represents an important risk factor for both anterior cruciate ligament (ACL) injury and ACL reconstruction failure.➤ PTS measurements can significantly differ on the basis of the imaging modality and the measurement technique used. PTS should be measured on strictly lateral radiographs, with a recommended proximal tibial length of 15 cm in the image. The PTS measurement can be made by placing 2 circles to define the proximal tibial axis, 1 just below the tibial tubercle and another 10 cm below it. PTS measurements are underestimated when made on magnetic resonance imaging and computed tomography.➤ Slope-reducing osteotomies can be performed using a (1) supratuberosity, (2) tubercle-reflecting transtuberosity, or (3) infratuberosity method. The correction target remains a topic of debate. Although it is controversial, some authors recommend overcorrecting the tibial slope slightly to a range of 4° to 6°. For instance, if the initial slope is 12°, a correction of 6° to 8° should be performed, given the target tibial slope of 4° to 6°.➤ Clinical outcomes following slope-reducing osteotomies have been favorable. However, potential complications, limited data with regard to the impact of slope-reducing osteotomies on osteoarthritis, and uncertainty with regard to the effects on the patellofemoral joint are notable concerns.➤ Patients with complex deformities may need biplanar osteotomies to comprehensively address the condition.

show abstract

Slope-Reducing High Tibial Osteotomy and Over-The-Top Anterior Cruciate Ligament Reconstruction With Achilles Tendon Allograft in Multiple Failed Anterior Cruciate Ligament Reconstruction

Cited by 3 publications

References 24 publications

A Soft Tissue Technique for Treating Knee Hyperextension or Recurvatum: Posterior Oblique Ligament Advancement

A Soft Tissue Technique for Treating Knee Hyperextension or Recurvatum: Posterior Oblique Ligament Advancement

The Role of Osteotomy in Anterior Cruciate Ligament Reconstruction

Slope Osteotomies in the Setting of Anterior Cruciate Ligament Deficiency

Contact Info

Product

Resources

About