Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope

Abstract

Our study has shown that decreasing the tibial slope >5° compared to pre-operative value has functionally favourable effect on the reconstructed ACL graft and outcome. It is known that increasing slope causes an anterior shift in tibial resting position that is accentuated under axial loads. This suggests that decreasing tibial slope may be protective in an ACL deficient knee. Hence by placing the tricortical graft posterior to midline in the opening wedge reduces the posterior tibial slope and thereby reduces the stress on the graft leading to better functional outcome.

Opening Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction or Revision

“…Reducing the tibial slope during surgery seems to have a key role in protecting the ACL graft, and this is essential in the case of ACL revision, when ACL failure is caused by an abnormally increased tibial slope. 6 Moreover, closing wedge HTO combined with ACL reconstruction is a valid alternative option, with the potential advantage of a reduced risk of nonunion. Closing wedge HTO usually results in a decreased tibial slope, but the amount of correction is more difficult to fine-tune.…”

A Systematic Review of Factors Associated with both Bilateral and Recurrent Anterior Cruciate Ligament Disruption

“…Two controlled laboratory studies demonstrated that athletes who underwent ACL reconstruction had asymmetries in force generation and absorption on their injured leg [36,57]. Another study compared the performance of ACLreconstructed patients to healthy controls and concluded ACL-reconstructed patients showed reduced range-of- [67]. Another study performed anterior closing wedge tibial osteotomies on 9 patients with increased PTS during ACL re-revision and reported no graft ruptures or recurrent instability at 2 years post-op [14,67].…”

“…Another study compared the performance of ACLreconstructed patients to healthy controls and concluded ACL-reconstructed patients showed reduced range-of- [67]. Another study performed anterior closing wedge tibial osteotomies on 9 patients with increased PTS during ACL re-revision and reported no graft ruptures or recurrent instability at 2 years post-op [14,67]. Using tibial osteotomies to decrease pathologic PTS and reduce stress on ACL grafts requires further study with larger sample sizes.…”

Management of Anterior Cruciate Ligament Injury

“… 129 130 Slope decreasing tibial osteotomy influences translational forces across the ACL graft during axial loading and may be protective. 131 Arun et al . found that individuals undergoing tibial osteotomy at the time of ACLR with >5° correction to decrease posterior tibial slope reported significantly better functional scores.…”

“…found that individuals undergoing tibial osteotomy at the time of ACLR with >5° correction to decrease posterior tibial slope reported significantly better functional scores. 131 However, Dean et al . reported that the use of an opening wedge proximal tibial osteotomy – in concert with posteromedially placed anteriorly angled osteotomy plate and anterior staple augmentation – failed to decrease sagittal tibial slope.…”