The Commonest Indication for Performing a Slope-Reducing Osteotomy With an Anterior Cruciate Ligament Reconstruction Is Graft Failure With a Posterior Tibial Slope of 12° or Greater: A Systematic Review of Indications, Techniques, and Outcomes.

Abstract

To (1) summarize indications/inclusion criteria and contraindications/exclusion criteria, operative techniques and details, and rehabilitation timelines for slope-reducing osteotomies with concomitant primary or revision anterior cruciate ligament (ACLR) and (2) summarize the radiographic and clinical outcomes that follow these types of surgeries. Three databases (MEDLINE, PubMed, and EMBASE) were searched on December 22, 2024, for studies with patients undergoing ACLR with concomitant slope-reducing osteotomy. The authors adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Revised Assessment of Multiple Systematic Reviews guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Six case series (Level IV) comprising 193 patients (27.5% female) with a mean age of 28.5 (range of means, 26.9-29.6) years were included. Four of 6 studies (66.7%) reported an indication for slope-reducing osteotomy, being a posterior tibial slope of 12° in revision or re-revision cases. Typical exclusion criteria for osteotomy reported by 5 studies included hyperextension of 5° to 10° or hypermobility (4 studies) and concomitant osteoarthritis (3 studies). Lysholm, Tegner, and visual analog scale scores all statistically increased postoperatively. Rates of return to sport at any level ranged from 81.3% to 100% and 25% to 100%, respectively. Graft failure rates in all studies ranged from 0% to 13%. Rates of recurvatum postoperatively ranged from 15% to 44%. Rates of hardware irritation/removal ranged from 0% to 46.2%. The most common indication for slope-reducing osteotomies with concurrent ACLR is in the revision setting in patients with a posterior tibial slope above 12°. Slope-reducing osteotomies with ACLR improve patient-reported outcome measures postoperatively and have low rates of instability and retear rates. Complications with osteotomy include postoperative recurvatum, postoperative hyperextension, and hardware removal. Level IV, systematic review of Level IV studies.