Combined revision ACL reconstruction with slope-correction osteotomy and lateral extra-articular tenodesis improves stability in patients with high posterior tibial slope and pivot shift.

Abstract

The purpose of this study was to evaluate the outcomes of patients undergoing single-stage revision anterior cruciate ligament (ACL) reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft, anterior closing wedge proximal tibial osteotomy (ACWPTO) and lateral extra-articular tenodesis (LET). An institutional review board-approved retrospective study of all patients who underwent a revision ACLR using a BPTB autograft, ACWPTO and LET from a single centre from 2018 to 2023 was performed. Inclusion criteria were patients >18 years of age with a failed ACLR, posterior tibial slope (PTS) of >15°, previous ACL-tunnel diameters of <14 mm, and intact ipsilateral patellar tendon. PTS and anterior tibial translation (ATT) were measured using the mechanical axis on long weight-bearing lateral tibial radiographs. Nine patients, all men, were evaluated with a mean age of 31.1 years and a mean follow-up of 31.4 months. The PTS significantly decreased from 16.8° (range: 15.1°-18.9°) preoperatively to 9.3° (range: 5.0°-14.7°) post-operatively (<i>p</i> < 0.001) and ATT significantly decreased from 14.6 mm (range: 10.7-19.0 mm) preoperatively to 6.3 mm (range: 1.3-11.5 mm) post-operatively (<i>p </i>< 0.001). Preoperatively, all patients showed significant instability with the Lachman test Grade 2/3 and the pivot shift test Grade 2/3. Post-operatively, Lachman test grade was 0 and Pivot shift test grade was 0 in all patients (<i>p</i> < 0.01), and the average post-operative subjective International Knee Documentation Committee (IKDC) score was 79.4 (range: 60.9-95.4). Single-stage revision ACLR using BPTB autograft, ACWPTO and LET in an ACL-deficient knee with high-grade pivot shift and increased PTS was safe and reliable, with significantly improved clinical and objective outcomes. Level IV, case series.