Single-Stage Primary Anterior Cruciate Ligament Reconstruction With Slope-Reducing Anterior Closing-Wedge Proximal Tibial Osteotomy and a Lateral Extra-Articular Tenodesis.

Shoemaker, Evan P; Tollefson, Luke V; Lee, Dustin R; Rasmussen, Matthew T; LaPrade, Robert F · Arthrosc Tech · 2025

case_report · Level V

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Abstract

Anterior cruciate ligament (ACL) tears with known risk factors for anterior cruciate ligament reconstruction (ACLR) graft failure, such as elevated posterior tibial slope ≥12°, require a comprehensive treatment approach. In primary ACLRs, slope-reducing anterior closing-wedge proximal tibial osteotomies are not frequently necessary; however, when slope is severely increased (>18°), they should be considered. This Technical Note describes a single-stage combined primary ACLR, anterior closing-wedge proximal tibial osteotomy, and lateral extra-articular tenodesis in a patient with a chronic ACL tear with increased posterior tibial slope.

Anatomy