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. 2020 Dec;48(14):3478-3485.
doi: 10.1177/0363546520966327. Epub 2020 Nov 2.

Slope-Correction Osteotomy with Lateral Extra-articular Tenodesis and Revision Anterior Cruciate Ligament Reconstruction Is Highly Effective in Treating High-Grade Anterior Knee Laxity

Ralph Akoto  1   2   3 , Lena Alm  1   3 , Tobias Claus Drenck  3 , Jannik Frings  4 , Matthias Krause  4 , Karl-Heinz Frosch  4
Affiliations

Slope-Correction Osteotomy with Lateral Extra-articular Tenodesis and Revision Anterior Cruciate Ligament Reconstruction Is Highly Effective in Treating High-Grade Anterior Knee Laxity

Ralph Akoto et al. Am J Sports Med. 2020 Dec.

Abstract

Background: Both an elevated posterior tibial slope (PTS) and high-grade anterior knee laxity are often present in patients who undergo revision anterior cruciate ligament (ACL) surgery, and these conditions are independent risk factors for ACL graft failure. Clinical data on slope-correction osteotomy combined with lateral extra-articular tenodesis (LET) do not yet exist.

Purpose: To evaluate the outcomes of patients undergoing revision ACL reconstruction (ACLR) and slope-correction osteotomy combined with LET.

Study design: Case series; Level of evidence, 4.

Methods: Between 2016 and 2018, we performed a 2-stage procedure: slope-correction osteotomy was performed first, and then revision ACLR in combination with LET was performed in 22 patients with ACLR failure and high-grade anterior knee laxity. Twenty patients (6 women and 14 men; mean age, 27.8 ± 8.6 years; range, 18-49 years) were evaluated, with a mean follow-up of 30.5 ± 9.3 months (range, 24-56 months), in this retrospective case series. Postoperative failure was defined as a side-to-side difference of ≥5 mm in the Rolimeter test and a pivot-shift grade of 2 or 3.

Results: The PTS decreased from 15.3° to 8.9°, the side-to-side difference decreased from 7.2 to 1.1 mm, and the pivot shift was no longer evident in any of the patients. No patients exhibited revision ACLR failure and all patients showed good to excellent postoperative functional scores (mean ± SD: visual analog scale, 0.5 ± 0.6; Tegner, 6.1 ± 0.9; Lysholm, 90.9 ± 6.4; Knee injury and Osteoarthritis Outcome Score [KOOS] Symptoms, 95.2 ± 8.4; KOOS Pain, 94.7 ± 5.2; KOOS Activities of Daily Living, 98.5 ± 3.2; KOOS Function in Sport and Recreation, 86.8 ± 12.4; and KOOS Quality of Life, 65.4 ± 14.9).

Conclusion: Slope-correction osteotomy in combination with LET is a safe and reliable procedure in patients with high-grade anterior knee laxity and a PTS of ≥12°. Normal knee joint stability was restored and good to excellent functional scores were achieved after a follow-up of at least 2 years.

Keywords: high-grade anterior knee instability; increased posterior tibial slope; revision anterior cruciate ligament reconstruction; slope-correction osteotomy.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: K.-H.F. received royalties and payment for educational support from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Measurement of the posterior tibial slope in the lateral radiograph of the tibia using the circle 3-point method and planning of the osteotomy. The angle between the middiaphysis at 90-150 mm below the joint line (center of the dotted circles) and the joint line minus 90° gives the PTS, (17°, yellow angle). The correction angle was 6.1° (blue angle) and the height of the osteotomy gap was 6.8 mm.
Figure 2.
Figure 2.
Preoperative planning and simulation of the osteotomy. A correction angle of 6.1° reduces the PTS (yellow angle) to 9°. Middiaphysis 90-150 mm below the joint line is marked by the dotted circles.
Figure 3.
Figure 3.
Tuberosity osteotomy with the oscillating saw via a medial skin incision of approximately 4 to 6 cm.
Figure 4.
Figure 4.
The tuberosity was looped upward at the patellar tendon and the anterior closed-wedge osteotomy was performed.
Figure 5.
Figure 5.
The slope-correction osteotomy was stabilized with the tuberosity, which was used as a “bioplate.” According to the preoperative planning, the postoperative PTS was 9° (angle). Middiaphysis 90-150 mm below the joint line is marked by the dotted circles.
See this image and copyright information in PMC

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