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

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-24 DOI:10.1002/jeo2.70384

Jesper Fritz, Alan Getgood, Ronald van Heerwaarden, Sebastien Parratte, Charles Brown, Luke V. Tollefson, Robert F. LaPrade

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Abstract

Purpose

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).

Methods

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.

Results

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 (p < 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 (p < 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 (p < 0.01), and the average post-operative subjective International Knee Documentation Committee (IKDC) score was 79.4 (range: 60.9–95.4).

Conclusions

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 of Evidence

Level IV, case series.

Abstract Image

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联合翻修前交叉韧带重建与斜面矫正截骨和外侧关节外肌腱固定术可改善胫骨高后斜面和枢轴移位患者的稳定性

目的本研究的目的是评估自体骨-髌腱-骨（BPTB）移植术、前闭合楔形胫骨近端截骨术（ACWPTO）和外侧关节外肌腱固定术（LET）单期翻修前交叉韧带（ACL）重建术（ACLR）患者的疗效。方法：一项机构审查委员会批准的回顾性研究，对2018年至2023年使用BPTB自体移植物、ACWPTO和LET进行翻修ACLR的所有患者进行回顾性研究。纳入标准为：18岁，ACLR失败，胫骨后斜度（PTS）为15°，之前的ACLR隧道直径为14 mm，同侧髌骨肌腱完整。利用机械轴在长负重胫骨侧位片上测量PTS和胫骨前平移（ATT）。结果9例患者均为男性，平均年龄31.1岁，平均随访31.4个月。PTS从术前的16.8°（范围：15.1°-18.9°）显著下降到术后的9.3°（范围：5.0°-14.7°）（p < 0.001）， ATT从术前的14.6 mm（范围：10.7-19.0 mm）显著下降到术后的6.3 mm（范围：1.3-11.5 mm）（p < 0.001）。术前，所有患者Lachman试验2/3级和枢轴移位试验2/3级均表现出明显的不稳定性。所有患者术后Lachman评分为0分，Pivot shift评分为0分（p < 0.01），术后平均主观国际膝关节文献委员会（IKDC）评分为79.4分（范围：60.9-95.4）。结论采用BPTB自体移植物、ACWPTO和LET治疗具有高度枢轴移位和PTS升高的acl缺陷膝的单期改良ACLR是安全可靠的，临床和客观结果均有显著改善。证据等级4级，案例系列。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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