2025 ISAKOS Biennial Congress ePoster
Slope Reducing High Tibial Osteotomy And Revision Anterior Cruciate Ligament Reconstruction For The Insufficiency Of Primary Anterior Cruciate Ligament Reconstruction: Clinical And Radiological Results With A Minimum Follow-Up Of 24 Months
Lorenz Fritsch, MD, Munich GERMANY
Stefan Hinterwimmer, MD, Munich, Bayern GERMANY
Maximilian Hinz, MD, Munich GERMANY
Romed Peter Vieider, MD, Munich GERMANY
Bastian Scheiderer, MD, Munich, Bavaria GERMANY
Sebastian Siebenlist, MD, MHBA, Prof., Munich, Bavaria GERMANY
Philipp Wilhelm Winkler, MD, Assoc. Prof., Linz AUSTRIA
Lukas Willinger, MD, Munich GERMANY
Julian Mehl, MD, Munich, Bavaria GERMANY
Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany., Munich, Bavaria, GERMANY
FDA Status Cleared
Summary
Slope reducing osteotomy in combination with revisions ACL reconstruction leads to good patient satisfaction and PROMs and a low retear rate.
ePosters will be available shortly before Congress
Abstract
Introduction
The posterior tibial slope (PTS) has emerged as a major risk factor for ACL-reconstruction failure, especially in revision cases. Biomechanical studies demonstrated that slope reducing osteotomies can decrease the load on the ACL graft and potentially reduce the risk of re-rupture. However, clinical studies reporting the postoperative results are rare.
The aim of the study was to assess clinical and radiological outcomes after slope-reducing high tibial osteotomy (HTO) and ACL-revision surgery for re-insufficiency of the anterior cruciate ligament.
Methods
All patients who underwent slope-reducing HTO and revision ACLR for ACL re-insufficiency between 01/2015 and 01/2022 were included. The pre- and postoperative slope was measured using lateral X-rays. At least 24 months postoperatively, patient satisfaction and the change from preoperative to postoperative pain (VAS) were recorded. The Tegner score, the IKDC score, the KOOS score and the Lysholm score were also recorded. A clinical examination of the knee joint in comparison to the contralateral knee was performed; the anterior tibial translation was measured with the Rolimeter in 25° flexion.
Results
After a mean follow-up of 34.3 ± 10.4 months, 24 patients (18 m, 6 w) with a mean age of 27.4 8.1 years at the time of surgery were examined. Postoperative, the slope was 5.7 ± 3.8° versus 15.2 ± 2.4° preoperative. Four patients had to undergo revision surgery (21%; 2 x reoccurring instability; 2 x traumatic ACL-rupture).
Not considering the failures, 60% of patients were very satisfied about the surgical result, 25% were happy, 10% were neutral about their surgery and 5% were not satisfied about the surgical result. Patients reported significantly less pain than before surgery (VAS: 4.0±2.8 vs. 1.4±1.3; p=0.004). On average, patients achieved 75.5 ± 1.5 points on the IKDC score 79.9 ± 12.7 in the Lysholm score, and 77.5 ± 11.5 points on the KOOS score (Symptoms: 75.7 ± 13.9; Pain: 87.2 ± 9.9; ADL 94.7 ± 6.7; Sport/Rec: 75.2 ± 21.8 and QOL: 54.5 ± 16.1). In comparison to the contralateral side, the operated knee joints showed a significantly increased anterior tibial translation in the Rolimeter test (25° flexion: mean side to side difference: 2,7mm, p=0.005).
At the time of the follow-up, in 68.8% of patients a firm endpoint was observed in the Lachman test, in 25% of patients a soft endpoint was noted. Additionally, 75% of patients returned to sports, while 64.3% of patients were able to return to their prior level. The median Tegner score was 5 points [interquartile range 4-7].
Conclusion
Slope reducing high tibial osteotomy with ACL revision surgery leads to promising clinical results, high patient satisfaction and a high return to sports rate. However, the level of sporting activity should be adapted.