2025 ISAKOS Biennial Congress Paper
A Non-Weight Bearing Protocol After ACL Reconstruction Improves Static Anterior Tibial Translation in Patients With Elevated Slope and Increased Weight Bearing Tibial Anterior Translation
Iacopo Romandini, MD, Doha QATAR
Nicolas Cance, MD, Lyon, Rhône-Alpes FRANCE
Michael J. Dan, Mbbs, PhD, MSc(res), FRACS(oath), Merewether AUSTRALIA
Tomas Pineda, MD, Santiago CHILE
Guillaume Demey, MD, Lyon, Rhône Alpes FRANCE
David H. Dejour, MD, Lyon FRANCE
Lyon Ortho Clinic, Clinique de La Sauvegarde, Lyon, Rhône Alpes, FRANCE
FDA Status Cleared
Summary
A 21-day non-weight bearing protocol after ACL reconstruction improves static anterior tibial translation at 9 months without affecting dynamic translation, especially in patients with specific risk factors like high posterior tibial slope or significant pre-operative anterior tibial translation.
Abstract
Purpose
The aim of this study is to evaluate the impact of a non-weight bearing (NWB) protocol within 21 post-operative days after anterior cruciate ligament (ACL) reconstruction on static and dynamic anterior tibial translations (SATT and DATT, respectively). The hypothesis is that delayed WB would improve ATT at 9 months follow-up.
Methods
A series of patients treated with ACL reconstruction was retrospectively reviewed, comparing a group with immediate post-operative weight bearing (WB group) and a group without post-operative weight bearing (NWB group). The NWB protocol was applied to patients with posterior tibial slope (PTS) ≥ 12°, pre-operative SATT ≥ 5 mm, and/or meniscal lesions of root or radial type. SATT, and PTS were measured on 20° flexion monopodal lateral x-rays, while DATT on Telos™ x-rays at pre-operative and 9-months follow-up.
Results
One hundred seventy-nine patients were included (50 NWB group, 129 WB group). The SATT worsened in the WB group with a mean increase of 0.7 mm (SD 3.1 mm), while in the NWB group, the SATT improved with a mean decrease of 1.4 mm (SD 3.1 mm) from the pre-operative to 9 months' follow-up (p < 0.001). The side-to-side Telos™ evaluation showed a significant improvement in DATT within both the groups (p < 0.001), but there was no difference between the two groups (p = 0.99).
Conclusion
The post-operative protocol of 21 days without WB led to an improvement in SATT at 9 months without an influence on DATT, and it is recommended for patients with a SATT ≥ 5 mm and/or a PTS ≥ 12° as part of an "à la carte" approach to ACL reconstruction.