2015 ISAKOS Biennial Congress ePoster #1286

Second Failure of ACL Graft : Third ACL Reconstruction Combined to Tibial Deflexion Osteotomy, a One Stage Procedure

Laurent Baverel, MD, Nantes FRANCE
Guillaume Odri, MD, Orleans FRANCE
Guillaume Demey, MD, Lyon, Rhône Alpes FRANCE
Mo Saffarini, MEnj, Venon FRANCE
David H. Dejour, MD, Lyon FRANCE

clinique de la sauvegarde, lyon, FRANCE

FDA Status Cleared

Summary: An excessive tibial slope as been identified as a risk factor of iterative rupture of ACL. The purpose of this study was to evaluate a third ACL reconstruction combined to tibial deflexion osteotomy in a one-stage procedure.

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Abstract:

Background

Anterior cruciate ligament (ACL) revision rate is estimated at 12%. First aetiology is the femoral tunnel malpositioning (36%). A tibial slope above 7° increases the anterior tibial translation (ATT). An excessive tibial slope as been identified as a risk factor of iterative rupture.
The purpose of this study was to evaluate a third ACL reconstruction combined to tibial deflexion osteotomy in a one-stage procedure.

Material And Methods

It is a retrospective study of 11 ACL reconstructions combined to a tibial deflexion osteotomy in one stage procedure. The mean age at surgery was 36,2 years (26-42). The indication was clinical instability in daily life and recreational sport activities combined with tibial slope above 10°. The IKDC score, and Tegner and Lysholm score were used to evaluate the knee preoperatively and postoperatively. Preoperative and postoperative weight bearing X-Rays were done to evaluate the tibial slope correction, bone tunnel position, and development of arthritis. A side to side stress X-Rays evaluated the pre and post ATT. The mean F.U was 78 months one patient was lost at F.U

Results

:. IKDC and Tegner and Lyshom score increased respectively from 45,3 to 76,5 and from 40,8 to 75,6 at final follow-up (p<0,05). No ACL re-rupture was observed. The tibial slope decreased from 11° to 5° (1-6°). Mean anterior tibial translation decreased from 16 mm to 8 mm. Of the 9 patients with no arthritis preoperatively, none has developed arthritis at final follow-up. 2 patients were stage I arthritis preoperatively, and progressed to stage II arthritis at final follow-up. All patient were very satisfied or satisfied with the results.

Discussion

- Conclusion : The tibial slope is an important factor to be measured in case of second or third ACL rupture. A pathological tibial slope > 10° could lead to a stress rupture of the graft especially in case of meniscectomy. When a surgical decision is taken the option of doing combined deflexion osteotomy and ACL reconstruction is an efficient procedure. The goal is to normalize the slope or event to over correct it of 4°, this decreased the stress on the graft and protects it. The one stage procedure does not change the rehab protocol except a none weight bearing period of 21 days.