Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2023

29-07-2023 | Osteoarthrosis | KNEE

First revision ACL reconstruction combined with tibial deflexion osteotomy improves clinical scores at 2 to 7 years follow-up

Authors: David Dejour, Anouk Rozinthe, Guillaume Demey, ReSurg

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2023

Login to get access

Abstract

Purpose

To report outcomes of first revision anterior cruciate ligament reconstruction (ACLR) with tibial deflexion osteotomy (TDO) in patients with posterior tibial slope (PTS) >10° at >2 years.

Methods

The authors studied outcomes of a consecutive series of 16 patients that underwent first revision ACLR with TDO, including Lysholm score, IKDC subjective and objective scores, Lachman test, PTS, and signs of osteoarthritis. One woman was excluded because of early signs of knee arthritis, as the first revision ACLR took place 27 years following the primary ACLR. This left a final cohort of 15 patients assessed at minimum follow-up of 2 years.

Results

The final cohort comprised 14 men and 1 woman aged 25.3 ± 6.6 years (range 16–39) at first revision ACLR. At final follow-up of 4.4 ± 1.5 years (range, 2–7), PTS was corrected from 12.5 ± 1.8° (range 8–15°) to 1.9 ± 3.6° (range – 4 to 8°), and none of the knees had radiographic signs of osteoarthritis. Lysholm score was 83.8±12.5, IKDC subjective score was 80.3±16.2, and IKDC objective score was A in 5 (33%), and B in 10 (67%). The net improvement exceeded the minimal clinically important difference (MCID) in 93% of patients for the IKDC subjective score and in 80% of patients for the Lysholm score. None of the knees had any retears, and only one required a reoperation to re-suture a medial meniscal tear due to trauma.

Conclusion

At 2-7 years following revision ACLR combined with TDO, net improvement exceeded the MCID in 93% of patients for IKDC subjective score and in 80% of patients for Lysholm score, with no retears or major complications. These results suggest that TDO is a safe technique to protect the ACL graft and might be considered as of first revision ACLR to correct excessive PTS.

Level of evidence

Level IV
Literature
1.
Akoto R, Alm L, Drenck TC, Frings J, Krause M, Frosch KH (2020) Slope-correction osteotomy with lateral extra-articular tenodesis and revision anterior cruciate ligament reconstruction is highly effective in treating high-grade anterior knee laxity. Am J Sports Med 48(14):3478–3485CrossRefPubMedPubMedCentral
2.
Bien DP (2011) Rationale and implementation of anterior cruciate ligament injury prevention warm-up programs in female athletes. J Strength Cond Res 25(1):271–285CrossRefPubMed
3.
Christensen JJ, Krych AJ, Engasser WM, Vanhees MK, Collins MS, Dahm DL (2015) Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Am J Sports Med 43(10):2510–2514CrossRefPubMed
4.
Cicchetti DV, Volkmar F, Sparrow SS, Cohen D, Fermanian J, Rourke BP (1992) Assessing the reliability of clinical scales when the data have both nominal and ordinal features: proposed guidelines for neuropsychological assessments. J Clin Exp Neuropsychol 14(5):673–686CrossRefPubMed
5.
Dejour D, Khun A, Dejour H (1998) Osteotomie tibiale de déflexion et laxité chronique antérieure à propos de 22 cas. Rev Chir Orthop. 84:28–29
6.
Dejour D, La Barbera G, Pasqualotto S, Valoroso M, Nover L, Reynolds R, Saffarini M (2017) Sagittal plane corrections around the knee. J Knee Surg 30(8):736–745CrossRefPubMed
7.
Dejour D, Pungitore M, Valluy J, Nover L, Saffarini M, Demey G (2019) Preoperative laxity in ACL-deficient knees increases with posterior tibial slope and medial meniscal tears. Knee Surg Sports Traumatol Arthrosc 27(2):564–572CrossRefPubMed
8.
Dejour D, Saffarini M, Demey G, Baverel L (2015) Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc 23(10):2846–2852CrossRefPubMed
9.
Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture Two radiological tests compared. J Bone Joint Surg Br. 76(5):745–749CrossRefPubMed
10.
Ebben WP, Fauth ML, Petushek EJ, Garceau LR, Hsu BE, Lutsch BN, Feldmann CR (2010) Gender-based analysis of hamstring and quadriceps muscle activation during jump landings and cutting. J Strength Cond Res 24(2):408–415CrossRefPubMed
11.
Engler ID, Salzler MJ, Wall AJ, Johnson WR, Makani A, Shields MV, Gill TJ (2020) Patient-reported outcomes after multiple-revision ACL reconstruction: good but not great. Arthrosc Sports Med Rehabil 2(5):e539–e546CrossRefPubMedPubMedCentral
12.
Feucht MJ, Mauro CS, Brucker PU, Imhoff AB, Hinterwimmer S (2013) The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 21(1):134–145CrossRefPubMed
13.
Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382CrossRefPubMed
14.
Griffith TB, Allen BJ, Levy BA, Stuart MJ, Dahm DL (2013) Outcomes of repeat revision anterior cruciate ligament reconstruction. Am J Sports Med 41(6):1296–1301CrossRefPubMed
15.
Gupta A, Tejpal T, Shanmugaraj A, Horner NS, Simunovic N, Duong A, Ayeni OR (2019) Surgical techniques, outcomes, indications, and complications of simultaneous high tibial osteotomy and anterior cruciate ligament revision surgery: a systematic review. HSS J 15(2):176–184CrossRefPubMed
16.
Gwinner C, Janosec M, Wierer G, Wagner M, Weiler A (2021) Graft survivorship after anterior cruciate ligament reconstruction based on tibial slope. Am J Sports Med 49(14):3802–3808CrossRefPubMedPubMedCentral
17.
Imhoff FB, Comer B, Obopilwe E, Beitzel K, Arciero RA, Mehl JT (2021) Effect of slope and varus correction high tibial osteotomy in the ACL-deficient and ACL-reconstructed knee on kinematics and ACL graft force: a biomechanical analysis. Am J Sports Med 49(2):410–416CrossRefPubMed
18.
19.
Malahias MA, Shahpari O, Kaseta MK (2018) The clinical outcome of one-stage high tibial osteotomy and anterior cruciate ligament reconstruction. A current concept systematic and comprehensive review. Arch Bone Jt Surg 6(3):161–168PubMedPubMedCentral
20.
Marouane H, Shirazi-Adl A, Adouni M, Hashemi J (2014) Steeper posterior tibial slope markedly increases ACL force in both active gait and passive knee joint under compression. J Biomech 47(6):1353–1359CrossRefPubMed
21.
Myer GD, Ford KR, Khoury J, Succop P, Hewett TE (2011) Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury. Br J Sports Med 45(4):245–252CrossRefPubMed
22.
Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41(5):582–592CrossRefPubMed
23.
Okutan AE, Kalkışım M, Gürün E, Ayas MS, Aynacı O (2022) Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 30(5):1584–1593CrossRefPubMed
24.
Rozinthe A, van Rooij F, Demey G, Saffarini M, Dejour D (2022) Tibial slope correction combined with second revision ACLR grants good clinical outcomes and prevents graft rupture at 7–15-year follow-up. Knee Surg Sports Traumatol Arthrosc 30(7):2336–2341CrossRefPubMed
25.
Salmon LJ, Heath E, Akrawi H, Roe JP, Linklater J, Pinczewski LA (2018) 20-year outcomes of anterior cruciate ligament reconstruction with hamstring tendon autograft: the catastrophic effect of age and posterior tibial slope. Am J Sports Med 46(3):531–543CrossRefPubMed
26.
Sonnery-Cottet B, Mogos S, Thaunat M, Archbold P, Fayard JM, Freychet B, Clechet J, Chambat P (2014) Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction. Am J Sports Med 42(8):1873–1880CrossRefPubMed
27.
Stride D, Wang J, Horner NS, Alolabi B, Khanna V, Khan M (2019) Indications and outcomes of simultaneous high tibial osteotomy and ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27(4):1320–1331CrossRefPubMed
28.
Tanaka T, Gale T, Nishida K, Xu C, Fu F, Anderst W (2023) Posterior tibial slope and meniscal slope correlate with in vivo tibial internal rotation during running and drop jump. Knee Surg Sports Traumatol Arthrosc 31(6):2366–2373CrossRefPubMed
29.
van der Wal WA, Meijer DT, Hoogeslag RAG, LaPrade RF (2022) Meniscal tears, posterolateral and posteromedial corner injuries, increased coronal plane, and increased sagittal plane tibial slope all influence anterior cruciate ligament-related knee kinematics and increase forces on the native and reconstructed anterior cruciate ligament: a systematic review of cadaveric studies. Arthroscopy 38(5):1664-1688.e1661CrossRefPubMed
30.
Waiwaiole A, Gurbani A, Motamedi K, Seeger L, Sim MS, Nwajuaku P, Hame SL (2016) Relationship of ACL injury and posterior tibial slope with patient age, sex, and race. Orthop J Sports Med 4(11):2325967116672852CrossRefPubMedPubMedCentral
31.
Winkler PW, Wagala NN, Hughes JD, Lesniak BP, Musahl V (2022) A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures. Knee Surg Sports Traumatol Arthrosc 30(1):139–148CrossRefPubMed
32.
Wyrwich KW, Bullinger M, Aaronson N, Hays RD, Patrick DL, Symonds T (2005) Estimating clinically significant differences in quality of life outcomes. Qual Life Res 14(2):285–295CrossRefPubMed
Metadata
Title
First revision ACL reconstruction combined with tibial deflexion osteotomy improves clinical scores at 2 to 7 years follow-up
Authors
David Dejour
Anouk Rozinthe
Guillaume Demey
ReSurg
Publication date
29-07-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07493-x

Other articles of this Issue 10/2023

Knee Surgery, Sports Traumatology, Arthroscopy 10/2023 Go to the issue

KNEE

Cross-cultural adaptation, validity and reliability of the Arabic version of the Forgotten Joint Score for knee arthroplasty

KNEE

Subchondral insufficiency fracture is a predictive factor of osteoarthritis progression and conversion to arthroplasty in non-surgically treated medial meniscus root tear

Hip

Superior outcomes after arthroscopic treatment of femoroacetabular impingement and labral tears with closed versus open capsule

KNEE

Pediatric meniscus morphology varies with age: a cadaveric study

KNEE

Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging-based study in outside-in anterior cruciate ligament reconstruction

KNEE

Outside-in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review